Beruflich Dokumente
Kultur Dokumente
Olivia Rozsits
PATIENT DESCRIPTION
PATIENT HISTORY
Social
Previous smoker, pack per
day for 2 years (Quit 9 years
ago)
Occasional alcohol use (2x per
week)
Obese (weight 273.4 lbs)
Family
Paternal grandmother Lung Cancer
Paternal grandfather prostate
cancer
Aunt with history of colorectal
cancer
PRESENTING SIGNS
Papilledema
Ataxia
Nystagmus
Visual symptoms
Gaze palsy
Extreme fatigue
Poor appetite/weight loss
dizziness
Bulbar palsy
Facial weakness
PATIENT PRESENTATION
Presents to urgent care with complaints of intermittent neck pain
Prescribed prednisone
Stopped prednisone and presented to emergency room on 5/14/16
Cervical spine films showed no abnormalities
Prescribed Medrol dosepak and oral analgesics
Returned to emergency room 5/19/16 with pain and onset of nausea & vomiting
Ct of brain showed cerebellar mass inferiorly which extended inferiorly into upper
cervical region
MRI of brain showed enhancing mass situated posterior to the cervical medullary
junction and upper cord extending into the 4th ventricle
Ct of chest, abdomen, and pelvis showed no evidence of primary lesions or
metastatic disease
Ependymomas usually
located along, within, or
next to the ventricular
system
Methods of Spread:
Crainiospinal fluid
MEDICATIONS
EPIDEMIOLOGY/
ETIOLOGY
HISTOLOGY
Subependymomas (G1): typically
slow-growing
Sixth most common brain tumor in
children
TREATMENT OPTIONS
Surgical resection of tumor
Radiation recommended for older children and adults following surgery
Role of chemotherapy unknown but may be used to treat tumors that have grown
back after radiation therapy
Spinal cord ependymomas have best chance of cure with surgery but side effects may
cause nerve damage
an uncommon tumor and we are relying mostly on single institution reviews for
guidance regarding management
SECOND OPINION
Patient presented to James Cancer Hospital for
second opinion Dr. Raval
Confirmed who Grade 2 posterior fossa
ependymoma
Significant inability to move tongue, muffled
speech, significant fullness over posterior neck
MRI revealed large post-op psuedomeningocele with
expansion
No signs of hydrocephalus or new cerebellar
symptoms
Prescribed dose:
4500cGy
25 fxns: 180cGy/fxn
Vmat 6MV
G1: 181-179 Coll: 45
146MU
G2: 179-181 Coll: 315
162MU
Aquaplast mask
Knee sponge
B headrest
Blue ring
CRITICAL ORGANS
Brain
5000 cGy
Brainstem
4500 cGy
Spinal cord
4700 cGy
Optic nerve
5000 cGy
Optic
chiasm
5000 cGy
METASTATIC
SITES
Intraventricular metastasis
Craniospinal fluid
Usually do not grow into
normal brain tissue
PROGNOSIS &
SURVIVAL
5 year relative survival rate
dependent on age
5-10: 40-50%
20-44: 91%
45-54: 86%
55-64: 85%
REFERENCES
Ependymoma. Brain Tumor Symptoms, Treatment, Support, Research.
http://www.abta.org/brain-tumor- information/types-of-tumors/ependymoma.html?
referrer=https://www.google.com/. Accessed
September 28, 2016.
Washington CM, Leaver DT.Principles and Practice of Radiation Therapy. St. Louis,
MO: Mosby Elsevier;
2010.
Survival rates for selected adult brain and spinal cord tumors. Survival rates for
selected adult brain and
spinal cord tumors.
http://www.cancer.org/cancer/braincnstumorsinadults/detailedguide/brain-andspinal-cord-tumors-in-adults-survival-rates. Accessed September 28, 2016.
Ruths Lecture on CNS Tumors