ABDOMINOPELVIC EPENDYMOMA: REPORT OF A RARE CASE

Case Report: A 22-year-old female patient was referred to our service in August 2018 due to an increased of abdominal volume since the beginning of 2018. Computed tomography (CT) revealed peritoneal mass on the right side under the liver, which was invading the liver and causing protrusion of the lungs. There was a mass on the left side between the liver and the spleen. Ascites and carcinomatosis were seen. Pelvic CT showed a mass in the right iliac fossa, 67mm diameter and other injuries in the whole pelvic cavity. Chest CT showed pleural effusion. Serological markers were CA-125: 29 U/ ml; CEA: < 0,5 ng/ml; CA19-9:17 U/ml. The patient was hospitalized to underwent an exploratory laparoscopic procedure and was classified as ASA I. The surgery started with a supraumbilical surgical incision with dissection to the abdominal cavity, which revealed peritoneal carcinomatosis and other injuries on the abdominal cavity and injuries in the ovaries, but it doesnt seen to be the primary site of the disease. The biopsy were positive for vimentin, GFPA, CD99, EMA dot pattern and estrogen receptor and negative for other markers like sexual cord/gonadal stroma, embrionyc and neuroendocrine. The diagnostic conclusion was an abdominopelvic ependymoma. The patient started chemotherapy with Etoposide 100mg/m2andCisplatin 20mg/m2 D1-D521 days, for six cycles until april 2019, with a clinical improvement. The patient underwent to a new surgery procedure on july 2019, but the complete resection of the tumor was not possible. Discussion: Ependymomas rarely occurs out of the neural system. The glial fibrillary acid protein (GFAP) is one of the most popular markers used in neuro-oncology cases, expressed in a ependymomas too. Tumor resection is the best therapy for ependymomas and it can get better when associated with radiotherapy and chemotherapy. The clinical course is indolent. Conclusion: Ependymoma, when it happens out of the nervous system, is extremely rare. The symptoms reported by the patient were nonspecific, which makes the diagnosis more difficult. After the surgery procedure and the pathology report showing positive reaction for GFAP, EMA dot pattern and vimentin, was possible to arrange a treatment to stabilize the progression of the tumor. Abdominopelvic ependymomas must be one of the differential diagnoses of the gynecologist and gastroenterologist cancer team and the diagnostic conclusion is result of the efforts of the clinical, surgery and pathology team.

 

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Publication History

Article published online:
23 October 2019