Subependynoma Versus Hamartoma?

Say that ten times fast while standing on one foot. My (lovely and caring) friends and family want to know exactly WHAT IS GOING ON with this brain stuff and what it means to me. At the risk of being a complete downer at cocktail parties and cookouts, I have eluded the topic in most social circles (how very WASPy of me). Also, I can't say most of the words. I just made my follow-up neurosurgery appointment since all this started and am now thinking about it again, so here is where things stand, today, right now:

Here is what the neurosurgeon's report (Jan 2008) says:

She has a small sub-centimeter sized lesion just at the septum pellucidum on the medial aspect of the frontal horn on the left lateral ventricle. I think she has hamartoma or a subependynoma in the front horn of the left lateral ventricle. [That explains it all. Right?]

Hamartoma (Wikipedia)

A hamartoma is a focal malformation that resembles a neoplasm in the tissue of its origin. This is not a malignant tumor, and it grows at the same rate as the surrounding tissues. It is composed of tissue elements normally found at that site, but which are growing in a disorganized mass. They occur in many different parts of the body and are most often asymptomatic and undetected unless seen on an image taken for another reason. Hamartomas result from an abnormal formation of normal tissue, although the underlying reasons for the abnormality are not fully understood. They grow along with, and at the same rate as, the organ from whose tissue they are made, and, unlike cancerous tumors, only rarely invade or compress surrounding structures significantly. Hamartomas, while generally benign, can cause problems due to their location. They may obstruct practically any organ in the body, such as the eye, the colon, etc. They are particularly likely to cause major health issues when located in the hypothalamus, spleen or kidneys. [So, short answer: Brain hamartoma is not a problem unless it gets bigger. Then it is a problem. Surgery for me, because of location of "lesion", is a big big problem.]

Ependymoma (Copyright, National Brain Tumor Foundation)

Ependymal tumors begin in the ependyma, cells that line the passageways in the brain where cerebral spinal fluid (CSF) is produced and stored. Ependymomas are classified as either supratentorial (in the cerebral hemispheres) or infratentorial (in the back of the brain). Variations of this tumor type include subependymoma, subependymal giant-cell astrocytoma, and malignant ependymoma.

Characteristics • Usually localized to one area of the brain• Develops from cells that line the hollow cavities at the bottom of the brain and the canal containing the spinal cord • Can be slow growing or fast growing • May be located in the ventricles• May block the ventricles, causing hydrocephalus (water on the brain)• Sometimes extends to the spinal cord • Occurrence peaks at age five and again at age 34• Accounts for two percent of all brain tumors. [Accounts for 2% of all brain tumors? What are the odds? I am no statistician, but I think, logically, the odds would be greater of being attacked by a shark while a meteor fell on your head as you were stuck by lightening and simultaneously shot by a terrorist .]

Symptoms • Severe headaches• Nausea and vomiting• Difficulty walking• Fatigue and sleepiness• Problems with coordination• Neck pain or stiffness• Visual problems [Dear Husband: Symptoms may also include compulsive shoe shopping at Neiman Marcus. There is no treatment for such symptoms. Palliative care is helpful, however, and after a long day of retail, resuscitative measures such as pedicures and dirty martinis should be considered.]

Treatment

The doctor will perform tests to determine if it has spread to the spinal cord. Surgery followed by radiation therapy is the usual course of treatment. A shunt may be needed to treat hydrocephalus caused by blockage of the ventricles. [Such options not offered at my favorite spa.]

Prognosis

The over-all five year survival rate is approximately 50%. Supratentorial epenedynomas, however, are generally more aggressive and have a poorer prognosis.

Studies of prognostic characteristics in ependymomas are limited by the rarity of this tumor. Most studies are reports of single-institution experiences with few patients. The Mayo Clinic (Rochester, MN) experience with 80 patients represents one of the largest single-institution reviews and was published by Schild et al. [3]. Seventy of the patients had low-grade tumors and 10 had high-grade tumors. Prognostic factors favorably associated with survival included tumor grade, location, and histologic subtype (myxopapillary vs other ependymomas). Survival did appear to be somewhat improved in patients who had more of an extensive resection, but this was not found to be significant on univariate or multivariate analysis. All of the patients in this review did receive radiation postoperatively, and the 5-year and 10-year actuarial survival rates in low-grade tumors was 87% and 79%, respectively. High-grade tumors did not fare as well with a 5-year survival rate of only 27%, with a high rate of local (80% recurrence at 5 years) and leptomeningeal (41% at 5 years) relapse. Guyotat et al. [4] reported their experience with 34 adult patients. They found that anaplasia and location dictated outcome. None of the 17 patients with anaplastic ependymoma survived 5 years, whereas 90% of patients with fourth ventricle tumors (most grade 2) were alive at 10 years, and lateral ventricle tumors had a 10-year survival rate of 60%, whereas patients with third ventricle tumors had a 35% 10-year survival rate. [F--K.]

©2008 National Brain Tumor Foundation / Call Us for Support 1.800.934.CURE

Enough medical jargon: So, I am fine? Or not?

Right now today I am fine. Hopefully, I will be fine after my next appointment. That is what I know right now. Case closed. Off to buy boobs now, but that is a post for another time ...