Fauzan Alam Hashmi
Aga Khan University, Pakistan
Title: Prognostic implications of histological clear cells in high grade intracranial ependymal tumors: A retrospective analysis from a tertiary care hospital in Pakistan
Biography
Biography: Fauzan Alam Hashmi
Abstract
Objective: Clear cell variant in ependymal tumors is rare. We aim to compare the features, clinical outcomes of clear cell variant with the classic pathology of grade 3 intracranial ependymal tumors in Pakistan. Materials & Methods: A retrospective cohort study conducted at the department of Neurosurgery, Aga Khan University. The medical record files from 2003 – 2014 were reviewed. MRI/C.T scans and histopathological slides of WHO Grade III ependymal tumors were reviewed. Analysis was done on SPSS 20. Results: There were 9 cases of clear cell variant and 23 cases of classic anaplastic ependymoma. The median age of clear cell variant cases was 52 years (range 24years-72 years), whereas that of anaplastic ependymoma cases was 37 years (range 3 months to 65 years). Symptoms included Headache 66% in CCE and 63% in AE, seizures 30% in CCE and 22% in AE, and raised ICP in 30% in CCE and 54% in AE. CCE was supratentorial in 70% cases, intracranial anaplastic ependymoma was supratentorial in 58% of cases. Gross total resection was achieved in 55% cases in CCE and 26% cases in AE. Subtotal resection was done in 45% cases in CCE and 65% in AE. Radiotherapy was given in 55% patients in CCE and in 52% in AE. Recurrence was there in 77% cases of CCE and 70% in AE. Repeat surgery was done in 30% cases of CCE and 34% cases of AE. Median progression free survival was 9 months (range 3-28 months) and overall survival was 13 months (range 3-41 months) in CCE. Median progression free survival was 14 months (range 0.5-53 months), and overall survival was 18 months (range 1.5- 36 months) in AE. Survival Analysis using Log Rank values showed age< 55 and radiotherapy to be significant prognostic factors. Survival analysis of the two histopathologies showed Clear cell Ependymoma to be 1.86 times worse in prognosis than Anaplastic Ependymoma. Conclusion: Clear cells in Grade III ependymal tumors are found mainly in adult population. Supratentorials show worse progression-free and overall survival than anaplastic ependymoma. Overall survival is significantly worse in our part of the world for Grade 3 ependymal tumors.