Ependymoma - Revision history

Jensflorian: /* Microscopic */ Spinal ependymoma

2022-09-19T13:20:31Z

Microscopic: Spinal ependymoma

← Older revision		Revision as of 13:20, 19 September 2022
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	*[[Oligodendroglioma]] (Clear cell ependymoma))		*[[Oligodendroglioma]] (Clear cell ependymoma))
	*CNS embryonal tumour with BCOR internal tandem duplication.		*CNS embryonal tumour with BCOR internal tandem duplication.

			===Spinal ependymoma===
			*Isomorphic nuclei.
			*Mitotic activity usu. very low.
			*Calcification, hemorrhage, cystic and/or metaplastic changes may be seen.
			*Most tumours show CNS grade 2 histology.
			**CNS grade 3 tumours should be examined for MYCN amplification.
			*Outcome usu. good, extent of resection is prognostic.

	DDx (spinal ependymoma):		DDx (spinal ependymoma):

Jensflorian: /* Microscopic */ PF

2022-09-19T13:16:23Z

Microscopic: PF

← Older revision		Revision as of 13:16, 19 September 2022
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	*Complete surgical resection is the best predictor.		*Complete surgical resection is the best predictor.
	*CSF spread in up to 15% of tumours.		*CSF spread in up to 15% of tumours.

			===Posterior fossa ependymoma===
			*Usu. 4th ventricle, less common in CPA.
			*Most frequent in children.
			*May contain tumour nodules with increased cell density.
			*Micocysts, vascular hyalinization and calcification can be present.
			*No morphologic differences between Group A and B tumours.
			*Perivascular pseudorosettes almost always present.
			*Rare papillary or tanicytic patterns.

	DDx (supratentorial and posterior fossa ependymoma):		DDx (supratentorial and posterior fossa ependymoma):
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	*Small cell glioblastoma (MYCN-amplified spinal ependymoma)		*Small cell glioblastoma (MYCN-amplified spinal ependymoma)

	====Images====		===Images===
	www:		www:
	*[http://www.flickr.com/photos/ckrishnan/3862487821/in/photostream Ependymoma (flickr.com)].		*[http://www.flickr.com/photos/ckrishnan/3862487821/in/photostream Ependymoma (flickr.com)].

Jensflorian: /* Supratentorial ependymoma */ children

2022-09-19T12:51:00Z

Supratentorial ependymoma: children

← Older revision		Revision as of 12:51, 19 September 2022
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	*Approx. 1/3 of all ependymal tumours (41% in children).		*Approx. 1/3 of all ependymal tumours (41% in children).
	*Irregular CM enhancement.		*Irregular CM enhancement.
			*YAP1-fused tumors in children oft large at time of diagnosis.
	*Cysts and/or calcification possible.		*Cysts and/or calcification possible.
	*Sharply demarcated from adjacent brain parenchyma.		*Sharply demarcated from adjacent brain parenchyma.

