Extraneural metastatic anaplastic ependymoma: A systematic review and a report of metastases to bilateral parotid glands

Gray Umbach, Tarek Y. El Ahmadieh, Aaron R. Plitt, Salah G. Aoun, Om J. Neeley, Kristopher A. Lyon, Ekokobe Fonkem, Jack M. Raisanen, Justin A. Bishop, Zabi Wardak, Toral R. Patel, Larry Myers, Bruce E. Mickey

Research output: Contribution to journalReview article

Abstract

Background: Anaplastic ependymoma with extraneural metastases is associated with a poor clinical outcome. Metastatic spread to the parotid gland is a rare clinical entity that requires multidisciplinary intervention. Herein, we present a systematic review of anaplastic ependymoma with extraneural metastases and report on a case with metastases to both parotid glands. Methods: Electronic databases were searched from their inception to February 2019. Inclusion criteria included reports of anaplastic ependymoma with extraneural metastasis. Studies were excluded if the tumor grade was not reported. A case illustration is provided. Results: The search yielded 15 cases of anaplastic ependymoma with extraneural metastases, including the present case. Mean age at diagnosis was 15 years. The initial tumor location was predominantly supratentorial (93.3%). All cases demonstrated leptomeningeal seeding before extraneural metastasis. Mean survival from initial diagnosis was 4.5 years. Metastasis to the parotid gland occurred in 2 cases, including the present case. We present a 17-year-old female patient who underwent gross total resection of a supratentorial, paraventricular anaplastic ependymoma followed by adjuvant external beam radiation therapy. The patient developed recurrent leptomeningeal seeding, treated with Gamma Knife radiosurgery over a 5-year period. She returned with a parotid mass and cervical lymphadenopathy and underwent parotidectomy and modified radical neck dissection. She continued to experience recurrences, including the left parotid gland, and was ultimately placed in hospice care. Conclusions: Anaplastic ependymoma with extraneural metastasis is rare. A combination of repeated surgical resection, radiation therapy, and chemotherapy can be used to manage recurrent and metastatic disease, but outcomes remain poor.

Original languageEnglish (US)
Pages (from-to)218-227
Number of pages10
JournalNeuro-Oncology Practice
Volume7
Issue number2
DOIs
StatePublished - Mar 19 2020

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Keywords

  • anaplastic ependymoma
  • extracranial
  • extraneural
  • metastasis
  • parotid gland

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

Umbach, G., El Ahmadieh, T. Y., Plitt, A. R., Aoun, S. G., Neeley, O. J., Lyon, K. A., Fonkem, E., Raisanen, J. M., Bishop, J. A., Wardak, Z., Patel, T. R., Myers, L., & Mickey, B. E. (2020). Extraneural metastatic anaplastic ependymoma: A systematic review and a report of metastases to bilateral parotid glands. Neuro-Oncology Practice, 7(2), 218-227. https://doi.org/10.1093/nop/npz041