Recent updates in supratentorial ependymoma with approach to integrated diagnosis: Review

Ependymomas are a distinct entity of glial tumor. We describe a patient with a supratentorial ependymoma with extensive calcification. A 28 year old male patient came with complaints of bilateral upper limb and lower limb weakness, head ache, accompanied by vertigo, vomiting, twice focal seizures over the past two to three months. Associated with lethargy and dizziness. Previous history of transient ischemic attack was there for which treatment was received. He had no history of hypertension, diabetes. On physical examination, spasticity present in both lower extremity and left unilateral grade II facial nerve palsy. Clinical diagnosis was give as right parietal space occupying lesion. CT, MRI brain showed well-defined heterogenously enhancing multilobulated, intra-axial lesion in right parietal lobe involving the post central gyrus with areas of calcification and necrosis. Features suggestive of primary malignant glial neoplasm. He underwent right craniotomy with excision of space occupying lesion. Histopathologically reported as Ependymomas with extensive intratumoral calcification. The tumour on immunostaining was positive for glial fibrillary acid protein (GFAP), Epithelial membrane antigen (EMA), and L1CAM was focally positive. The Ki-67 labelling index was less than 2%. Expression of p53 protein, IDH-1, and neuronal proteins such as synaptophysin and enolase was not observed. we report this case of supratentorial Ependymoma for its clinical, radioimaging, histopathological, immunohistochemical findings with recent updates and approach to integrated diagnosis. The ependymoma with extensive intratumoral calcification is rare finding.