Ependymoma classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]


Ependymoma may be classified into several subtypes based on WHO classification (grade I, II, III) and the site of origin.[1]


  • In the most recent World Health Organization (WHO) classification of brain tumors, ependymal tumors are classified into the following four main subtypes:[2][3]
  • Myxopapillary ependymoma (WHO grade I): a myxopapillary ependymoma arises almost exclusively in the location of the conus medullaris, cauda equina, and filum terminale of the spinal cord and is characterized histologically by tumor cells arranged in a papillary manner around vascularized myxoid stromal cores.
  • Ependymoma (WHO grade II): the ependymoma, which is considered a grade II neoplasm originating from the walls of the ventricles or from the spinal canal, is composed of neoplastic ependymal cells. Ependymomas are subdivided, based on histological findings, into the following four subtypes:
  • Cellular ependymoma: the most common subtype, this subtype usually demonstrates significant cellularity without an increase in mitotic activity.
  • Papillary ependymoma: forms linear, epithelial-like surfaces along cerebrospinal fluid.
  • Clear cell ependymoma: displays an oligodendroglial-like appearance with perinuclear halos, this variant is preferentially located in the supratentorial compartment of the brain.
  • Tanycytic ependymoma: the rarest form of grade II ependymoma, this subtype is most commonly found in the spinal cord; tumor cells are arranged in fascicles of variable width and cell density and are poorly intertwined.
  • Anaplastic ependymoma (WHO grade III): also known as malignant ependymoma. An anaplastic ependymoma is considered a malignant glioma of ependymal differentiation and, compared with the grade II ependymomas, shows increased cellularity and increased mitotic activity. It is often associated with microvascular proliferation and necrosis.
  • Ependymal tumors are also classified based on their sites of origin into:[3][4]


  1. .Ependymomas Dr Bruno Di Muzio and Dr Frank Gaillard Gold Supporter since June 24, 2015">. Radiopaedia.org 2015.http://radiopaedia.org/articles/ependymoma
  2. Louis DN, Ohgaki H, Wiestler OD, et al., eds.: WHO Classification of Tumours of the Central Nervous System. 4th ed. Lyon, France: IARC Press, 2007.
  3. 3.0 3.1 Eoendymoma. http://www.cancer.gov/types/brain/hp/child-ependymoma-treatment-pdq#section/_35 URL Accessed on 10 6 2015.
  4. Andreiuolo F, Puget S, Peyre M, Dantas-Barbosa C, Boddaert N, Philippe C et al. (2010). "Neuronal differentiation distinguishes supratentorial and infratentorial childhood ependymomas.". Neuro Oncol 12 (11): 1126-34. doi:10.1093/neuonc/noq074. PMID 20615923.