iMedPub Journals ht tp://www.imedpub.com JOURNAL OF NEUROLOGY AND NEUROSCIENCE ISSN 2171-6625 2015 Vol. 6 No. 3:26 1 © Under License of Creative Commons Attribution 3.0 License | This article is available in: www.jneuro.com Case Report DOI: 10.21767/2171-6625.100026 Charuta Gavankar 1 , Ryan A Grant 1* , Robert Fulbright 2 , Anita Huttner 3 and Jennifer Moliterno 1 1 Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, USA 2 Department of Radiology, Yale University School of Medicine, New Haven, CT, USA 3 Department of Pathology, Yale University School of Medicine, New Haven, CT, USA Corresponding author: Ryan Grant  ryan.grant@yale.edu Department of Neurosurgery, Yale School of Medicine, 333 Cedar Street, TMP4, New Haven, CT 06510, USA. Tel:203.785.2805 Fax: 203.785.6916 Citation: Gavankar C, Grant RA, Fulbright R, et al. Mixed Tumor with Subependymoma and Ependymoma Features: A Case Report and Review of the Literature. J Neurol Neurosci. 2016, 6:3. Introducton Subependymomas are rare, slow-growing, benign ependymal neoplasms histologically characterized as grade I tumors by the World Health Organizaton (WHO) [1]. First described as pathologically distnct enttes in 1945, subependymomas have a predilecton for the fourth (50-60%) and lateral (30-40%) ventricles [2,3]. Characteristcally indolent and asymptomatc, most go unreported; however, some studies estmate subependymomas to represent 0.2%–0.7% of all intracranial tumors and approximately 8% of ependymal tumors [4,5]. Rare clinical manifestatons of subependymomas include hydrocephalus secondary to cerebrospinal fuid (CSF) obstructon and less frequently mass efect [6,7]. More commonly, subependymomas are clinically silent and treated with expectant management untl hydrocephalus or mass efect warrants surgical resecton [6]. On the other hand, ependymomas are WHO grade II tumors of neuroectodermal origin that consttute between 2%–6% of adult intracranial tumors and 6% - 10% of pediatric brain tumors [8- 11]. Ependymomas arise within the ventricular system of the central neuraxis and are most commonly infratentorial (60%), showing a predilecton for the foor of the fourth ventricle [12]. Given the increased risk of recurrence and drop metastasis associated with these tumors, complete surgical resecton followed by postoperatve radiaton therapy represents the standard of care for ependymomas [13-17]. The signifcant diference in ependymoma and subependymoma behavior and thus management makes accurate preoperatve diagnosis especially crucial. Considering both tumors arise in similar locatons, magnetc resonance (MR) imaging characteristcs can help diferentate the two diagnoses and guide management. Mixed Tumor with Subependymoma and Ependymoma Features: A Case Report and Review of the Literature Abstract Background: Subependymomas are slow-growing, benign ependymal neoplasms histologically characterized as grade I tumors. On the other hand, ependymomas are higher-grade tumors of neuroectodermal origin that share a predilecton for the fourth ventricle. Given that these tumors can occur simultaneously as mixed lesions, features that raise clinical suspicion of a combined pathology warrant surgical resecton for defnitve diagnosis and potental cure. Case report: A 61-year-old ambidextrous male presented with headache and an MRI demonstratng a lesion involving the fourth ventricle. Imaging demonstrated faint contrast enhancement and growth through the foramen of Luschka, rendering the possibility of an ependymoma or a mixed entty. The patent underwent gross total resecton, with pathology confrming a mixed subependymoma-ependymoma. He was discharged neurologically intact and underwent external beam radiotherapy. Conclusions: Mixed subependymoma-ependymomas are exceedingly rare tumors ofen misdiagnosed as pure subependymomas. In the setng of a mixed pathology, however, the lesion warrants neurosurgical interventon and requires the more aggressive management that is standard for ependymomas. While the exact origin of these mixed neoplasms remains unknown, further investgaton using molecular methods will likely help elucidate the pathogenesis and mechanisms that underlie combined subependymoma-ependymoma tumors. Keywords: Mixed subependymoma ependymoma; Subependymoma; Ependymoma Received: August 25, 2015; Accepted: November 10, 2015; Published: November 14, 2015