Jensflorian: /* Molecular */ Update

2022-09-19T12:50:01Z

Molecular: Update

← Older revision		Revision as of 12:50, 19 September 2022
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	==Molecular==		==Molecular==
			'''Supratentorial Ependymoma'''
			*SE, ZFTA-fusion positive: Adults and children (up to 80% of cases).<ref>{{Cite journal \| last1 = Parker \| first1 = M. \| last2 = Mohankumar \| first2 = KM. \| last3 = Punchihewa \| first3 = C. \| last4 = Weinlich \| first4 = R. \| last5 = Dalton \| first5 = JD. \| last6 = Li \| first6 = Y. \| last7 = Lee \| first7 = R. \| last8 = Tatevossian \| first8 = RG. \| last9 = Phoenix \| first9 = TN. \| title = C11orf95-RELA fusions drive oncogenic NF-κB signalling in ependymoma. \| journal = Nature \| volume = 506 \| issue = 7489 \| pages = 451-5 \| month = Feb \| year = 2014 \| doi = 10.1038/nature13109 \| PMID = 24553141 }}</ref>
			**ZFTA-RELA fusion most common alteration.
			**Chromothripsis.
			**EPHB2 amplifications and CDKN2A deletions in a subset of these tumors<ref>{{Cite journal \| last1 = Philip-Hollingsworth \| first1 = S. \| last2 = Hollingsworth \| first2 = RI. \| last3 = Dazzo \| first3 = FB. \| title = Host-range related structural features of the acidic extracellular polysaccharides of Rhizobium trifolii and Rhizobium leguminosarum. \| journal = J Biol Chem \| volume = 264 \| issue = 3 \| pages = 1461-6 \| month = Jan \| year = 1989 \| doi = \| PMID = 2912966 }}</ref>
			*SE, YAP-fusion positive.
			**Restricted to children (6-7% of all supratentorial ependymomas).
			**YAP-MAMLD fusion most common alteration.
			'''Posterior fossa Ependymoma'''
	Two distinct molecular subgroups exist in the posterior fossa:<ref>{{Cite journal \| last1 = Witt \| first1 = H. \| last2 = Mack \| first2 = SC. \| last3 = Ryzhova \| first3 = M. \| last4 = Bender \| first4 = S. \| last5 = Sill \| first5 = M. \| last6 = Isserlin \| first6 = R. \| last7 = Benner \| first7 = A. \| last8 = Hielscher \| first8 = T. \| last9 = Milde \| first9 = T. \| title = Delineation of two clinically and molecularly distinct subgroups of posterior fossa ependymoma. \| journal = Cancer Cell \| volume = 20 \| issue = 2 \| pages = 143-57 \| month = Aug \| year = 2011 \| doi = 10.1016/j.ccr.2011.07.007 \| PMID = 21840481 }}</ref>		Two distinct molecular subgroups exist in the posterior fossa:<ref>{{Cite journal \| last1 = Witt \| first1 = H. \| last2 = Mack \| first2 = SC. \| last3 = Ryzhova \| first3 = M. \| last4 = Bender \| first4 = S. \| last5 = Sill \| first5 = M. \| last6 = Isserlin \| first6 = R. \| last7 = Benner \| first7 = A. \| last8 = Hielscher \| first8 = T. \| last9 = Milde \| first9 = T. \| title = Delineation of two clinically and molecularly distinct subgroups of posterior fossa ependymoma. \| journal = Cancer Cell \| volume = 20 \| issue = 2 \| pages = 143-57 \| month = Aug \| year = 2011 \| doi = 10.1016/j.ccr.2011.07.007 \| PMID = 21840481 }}</ref>
	* Group A ependymomas:		* Group A ependymomas:
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	**gene expression profiles similar to that of spinal cord ependymomas.		**gene expression profiles similar to that of spinal cord ependymomas.
	**increased Chromosomal 1q gains. <ref>{{Cite journal \| last1 = Korshunov \| first1 = A. \| last2 = Witt \| first2 = H. \| last3 = Hielscher \| first3 = T. \| last4 = Benner \| first4 = A. \| last5 = Remke \| first5 = M. \| last6 = Ryzhova \| first6 = M. \| last7 = Milde \| first7 = T. \| last8 = Bender \| first8 = S. \| last9 = Wittmann \| first9 = A. \| title = Molecular staging of intracranial ependymoma in children and adults. \| journal = J Clin Oncol \| volume = 28 \| issue = 19 \| pages = 3182-90 \| month = Jul \| year = 2010 \| doi = 10.1200/JCO.2009.27.3359 \| PMID = 20516456 }}</ref>		**increased Chromosomal 1q gains. <ref>{{Cite journal \| last1 = Korshunov \| first1 = A. \| last2 = Witt \| first2 = H. \| last3 = Hielscher \| first3 = T. \| last4 = Benner \| first4 = A. \| last5 = Remke \| first5 = M. \| last6 = Ryzhova \| first6 = M. \| last7 = Milde \| first7 = T. \| last8 = Bender \| first8 = S. \| last9 = Wittmann \| first9 = A. \| title = Molecular staging of intracranial ependymoma in children and adults. \| journal = J Clin Oncol \| volume = 28 \| issue = 19 \| pages = 3182-90 \| month = Jul \| year = 2010 \| doi = 10.1200/JCO.2009.27.3359 \| PMID = 20516456 }}</ref>

