Classification and controversies in pathology of ependymomas

Childs Nerv Syst. 2009 Oct;25(10):1185-93. doi: 10.1007/s00381-008-0804-4. Epub 2009 Feb 11.


Purpose: Bailey and Cushing established ependymoma as a brain tumour entity in the first brain tumour classification (1926). Diagnosis of ependymomas is not subject to controversy as long as other tumours presenting ependymoma-like features have been ruled out. Grading conversely is a source of debate. Description of histological features establishing diagnosis and grading of ependymomas may help to better understand this controversy.

Methods: Literature has been reviewed using PubMed with the following key words: ependymoma, +/- prognosis, +/- biomaker, +/- grading, +/- immunohistochemistry, +/- proliferative index.

Results: Grading controversy arises from elusive WHO features and individual characteristics of ependymomas including tumour location, tumour pattern/variant and variable expression of biomarkers.

Conclusion: There is a need for a grading scheme with a proven general ability to dissociate grades, and to predict individual clinical evolution. Only then will stratified and targeted therapeutics for ependymal tumours be possible.

Publication types

  • Review

MeSH terms

  • Brain / pathology
  • Brain Neoplasms / classification
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / pathology
  • Diagnosis, Differential
  • Ependymoma / classification*
  • Ependymoma / diagnosis
  • Ependymoma / pathology*
  • Humans
  • Neoplasm Staging