Spinal Cord Ependymomas: UCSF Experience 1983-2010.
Agne Naujokas, Peter Modera, Phillip Weinstein, Tarik Tihan. University of California-San Francisco
Background: The ependymal tumors in the spinal cord are graded in a similar fashion as the intracranial examples and are designated as grades I through III based on the WHO criteria. Subependymomas and myxopapillary ependymomas are WHO grade I tumors, while classical ependymomas are can be grade II or III. Most spinal ependymomas have a more favorable outcome but many studies combine cranial and spinal cord examples without regard to their different biological behavior.
Design: In order to determine the types and behavior of spinal cord ependymomas, we reviewed the Department of Pathology archives during a 27-year period (1983-2010). Patients without available pathology material or sufficient information were excluded. Histopathological features of tumors were recorded and were correlated with tumor clinical findings in order to determine their association with outcome parameters.
Results: Among a total of 352 patients with primary spinal cord neoplasms, 134 (38%) had ependymomas (85 male/49 female). Thirty patients had WHO grade I ependymomas (28 myxopapillary, 2 subependymomas; median age: 28.2), 101 had WHO grade II (89% classic type, 5% focal myxoid, 6% tanycytic; median age: 43.3), and three had WHO grade III tumors. Myxopapillary ependymomas were located predominantly in the lumbar spine, while grade II ependymomas were more common in cervical cord. Uncommon findings in ependymomas included necrosis (17% grade I, 19% grade II, 100% grade III), degenerative changes, pseudoglandular formation and extensive collagenization (25% grade I, 24% gradeII). Gross total resection (GTR) was achieved in 57% of grade I ependymomas, 58% grade II ependymomas and one of three grade III ependymomas. All three grade III ependymomas recurred and underwent additional surgery, chemotherapy and/or radiation. The recurrence rate was 32% in grade I and 19% in grade II ependymomas. Up to 20% of grade I and only 9% of grade II ependymomas required additional surgical intervention. Progression free survival time was 74 months in grade I, and 164.6 months in grade II ependymomas (p=0.07). Progression free survival time in grade II ependymomas was dependent on the extent of the surgery (p=0.01).
Conclusions: Despite their classification as grade I tumors, spinal cord myxopapillary ependymomas appear to have similar if not worse behavior as that of grade II spinal cord ependymomas, with increased recurrence rate, shorter progression free survival, and higher likelihood of subsequent surgical interventions.
Tuesday, March 1, 2011 2:30 PM
Platform Session: Section G, Tuesday Afternoon