Thursday, June 18, 2009

Ependymoblastoma: Dear, Damned, Distracting Diagnosis, Farewell!

In an article entitled "Ependymoblastoma: Dear, Damned, Distracting Diagnosis, Farewell!" published online in Brain Pathology, authors Alexander R. Judkins (UPenn) and David W. Ellison (St. Jude's, Memphis) adapt a line from Alexander Pope's poem A Farewell to London (1715) for their title. Judkins and Ellison conclude the following: "We believe that ependymoblastoma as a diagnosis is neither precise nor specific and that it is time once and for all to retire this diagnosis from the lexicon of neuropathology." For now, the World Health Organization tumor classification sytem continues to recognize ependymoblastoma as a distinct nosologic entity. These neoplasms are often large, supratentorial, and usually connect to the ventricles. Although there is no definitive feature of ependymoblastoma, the ependymoblastomatous rosette is a histologic characteristic that has been used in making the diagnosis. A photomicrograph of such a rosette from the Judkins & Ellison article is shown. In this picture, epithelial membrane antigen (EMA) immunohistochemistry highlights the limiting lumenal membrane of rossette. (Note: Although published online in December '08, I got word today via email from Dr. Ellison that this article will likely appear in print in the next issue of Brain Pathology.)


Anonymous said...

Huzzah for Drs Judkins and Ellison. I've been saying this for years, and Lucy Rorke more or less said it back in 1982. Many cerebral primitive neuroectodermal tumors have focal or more extensive ependymal differentiation, along with other lines of differentiation, and the concept of a distinct "ependymoblastoma" has not made sense for a great many years. (Douglas C Miller MD,PhD)

Brian E. Moore, MD said...

This post may the be nidus for a change to the next edition of the World Health Organization tumor classification book!

Anonymous said...

Unbelievable I was doing a quick google search for a friend of mine diagnosed with Ependymoblastoma late 2012 looking for other living adult cases he might use as a support group, and I see he was diagnosed at YOUR hospital! Ha you better start the redefining there before you tackle WHO.