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A challenging case of a tanycytic ependymoma – A case report

Intramedullary spinal cord neoplasms are among one of the rare tumors and account for 4% to 10% of all the central nervous system tumors. Spinal cord ependymomas are the most common type of tumors in adults, and astrocytomas of the cord are most common in children. Among the ependymomas, Tanycytic type is a rare one that usually arises in the intramedullary part of the spine. The histology is unique which is emphasized by the absence of ependymal pattern of cells but has close resemblance to schwannoma and astrocytoma which poses a diagnostic challenge. Hereby we present a case of a young male diagnosed as tanycytic ependymoma but was initially thought to be a glioma clinically. The histology showed spindle cells with oval and elongated nuclei in fascicles in a fibrillary background suggesting a preliminary diagnosis of glioma / schwannoma. However with the help of Immunohistochemical staining, a strong immunoreactivity for glial fibrillary acidic protein (GFAP) with S-100 positivity, confirmed that the tumor was a tanycytic ependymoma. This case underlines the importance of accurate diagnosis of CNS tumors with the help of age, location, detailed histopathological examination and immunohistochemistry to differentiate from other neoplasms as treatment differs for different tumors.