	~~Supratentorial ependymomas have also a distinct profile:~~
	*70 % of these ependymomas are ZFTA-fusion positive and have recurrent gene fusions mostly involving RELA<ref>{{Cite journal \| last1 = Parker \| first1 = M. \| last2 = Mohankumar \| first2 = KM. \| last3 = Punchihewa \| first3 = C. \| last4 = Weinlich \| first4 = R. \| last5 = Dalton \| first5 = JD. \| last6 = Li \| first6 = Y. \| last7 = Lee \| first7 = R. \| last8 = Tatevossian \| first8 = RG. \| last9 = Phoenix \| first9 = TN. \| title = C11orf95-RELA fusions drive oncogenic NF-κB signalling in ependymoma. \| journal = Nature \| volume = 506 \| issue = 7489 \| pages = 451-5 \| month = Feb \| year = 2014 \| doi = 10.1038/nature13109 \| PMID = 24553141 }}</ref>
	**EPHB2 amplifications and CDKN2A deletions in a subset of these tumors<ref>{{Cite journal \| last1 = Philip-Hollingsworth \| first1 = S. \| last2 = Hollingsworth \| first2 = RI. \| last3 = Dazzo \| first3 = FB. \| title = Host-range related structural features of the acidic extracellular polysaccharides of Rhizobium trifolii and Rhizobium leguminosarum. \| journal = J Biol Chem \| volume = 264 \| issue = 3 \| pages = 1461-6 \| month = Jan \| year = 1989 \| doi = \| PMID = 2912966 }}</ref>
	*6-8% are YAP1-fusion positive, mostly MAMLD1 as fusion partner.
	~~Note: Molecular subgroups have no treatment implications (at the moment).~~

	==See also==		==See also==

Jensflorian: /* Microscopic */ Supratentorial ependymoma

2022-09-19T12:43:25Z

Microscopic: Supratentorial ependymoma

← Older revision		Revision as of 12:43, 19 September 2022
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	*Rare cases with cartilagineous metaplasia.<ref>{{Cite journal \| last1 = Wang \| first1 = X. \| last2 = Zhang \| first2 = S. \| last3 = Ye \| first3 = Y. \| last4 = Chen \| first4 = Y. \| last5 = Liu \| first5 = X. \| title = Ependymoma with cartilaginous metaplasia might have more aggressive behavior: a case report and literature review. \| journal = Brain Tumor Pathol \| volume = 29 \| issue = 3 \| pages = 172-6 \| month = Jul \| year = 2012 \| doi = 10.1007/s10014-011-0079-4 \| PMID = 22228122 }}</ref>		*Rare cases with cartilagineous metaplasia.<ref>{{Cite journal \| last1 = Wang \| first1 = X. \| last2 = Zhang \| first2 = S. \| last3 = Ye \| first3 = Y. \| last4 = Chen \| first4 = Y. \| last5 = Liu \| first5 = X. \| title = Ependymoma with cartilaginous metaplasia might have more aggressive behavior: a case report and literature review. \| journal = Brain Tumor Pathol \| volume = 29 \| issue = 3 \| pages = 172-6 \| month = Jul \| year = 2012 \| doi = 10.1007/s10014-011-0079-4 \| PMID = 22228122 }}</ref>
	*Branching capillaries usu. only in supratentorial ependymomas.		*Branching capillaries usu. only in supratentorial ependymomas.

			===Supratentorial ependymoma===
			*Usu. connected to the ventricles.
			*Mostly frontal or temporal lobe.
			*Approx. 1/3 of all ependymal tumours (41% in children).
			*Irregular CM enhancement.
			*Cysts and/or calcification possible.
			*Sharply demarcated from adjacent brain parenchyma.
			*True ependymal rosettes are rare.
			*Occasionally branching capillary vessels.
			*Clear cell phenotypes more common than in other locations.
			*Complete surgical resection is the best predictor.
			*CSF spread in up to 15% of tumours.

	DDx (supratentorial and posterior fossa ependymoma):		DDx (supratentorial and posterior fossa ependymoma):
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	**Invasive border = GBM; circumscribed border of lesion = ependymoma.		**Invasive border = GBM; circumscribed border of lesion = ependymoma.
	*[[Oligodendroglioma]] (Clear cell ependymoma))		*[[Oligodendroglioma]] (Clear cell ependymoma))
			*CNS embryonal tumour with BCOR internal tandem duplication.

	DDx (spinal ependymoma):		DDx (spinal ependymoma):

Jensflorian: Update molecular classes.

2022-09-19T12:32:46Z

Update molecular classes.

