Histological predictors of outcome in ependymoma are dependent on anatomic site within the central nervous system

Aditya Raghunathan, Khalida Wani, Terri S. Armstrong, Elizabeth Vera-Bolanos, Maryam Fouladi, Richard Gilbertson, Amar Gajjar, Stewart Goldman, Norman L. Lehman, Phillipe Metellus, Tom Mikkelsen, Mary Jo T. Necesito-Reyes, Antonio Omuro, Roger J. Packer, Sonia Partap, Ian F. Pollack, Michael D. Prados, H. Ian Robins, Riccardo Soffietti, Jing WuC. Ryan Miller, Mark R. Gilbert, Kenneth D. Aldape

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Ependymomas originate in posterior fossa (PF), supratentorial (ST) or spinal cord (SC) compartments. At present, grading schemes are applied independent of anatomic site. We performed detailed histological examination on 238 World Health Organization grade II and III ependymomas. Among PF ependymomas, the presence of hypercellular areas, necrosis, microvascular proliferation and elevated mitotic rate (all P < 0.01) were significantly associated with worse progression-free survival (PFS), while extensive ependymal canal formation was not (P = 0.89). Similar to the PF tumors, microvascular proliferation (P = 0.01) and elevated mitotic rate (P = 0.03) were significantly associated with worse PFS in the ST tumors. However, in contrast to PF tumors, extensive ependymal canals (P = 0.03) were associated with worse clinical outcome in ST ependymomas, but hypercellularity (P = 0.57) and necrosis (P = 0.47) were not. On multivariate Cox regression, after adjusting for relevant clinical variables, individual histological factors and a composite histological score remained significant among ST and PF ependymoma. In contrast to both PF and ST ependymoma, histological features were not found to be associated with PFS in SC tumors. Taken together, the clinical relevance of specific histological features in ependymoma appears to be related to the anatomic site of origin and suggests that site-specific grading criteria be considered in future classification systems.

Original languageEnglish (US)
Pages (from-to)584-594
Number of pages11
JournalBrain Pathology
Issue number5
StatePublished - Sep 2013


  • Ependymoma
  • histology
  • progression-free survival

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Neuroscience(all)
  • Clinical Neurology


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