LipomatousExtensively Vacuolated Ependymoma with Signet-Ring Cell-Like Appearance: Analysis of a Case with Extensive Literature Review

Abstract EN

“Lipomatous” and “extensively vacuolated” are descriptive captions that have been used to portray a curious subset of ependymomas distinctively bearing cells with a large vacuole pushing the nucleus to the periphery and, thus, simulating a signet-ring cell appearance.

Here, we would like to report the first ependymoma of this kind in a Latin American institution.

A 16-year-old boy experienced cephalea during three months.

Magnetic resonance imaging scans showed a left paraventricular tumour which corresponded to anaplastic ependymoma.

Intriguingly, it was also composed of cells with single or multiple hollow cytoplasmic vacuoles sometimes giving a signet-ring cell-like configuration.

Immunolabeling of these showed membrane positivity for GFAP, PS100, and CD99, while Ki-67 expression was null.

Ultrastructural examination of retrieved paraffin-embedded tissue showed the presence of scarce microlumina filled with microvilli but failed to demonstrate any content in such optically empty vacuoles as only scant granulofibrillary debris was observed.

A schism prevails at present regarding these unusual morphological variants, being either “lipomatous” or “vacuolated” based mainly on the EMA immunoprofile.

This, however, is a misappropriate approaching.

Could it be that perhaps we are dealing with the same histopathological entity or it may simply happen that fixation and artefacts cannot allow for their proper identification?