← Older revision		Revision as of 12:32, 19 September 2022
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	There are currently ~~eight~~ main ependymal tumors:<ref name=Ref_WHOCNS_74>{{Ref WHOCNS\|74}}</ref>		There are currently ten main ependymal tumors:<ref name=Ref_WHOCNS_74>{{Ref WHOCNS\|74}}</ref>
			#Supratentorial [[Subependymoma]]
	#Supratentorial ependymoma, ZFTA-fusion positive		#Supratentorial ependymoma, ZFTA-fusion positive
	#Supratentorial ependymoma, YAP1-fusion positive		#Supratentorial ependymoma, YAP1-fusion positive
			#Posterior fossa [[Subependymoma]]
	#Posterior fossa ependymoma group A		#Posterior fossa ependymoma group A
	#Posterior fossa ependymoma group B		#Posterior fossa ependymoma group B
			#Spinal [[Subependymoma]]
	#Spinal ependymoma		#Spinal ependymoma
	#Spinal ependymoma, MYCN-amplified		#Spinal ependymoma, MYCN-amplified
	#[[Myxopapillary ependymoma]]		#[[Myxopapillary ependymoma]]
	~~#[[Subependymoma]]~~

	Ependymoma, NOS (not otherwise specified): Molecular analysis still missing.		Ependymoma, NOS (not otherwise specified): Molecular analysis still missing.
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	**Cellular ependymoma.		**Cellular ependymoma.
	**Ependymoma, RELA fusion-positive.<ref>{{Cite journal \| last1 = Parker \| first1 = M. \| last2 = Mohankumar \| first2 = KM. \| last3 = Punchihewa \| first3 = C. \| last4 = Weinlich \| first4 = R. \| last5 = Dalton \| first5 = JD. \| last6 = Li \| first6 = Y. \| last7 = Lee \| first7 = R. \| last8 = Tatevossian \| first8 = RG. \| last9 = Phoenix \| first9 = TN. \| title = C11orf95-RELA fusions drive oncogenic NF-κB signalling in ependymoma. \| journal = Nature \| volume = 506 \| issue = 7489 \| pages = 451-5 \| month = Feb \| year = 2014 \| doi = 10.1038/nature13109 \| PMID = 24553141 }}</ref><ref>{{Cite journal \| last1 = Pietsch \| first1 = T. \| last2 = Wohlers \| first2 = I. \| last3 = Goschzik \| first3 = T. \| last4 = Dreschmann \| first4 = V. \| last5 = Denkhaus \| first5 = D. \| last6 = Dörner \| first6 = E. \| last7 = Rahmann \| first7 = S. \| last8 = Klein-Hitpass \| first8 = L. \| title = Supratentorial ependymomas of childhood carry C11orf95-RELA fusions leading to pathological activation of the NF-κB signaling pathway. \| journal = Acta Neuropathol \| volume = 127 \| issue = 4 \| pages = 609-11 \| month = Apr \| year = 2014 \| doi = 10.1007/s00401-014-1264-4 \| PMID = 24562983 }}</ref> This is now called Supratentorial ependymoma, ZFTA-fusion positive.		**Ependymoma, RELA fusion-positive.<ref>{{Cite journal \| last1 = Parker \| first1 = M. \| last2 = Mohankumar \| first2 = KM. \| last3 = Punchihewa \| first3 = C. \| last4 = Weinlich \| first4 = R. \| last5 = Dalton \| first5 = JD. \| last6 = Li \| first6 = Y. \| last7 = Lee \| first7 = R. \| last8 = Tatevossian \| first8 = RG. \| last9 = Phoenix \| first9 = TN. \| title = C11orf95-RELA fusions drive oncogenic NF-κB signalling in ependymoma. \| journal = Nature \| volume = 506 \| issue = 7489 \| pages = 451-5 \| month = Feb \| year = 2014 \| doi = 10.1038/nature13109 \| PMID = 24553141 }}</ref><ref>{{Cite journal \| last1 = Pietsch \| first1 = T. \| last2 = Wohlers \| first2 = I. \| last3 = Goschzik \| first3 = T. \| last4 = Dreschmann \| first4 = V. \| last5 = Denkhaus \| first5 = D. \| last6 = Dörner \| first6 = E. \| last7 = Rahmann \| first7 = S. \| last8 = Klein-Hitpass \| first8 = L. \| title = Supratentorial ependymomas of childhood carry C11orf95-RELA fusions leading to pathological activation of the NF-κB signaling pathway. \| journal = Acta Neuropathol \| volume = 127 \| issue = 4 \| pages = 609-11 \| month = Apr \| year = 2014 \| doi = 10.1007/s00401-014-1264-4 \| PMID = 24562983 }}</ref> This is now called Supratentorial ependymoma, ZFTA-fusion positive.
	**Anaplastic ependymoma.		**Anaplastic ependymoma. This is now called CNS grade 3 ependymoma.

