Mediastinal metastasis of primary extraneural ependymoma: Case report

Introduction. The rarity of primary extraneural ependymomas (EnEs), its great variations in morphology and rare occurrence of metastasis, increase chances of misdiagnosis, particularly if they are found in paraovarian localization. Case report. The presented patient was diagnosed with malignant meso...

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Main Authors: Andrejić-Višnjić Bojana, Tegeltija Dragana, Lovrenski Aleksandra, Vučković Dejan, Samardžija Golub, Tadić-Latinović Ljiljana
Format: Article
Language:English
Published: Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade 2020-01-01
Series:Vojnosanitetski Pregled
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Online Access:http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501800181A.pdf
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author Andrejić-Višnjić Bojana
Tegeltija Dragana
Lovrenski Aleksandra
Vučković Dejan
Samardžija Golub
Tadić-Latinović Ljiljana
author_facet Andrejić-Višnjić Bojana
Tegeltija Dragana
Lovrenski Aleksandra
Vučković Dejan
Samardžija Golub
Tadić-Latinović Ljiljana
author_sort Andrejić-Višnjić Bojana
collection DOAJ
description Introduction. The rarity of primary extraneural ependymomas (EnEs), its great variations in morphology and rare occurrence of metastasis, increase chances of misdiagnosis, particularly if they are found in paraovarian localization. Case report. The presented patient was diagnosed with malignant mesothelioma 14 years ago, after right salpingo-oophorectomy. In following years patient had multiple and extensive surgical procedures, resulting in different histopathological diagnoses, and after seven years, a diagnosis of EnE was established. Later on, patient was surgically treated in several medical centers across the region, again with different histopathological diagnoses. At present, the tumor metastasized to mediastinum, presenting as a grey to brown, multicystic formation with cysts filled with a clear serous fluid or red-brown hemorrhagic fluid. The inner surface of the cysts had smooth to partly papillary appearance. Tumor cells exhibited several architectural patterns (solid, pseudorosette or rosette formations, papillary and pseudopapilary structures), and immunophenotype specific for EnE [glial fibrillary acidic protein (GFAP), estrogen receptor (ER), and progesterone receptor (PR) positive; calretinin, WT-1, S100, synaptophysin, chromogranin, CK7 and pan-cytokeratin negative]. Conclusion. This case demonstrates not only specific diagnostic immunophenotype of extraneural ependymoma, but above all an important principle in tumor pathology. Rare neoplasms may occur in unusual and unexpected primary and metastatic sites. Pathologists need to be familiar with histologic features of a wide range of neoplasms and not just the appearance of neoplasms within their own limited subspecialty area.
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spelling doaj-art-71b8dd2d4da54fa98152266da6627e602025-08-20T02:06:32ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502406-07202020-01-0177111221122510.2298/VSP181023181A0042-84501800181AMediastinal metastasis of primary extraneural ependymoma: Case reportAndrejić-Višnjić Bojana0Tegeltija Dragana1Lovrenski Aleksandra2Vučković Dejan3Samardžija Golub4Tadić-Latinović Ljiljana5University of Novi Sad, Faculty of Medicine, Department of Histology and Embryology, Novi Sad, SerbiaUniversity of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia + Institute for Lung Diseases of Vojvodina Department of Pathoanatomical and Molecular Diagnostics, Sremska Kamenica, SerbiaUniversity of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia + Institute for Lung Diseases of Vojvodina Department of Pathoanatomical and Molecular Diagnostics, Sremska Kamenica, SerbiaUniversity of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia + Institute for Lung Diseases of Vojvodina Department of Pathoanatomical and Molecular Diagnostics, Sremska Kamenica, SerbiaUniversity of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia + Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica, SerbiaUniversity Clinical Center of the Republic of Srpska, Department of Pathology, Banja Luka, Republic of Srpska, Bosnia and HerzegovinaIntroduction. The rarity of primary extraneural ependymomas (EnEs), its great variations in morphology and rare occurrence of metastasis, increase chances of misdiagnosis, particularly if they are found in paraovarian localization. Case report. The presented patient was diagnosed with malignant mesothelioma 14 years ago, after right salpingo-oophorectomy. In following years patient had multiple and extensive surgical procedures, resulting in different histopathological diagnoses, and after seven years, a diagnosis of EnE was established. Later on, patient was surgically treated in several medical centers across the region, again with different histopathological diagnoses. At present, the tumor metastasized to mediastinum, presenting as a grey to brown, multicystic formation with cysts filled with a clear serous fluid or red-brown hemorrhagic fluid. The inner surface of the cysts had smooth to partly papillary appearance. Tumor cells exhibited several architectural patterns (solid, pseudorosette or rosette formations, papillary and pseudopapilary structures), and immunophenotype specific for EnE [glial fibrillary acidic protein (GFAP), estrogen receptor (ER), and progesterone receptor (PR) positive; calretinin, WT-1, S100, synaptophysin, chromogranin, CK7 and pan-cytokeratin negative]. Conclusion. This case demonstrates not only specific diagnostic immunophenotype of extraneural ependymoma, but above all an important principle in tumor pathology. Rare neoplasms may occur in unusual and unexpected primary and metastatic sites. Pathologists need to be familiar with histologic features of a wide range of neoplasms and not just the appearance of neoplasms within their own limited subspecialty area.http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501800181A.pdfependymomacentral nervous system neoplasmsdiagnosishistological techniquesimmunohistochemistrymediastinal neoplasmsneoplasm metastasis
spellingShingle Andrejić-Višnjić Bojana
Tegeltija Dragana
Lovrenski Aleksandra
Vučković Dejan
Samardžija Golub
Tadić-Latinović Ljiljana
Mediastinal metastasis of primary extraneural ependymoma: Case report
Vojnosanitetski Pregled
ependymoma
central nervous system neoplasms
diagnosis
histological techniques
immunohistochemistry
mediastinal neoplasms
neoplasm metastasis
title Mediastinal metastasis of primary extraneural ependymoma: Case report
title_full Mediastinal metastasis of primary extraneural ependymoma: Case report
title_fullStr Mediastinal metastasis of primary extraneural ependymoma: Case report
title_full_unstemmed Mediastinal metastasis of primary extraneural ependymoma: Case report
title_short Mediastinal metastasis of primary extraneural ependymoma: Case report
title_sort mediastinal metastasis of primary extraneural ependymoma case report
topic ependymoma
central nervous system neoplasms
diagnosis
histological techniques
immunohistochemistry
mediastinal neoplasms
neoplasm metastasis
url http://www.doiserbia.nb.rs/img/doi/0042-8450/2020/0042-84501800181A.pdf
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