Prolactinoma associated with an ependymoma in the fourth ventricle: A case report and review of the literature

Abstract

Pituitary adenoma associated with ependymoma in the fourth ventricle is a rare condition. In the present study, a 46-year-old man diagnosed with prolactinoma, who previously underwent two surgical procedures (one for the removal of a primary tumor and a second following its recurrence) developed a complication of ependymoma in the fourth ventricle. The presence of the ependymoma was confirmed by pathological analysis and the patient recovered well following two-phase surgical resection of the two tumors. The present study compared the probable cause of concurrent pituitary adenoma and ependymoma within the fourth ventricle with previous relevant studies. These comparisons were used to propose possible genomic and endocrine contributions for the development of the ependymoma from the pituitary adenoma.

Keywords: ependymoma; fourth ventricle; pituitary adenoma.

Figure 1.

Magnetic resonance imaging of the pituitary adenoma prior to resection, revealing (A) an hourglass-shaped lesion in the sellar region exhibiting a low-density signal on T1-weighted imaging. In addition, the optic chiasm appears elevated and (B) the tumor has invaded the cavernous sinus.

Figure 2.

Magnetic resonance imaging of a pituitary adenoma associated with ependymoma in the fourth ventricle prior to resection. Lesions in the (A) sellar region (4.6×4.7×2.3 cm) and (B) ventricles (3.5×3.5×3.0 cm) were observed as low-density T1-weighted imaging (T1WI) and relatively high-density T2WI signals, respectively. The fourth ventricle expanded in response to compression, but was not completely blocked. (C) and (D) represent enhanced scans of (A) and (B), respectively.

Figure 3.

Hemotoxylin and eosin staining of the fourth ventricle. (A) Densely arranged tumor cells, some forming cell masses (magnification, x200), (B) exhibiting round or ovoid nuclei, dense chromatin and slim nucleoli (magnification, x400). The tumor was diagnosed as an ependymoma (World Health Organization class II).

Figure 4.

(A) Sagittal and (B) axial magnetic resonance imaging scans following resection of the ependymoma.

Figure 5.

Pathological analysis of lesions that developed in the sellar region. (A) Tumor cells detected by hemotoxylin and eosin staining were diffusely distributed with minimal extracellular matrix. (B) Immunohistochemical assays detected prolactin expression in the in tumor tissues, resulting in a diagnosis of prolactinoma. Magnification, x200.