	==Gross==		==Gross==

Jensflorian: /* General */ Update

2022-09-19T12:29:39Z

General: Update

← Older revision		Revision as of 12:29, 19 September 2022
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	==General==		==General==
	*Called the forgotten glial tumour.		*Called the forgotten glial tumour.
	*Anatomic location is essential for tumor diagnosis.		*Anatomic location and molecular data is essential for tumor diagnosis.


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	#[[Subependymoma]]		#[[Subependymoma]]

	Ependymoma (not otherwise specified).		Ependymoma, NOS (not otherwise specified): Molecular analysis still missing.
			Ependymoma, NEC (not elsewhere classfied): Tumor cannot assigned to any of the defined entities.

			Note: Molecularly defined ependymomas can be still graded as CNS grade 2 or 3 depending on histological features.

	*Depreceated terminologies:		*Depreceated terminologies:

Jensflorian: /* Classic ependymoma */ DDx

2022-04-12T12:56:50Z

Classic ependymoma: DDx

← Older revision		Revision as of 12:56, 12 April 2022
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	==Microscopic==		==Microscopic==
	===Classic ependymoma===		==="Classic" ependymoma===
	*Come in two CNS WHO grades: 2 and 3.		*Come in two CNS WHO grades: 2 and 3.
	*Usu. sharply demarcated from surrounding brain parenchyma.		*Usu. sharply demarcated from surrounding brain parenchyma.
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	*Branching capillaries usu. only in supratentorial ependymomas.		*Branching capillaries usu. only in supratentorial ependymomas.

	DDx (~~classic~~ ependymoma):		DDx (supratentorial and posterior fossa ependymoma):
	*[[Subependymoma]].		*[[Subependymoma]].
	*[[Glioblastoma]] (GBM).		*[[Glioblastoma]] (GBM).
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	*[[Astroblastoma]], MN1-altered.		*[[Astroblastoma]], MN1-altered.
	**Invasive border = GBM; circumscribed border of lesion = ependymoma.		**Invasive border = GBM; circumscribed border of lesion = ependymoma.
			*[[Oligodendroglioma]] (Clear cell ependymoma))

			DDx (spinal ependymoma):
	*[[Pilocytic astrocytoma]] (Tanycytic ependymoma)		*[[Pilocytic astrocytoma]] (Tanycytic ependymoma)
	*~~[[Oligodendroglioma]]~~ (~~Clear cell~~ ependymoma))		*Diffuse midline glioma, H3 K27-altered
			*Small cell glioblastoma (MYCN-amplified spinal ependymoma)

