Anaplastic Ependymoma

45-year-old female with chronic headaches. There is a well circumscribed, solid and cystic, T1-hypointense, T2/FLAIR-hyperintense, enhancing mass with increased blood volume centered on the foramen of Magendie. The mass enlarges the foramen spilling into both the cisterna magna and fourth ventricle. The differential includes ependymoma, subependymoma, choroid plexus papilloma, meningioma and metastatic disease, given the patient’s age. This was an anaplastic ependymoma. Ependymomas represent slow growing tumors of the ependymal cells. 2/3 are infratentorial with most centered in the fourth ventricle. Calcifications are common, and cysts and/or hemorrhage may be present. Despite the tumor having low cellularity, ADC values are typically low.