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Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1123-1124

Balloons in Filum Terminale Ependymoma


1 Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (or Trivandrum), Kerala, India
2 Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (or Trivandrum), Kerala, India

Date of Submission18-May-2019
Date of Decision25-Aug-2019
Date of Acceptance18-Jul-2019
Date of Web Publication2-Sep-2021

Correspondence Address:
Rajalakshmi Poyuran
Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram (or Trivandrum) - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325343

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How to cite this article:
Narasimhaiah D, Sudhir B J, Poyuran R. Balloons in Filum Terminale Ependymoma. Neurol India 2021;69:1123-4

How to cite this URL:
Narasimhaiah D, Sudhir B J, Poyuran R. Balloons in Filum Terminale Ependymoma. Neurol India [serial online] 2021 [cited 2021 Sep 18];69:1123-4. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1123/325343




A 19-year-old woman presented with weakness of lower limbs and back pain for two weeks. She was diagnosed with a mass in the region of conus, and the lesion was excised intraoperatively. The tumor was arising from the filum terminale and was yellowish-white, soft, and suckable with a good plane with surrounding nerve roots.

The histopathological examination of the tumor revealed a glial neoplasm composed of sheets of oval to elongated cells with glial fibrillary acidic protein (GFAP)-positive fibrillary processes with perivascular arrangement forming pseudorosettes [Figure 1]a and [Figure 1]b. The tumor cells displayed mild nuclear pleomorphism and inconspicuous mitotic activity. Immunostain for epithelial membrane antigen (EMA) revealed paranuclear dots. In foci, the tumor cells were separated from the blood vessel by an intervening layer of mucin. There were mucin-filled microcystic spaces containing small, round to oval, eosinophilic structures with peripheral striations referred as “balloons” [Figure 1]c. The balloons were highlighted by Masson trichrome, periodic acid-Schiff (PAS), and Alcian blue stains [Figure 1]d, [Figure 1]e, [Figure 1]f. A diagnosis of ependymoma with features of classical and myxopapillary ependymoma was rendered.
Figure 1: Histopathology of balloons. Microcystic spaces with ovoid eosinophilic structures on haematoxylin and eosin (a and c) highlighted by Masson trichrome (d), PAS (e), and Alcian blue (f) stains. The tumor cells expressed GFAP (b) and EMA positive paranuclear dots (b-inset). [Original magnifications: a: 100×, b: 200×, c-e: 400×. Scale bars: a: 100 μm, b: 50 μm, c-f: 20 μm]

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Balloons are histopathological curiosities reported mostly in myxopapillary ependymomas and rarely in tanycytic ependymomas.[1],[2] They are poorly characterized round, extracellular structures with spiculations or peripheral striations containing collagen. They are highlighted by Masson trichrome, Alcian blue, PAS, and reticulin stains. There is no prognostic relevance attached to the occurrence of balloons and the reason for their occurrence is not clear, but may represent a pattern of degenerative change.

Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sonneland PR, Scheithauer BW, Onofrio BM. Myxopapillary ependymoma. A clinicopathologic and immunocytochemical study of 77 cases. Cancer 1985;56:883-93.  Back to cited text no. 1
    
2.
Kobata H, Kuroiwa T, Isono N, Nagasawa S, Ohta T, Tsutsumi A. Tanycytic ependymoma in association with neurofibromatosis type 2. Clin Neuropathol 2001;20:93-100.  Back to cited text no. 2
    


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