	====Images====		====Images====

Jensflorian: /* Molecular */ update

2022-04-12T12:53:32Z

Molecular: update

← Older revision		Revision as of 12:53, 12 April 2022
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	Supratentorial ependymomas have also a distinct profile:		Supratentorial ependymomas have also a distinct profile:
	*70 % of these ependymomas are ZFTA-fusion positive and have recurrent gene fusions mostly involving RELA<ref>{{Cite journal \| last1 = Parker \| first1 = M. \| last2 = Mohankumar \| first2 = KM. \| last3 = Punchihewa \| first3 = C. \| last4 = Weinlich \| first4 = R. \| last5 = Dalton \| first5 = JD. \| last6 = Li \| first6 = Y. \| last7 = Lee \| first7 = R. \| last8 = Tatevossian \| first8 = RG. \| last9 = Phoenix \| first9 = TN. \| title = C11orf95-RELA fusions drive oncogenic NF-κB signalling in ependymoma. \| journal = Nature \| volume = 506 \| issue = 7489 \| pages = 451-5 \| month = Feb \| year = 2014 \| doi = 10.1038/nature13109 \| PMID = 24553141 }}</ref>		*70 % of these ependymomas are ZFTA-fusion positive and have recurrent gene fusions mostly involving RELA<ref>{{Cite journal \| last1 = Parker \| first1 = M. \| last2 = Mohankumar \| first2 = KM. \| last3 = Punchihewa \| first3 = C. \| last4 = Weinlich \| first4 = R. \| last5 = Dalton \| first5 = JD. \| last6 = Li \| first6 = Y. \| last7 = Lee \| first7 = R. \| last8 = Tatevossian \| first8 = RG. \| last9 = Phoenix \| first9 = TN. \| title = C11orf95-RELA fusions drive oncogenic NF-κB signalling in ependymoma. \| journal = Nature \| volume = 506 \| issue = 7489 \| pages = 451-5 \| month = Feb \| year = 2014 \| doi = 10.1038/nature13109 \| PMID = 24553141 }}</ref>
	*EPHB2 amplifications and CDKN2A deletions in a subset of these tumors<ref>{{Cite journal \| last1 = Philip-Hollingsworth \| first1 = S. \| last2 = Hollingsworth \| first2 = RI. \| last3 = Dazzo \| first3 = FB. \| title = Host-range related structural features of the acidic extracellular polysaccharides of Rhizobium trifolii and Rhizobium leguminosarum. \| journal = J Biol Chem \| volume = 264 \| issue = 3 \| pages = 1461-6 \| month = Jan \| year = 1989 \| doi = \| PMID = 2912966 }}</ref>		**EPHB2 amplifications and CDKN2A deletions in a subset of these tumors<ref>{{Cite journal \| last1 = Philip-Hollingsworth \| first1 = S. \| last2 = Hollingsworth \| first2 = RI. \| last3 = Dazzo \| first3 = FB. \| title = Host-range related structural features of the acidic extracellular polysaccharides of Rhizobium trifolii and Rhizobium leguminosarum. \| journal = J Biol Chem \| volume = 264 \| issue = 3 \| pages = 1461-6 \| month = Jan \| year = 1989 \| doi = \| PMID = 2912966 }}</ref>
			*6-8% are YAP1-fusion positive, mostly MAMLD1 as fusion partner.
	Note: Molecular subgroups have no treatment implications (at the moment).		Note: Molecular subgroups have no treatment implications (at the moment).

