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Washington University Experience | NEOPLASMS (GLIAL) | Ependymoma - Gross & Microscopic | 3A0 Case 3 History
Case 3 History ---- The patient was a 13 month old male diagnosed with an anaplastic ependymoma of the posterior fossa in 2/1990 at 7 1/2 months of age. That tumor was described as having a significant degree of cellular atypia, mitotic activity, tumor necrosis, and the formation of tumor sheets in some regions which represent aggressive features. On 2/5 of that same year his first symptom was projectile vomiting. Head CT scan at SLCH showed a large mass occupying all of the right posterior fossa with extension from the foramen magnum into and through the incisura with invasion into the right brainstem and right lateral wall and floor of the fourth ventricle. The tumor caused significant obstructive hydrocephalus. Partial resection (approx. 70%) of the tumor and a left ventriculostomy were performed on 2/8. Operative findings included a massive invasive posterior fossa tumor diagnosed again as an anaplastic ependymoma. The patient continued to require ventilator support and had evidence of a decreased gag reflex; therefore, a tracheostomy and gastrostomy tube were placed for the anticipated chronic care he would require. The patient was discharged to home in late March. Since that time, the patient has had numerous SLCH admissions for control of recurrent seizure activity. Approximately one month ago, the patient began to experience an increase in seizure frequency. He was admitted to SLCH on 6/14 for further neurological evaluation of the seizures and consideration for possible chemotherapy. A staging MRI showed recurrence of the tumor in the right posterior fossa which had regrown to at least its original size) with associated mass effect and obliteration of the fourth ventricle. The patient’s seizure medication was adjusted and the patient was discharged the following day (6/15), but was readmitted on 6/16 for recurrent seizure activity. The Dilantin dose was increased for improved control of the seizures. Given the poor prognosis associated with this tumor, the parents elected not to intervene further with patient's disease (declining further surgery or chemotherapy). The patient was subsequently discharged to home (with home nursing care) on 6/20. He became comatose approximately l to 2 days prior to his expiration. The patient died at home on 7/10.
