Cartilaginous metaplasia in ependymomas is extremely rare and only few cases have been reported in the literature. We describe a case of a 5-year-old patient with a 5th recurrence of 4th ventricle ependymoma. He was previously treated with 4 resections, chemotherapy and radiotherapy. Histopathology revealed well-differentiated chondroid tissue occupying almost the entire lesion. Near total resection was achieved for the 5th time, but the patient died 3 months later achieving a total survival of 48 months, the 3rd longest reported in literature. Multiple resections of tumour recurrence provided a new insight in this very rare tumour, as it gave us the opportunity to observe the progression of tumour aggressiveness from grade II to grade III and finally to chondroid metaplasia. Cartilaginous metaplasia in posterior fossa ependymomas is a very atypical and challenging tumour with poor overall prognosis.

1.
Grundy RG, Wilne SH, Robinson KJ, Ironside JW, Cox T, Chong WK, Michalski A, Campbell RH, Bailey CC, Thorp N, Pizer B, Punt J, Walker DA, Ellison DW, Machin D, Children's Cancer and Leukaemia Group (formerly UKCCSG) Brain Tumour Committee: Primary postoperative chemotherapy without radiotherapy for treatment of brain tumours other than ependymoma in children under 3 years: results of the first UKCCSG/SIOP CNS 9204 trial. Eur J Cancer 2010;46:120-133.
2.
Mackay RP: Ependymoblastoma in the fourth ventricle, with new bone formation. Arch Neurol Psychiatry 1935;34:844-853.
3.
Wang X, Zhang S, Ye Y, Chen Y, Liu X: Ependymoma with cartilaginous metaplasia might have more aggressive behavior: a case report and literature review. Brain Tumor Pathol 2012;29:172-176.
4.
Chakraborti S, Govindan A, Alapatt JP, Radhakrishnan M, Santosh V: Primary myxopapillary ependymoma of the fourth ventricle with cartilaginous metaplasia: a case report and review of the literature. Brain Tumor Pathol 2012;29:25-30.
5.
Gessi M, Kuchelmeister K, Lauriola L, Pietsch T: Rare histological variants in ependymomas: histopathological analysis of 13 cases. Virchows Arch 2011;459:423-429.
6.
Mridha AR, Sharma MC, Sarkar C, Garg A, Singh MM, Suri V: Anaplastic ependymoma with cartilaginous and osseous metaplasia: report and review of the literature. J Neurooncol 2007;82:75-80.
7.
Kepes JJ, Rubinstein LJ, Chiang H: The role of astrocytes in the formation of cartilage in gliomas. An immunohistochemical study of four cases. Am J Pathol 1984;117:471-483.
8.
Siqueira EB, Bucy PC: Case report. Chondroma arising within a mixed glioma. J Neuropathol Exp Neurol 1966;25:667-673.
9.
Ghosal N, Murthy G, Dadlani R, Hegde AS, Singh D: Recurrent posterior fossa anaplastic ependymoma with prominent chondroid metaplasia: a case report and review of the literature. Indian J Pathol Microbiol 2010;53:787-789.
10.
Bannykh S, Baering JM: Images in neuro-oncology: rapid development of osseous and chondrous metaplasia in recurrent anaplastic ependymoma. J Neurooncol 2007;81:257-258.
11.
Feyza KG, Erhan E, Çicek B, Serdar NB, Baris S, Ibrahim A: Ependymoma with cartilage formation: a case report. Turk Neurosurg 2005;15:12-17.
12.
Jain A, Rishi A, Suri V, Garg A, Sharma MC, Sarkar C, Sharma BS: Recurrent ependymoma with cartilaginous metaplasia in an adult: report of a rare case and review of the literature. Clin Neuropathol 2009;28:257-258.
13.
Mathews T, Moossy J: Gliomas containing bone and cartilage. J Neuropathol Exp Neurol 1974;33:456-471.
14.
Nishioka H, Hirano A, Haraoka J, Nakajima N: Histological changes in the pituitary gland and adenomas following radiotherapy. Neuropathology 2002;22:19-25.
15.
Cowan DF, Orihuela E, Motamedi M, Pow-Sang M, Tbakhi A, LaHaye M: Histopathologic effects of laser radiation on the human prostate. Mod Pathol 1995;8:716-721.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.