Jensflorian: /* IHC */ Update

2022-04-12T12:52:21Z

IHC: Update

← Older revision		Revision as of 12:52, 12 April 2022
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	*[[IDH-1]]-ve.		*[[IDH-1]]-ve.
	*EMA (dots and rings).<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Paulus \| first2 = W. \| title = Sensitivity and specificity of epithelial membrane antigen staining patterns in ependymomas. \| journal = Acta Neuropathol \| volume = 106 \| issue = 4 \| pages = 385-8 \| month = Oct \| year = 2003 \| doi = 10.1007/s00401-003-0752-8 \| PMID = 12898159 }}</ref>		*EMA (dots and rings).<ref>{{Cite journal \| last1 = Hasselblatt \| first1 = M. \| last2 = Paulus \| first2 = W. \| title = Sensitivity and specificity of epithelial membrane antigen staining patterns in ependymomas. \| journal = Acta Neuropathol \| volume = 106 \| issue = 4 \| pages = 385-8 \| month = Oct \| year = 2003 \| doi = 10.1007/s00401-003-0752-8 \| PMID = 12898159 }}</ref>
			**Widespread and strong EMA expression is indicative of YAP1-fused ependymoma.
	*Olig2-ve.<ref>{{Cite journal \| last1 = Švajdler \| first1 = M. \| last2 = Rychlý \| first2 = B. \| last3 = Mezencev \| first3 = R. \| last4 = Fröhlichová \| first4 = L. \| last5 = Bednárová \| first5 = A. \| last6 = Pataky \| first6 = F. \| last7 = Daum \| first7 = O. \| title = SOX10 and Olig2 as negative markers for the diagnosis of ependymomas: An immunohistochemical study of 98 glial tumors. \| journal = Histol Histopathol \| volume = 31 \| issue = 1 \| pages = 95-102 \| month = Jan \| year = 2016 \| doi = 10.14670/HH-11-654 \| PMID = 26287936 }}</ref>		*Olig2-ve.<ref>{{Cite journal \| last1 = Švajdler \| first1 = M. \| last2 = Rychlý \| first2 = B. \| last3 = Mezencev \| first3 = R. \| last4 = Fröhlichová \| first4 = L. \| last5 = Bednárová \| first5 = A. \| last6 = Pataky \| first6 = F. \| last7 = Daum \| first7 = O. \| title = SOX10 and Olig2 as negative markers for the diagnosis of ependymomas: An immunohistochemical study of 98 glial tumors. \| journal = Histol Histopathol \| volume = 31 \| issue = 1 \| pages = 95-102 \| month = Jan \| year = 2016 \| doi = 10.14670/HH-11-654 \| PMID = 26287936 }}</ref>
	*~~H3K27me~~ in ~~posterior~~ fossa (loss ~~indicates group A~~).<ref>{{Cite journal \| last1 = Panwalkar \| first1 = P. \| last2 = Clark \| first2 = J. \| last3 = Ramaswamy \| first3 = V. \| last4 = Hawes \| first4 = D. \| last5 = Yang \| first5 = F. \| last6 = Dunham \| first6 = C. \| last7 = Yip \| first7 = S. \| last8 = Hukin \| first8 = J. \| last9 = Sun \| first9 = Y. \| title = Immunohistochemical analysis of H3K27me3 demonstrates global reduction in group-A childhood posterior fossa ependymoma and is a powerful predictor of outcome. \| journal = Acta Neuropathol \| volume = \| issue = \| pages = \| month = Jul \| year = 2017 \| doi = 10.1007/s00401-017-1752-4 \| PMID = 28733933 }}</ref>		*H3K27me3 nuclear loss in Posterior fossa group A ependymoma (nuclear loss is diagnostic).<ref>{{Cite journal \| last1 = Panwalkar \| first1 = P. \| last2 = Clark \| first2 = J. \| last3 = Ramaswamy \| first3 = V. \| last4 = Hawes \| first4 = D. \| last5 = Yang \| first5 = F. \| last6 = Dunham \| first6 = C. \| last7 = Yip \| first7 = S. \| last8 = Hukin \| first8 = J. \| last9 = Sun \| first9 = Y. \| title = Immunohistochemical analysis of H3K27me3 demonstrates global reduction in group-A childhood posterior fossa ependymoma and is a powerful predictor of outcome. \| journal = Acta Neuropathol \| volume = \| issue = \| pages = \| month = Jul \| year = 2017 \| doi = 10.1007/s00401-017-1752-4 \| PMID = 28733933 }}</ref>
	*L1CAM in supratentorial tumors (expression indicates ~~RELA~~ fusion).<ref>{{Cite journal \| last1 = Parker \| first1 = M. \| last2 = Mohankumar \| first2 = KM. \| last3 = Punchihewa \| first3 = C. \| last4 = Weinlich \| first4 = R. \| last5 = Dalton \| first5 = JD. \| last6 = Li \| first6 = Y. \| last7 = Lee \| first7 = R. \| last8 = Tatevossian \| first8 = RG. \| last9 = Phoenix \| first9 = TN. \| title = C11orf95-RELA fusions drive oncogenic NF-κB signalling in ependymoma. \| journal = Nature \| volume = 506 \| issue = 7489 \| pages = 451-5 \| month = Feb \| year = 2014 \| doi = 10.1038/nature13109 \| PMID = 24553141 }}</ref>		*L1CAM in supratentorial tumors (expression indicates ZFTA fusion).<ref>{{Cite journal \| last1 = Parker \| first1 = M. \| last2 = Mohankumar \| first2 = KM. \| last3 = Punchihewa \| first3 = C. \| last4 = Weinlich \| first4 = R. \| last5 = Dalton \| first5 = JD. \| last6 = Li \| first6 = Y. \| last7 = Lee \| first7 = R. \| last8 = Tatevossian \| first8 = RG. \| last9 = Phoenix \| first9 = TN. \| title = C11orf95-RELA fusions drive oncogenic NF-κB signalling in ependymoma. \| journal = Nature \| volume = 506 \| issue = 7489 \| pages = 451-5 \| month = Feb \| year = 2014 \| doi = 10.1038/nature13109 \| PMID = 24553141 }}</ref>
			*p65 nuclear +ve in ZFTA-fused ependymoma.

	==Molecular==		==Molecular==