Ependymoma Case-Based MCQs: Rosettes, Tanycytic and Myxopapillary Patterns, WHO CNS5 Groups

Subtitle: A case-based ependymoma quiz: a spinal tumour in NF2, perivascular pseudorosettes, tanycytic and myxopapillary patterns, IHC and WHO CNS5 molecular groups, with 10 MCQs and explanations.

Author: PathologyMCQ Editorial Board

Category: Neuropathology

Last Updated: October 2026

Read Time: 6 minutes

At-a-Glance

Hallmarks: perivascular pseudorosettes and true ependymal rosettes; GFAP positive with dot-like EMA.
Patterns: clear cell, papillary and tanycytic are histological patterns in WHO CNS5, not separate types.
Myxopapillary ependymoma (filum terminale) is now CNS WHO grade 2.
Molecular groups: ZFTA and YAP1 (supratentorial), PFA and PFB (posterior fossa), spinal and MYCN-amplified spinal.
Spinal ependymomas are linked to NF2 and generally do well.

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The Case

A 22-year-old man with neurofibromatosis type 2 has a hyperintense intramedullary lesion on spinal MRI. The lesion is resected. Look at the images below, then answer the 10 MCQs.

Case Images

Image 1: spinal tumour histology with perivascular pseudorosettes — Image 1: the resected spinal tumour.

Image 2: ependymoma with elongated fibrillary cells — Image 2: elongated, fibrillary tumour cells.

Image 3: filum terminale tumour with myxoid vascular cores — Image 3: filum terminale tumour. Image credit: twitter.com/DrAldehyde

Test Yourself: 10 MCQs

Ependymoma case: 10 MCQs

Rosettes, patterns, myxopapillary and molecular groups, with instant explanations.

Score: 0 / 10

More practice: the CNS tumours MCQ bank →

Answer Images

Open these after the quiz.

Types of rosettes in CNS tumours — Types of rosettes: ependymal rosettes have an empty central lumen; perivascular pseudorosettes surround a vessel.

Types of tanycytes — Tanycytes: fibrillary cells lining the ventricles, the model for tanycytic ependymoma.

Mucin stain positive in myxopapillary ependymoma — Myxoid matrix of myxopapillary ependymoma stains with mucin stains.

Quick Review

Ependymoma at a glance (WHO CNS5)

Type	Key features	Grade / behaviour
Supratentorial, ZFTA fusion-positive	Children and adults; L1CAM and p65 positive	Grade 2 or 3; worse
Supratentorial, YAP1 fusion-positive	Infants; mostly boys	Grade 2 or 3; better
Posterior fossa, PFA	Infants; H3 K27me3 loss, EZHIP	Grade 2 or 3; worse
Posterior fossa, PFB	Adolescents and adults; H3 K27me3 retained	Grade 2 or 3; better
Spinal ependymoma	Adults; NF2 association	Grade 2 or 3; good
Spinal, MYCN-amplified	Young adults; early dissemination	Aggressive
Myxopapillary ependymoma	Filum terminale; myxoid perivascular cores	Grade 2
Subependymoma	Fourth and lateral ventricles; clustered nuclei in fibrillary matrix	Grade 1

Full detail: ependymoma molecular types → · WHO CNS5 updates →

Exam Pearls

Perivascular pseudorosettes + GFAP + dot-like EMA = ependymoma.
Tanycytic pattern mimics pilocytic astrocytoma and schwannoma.
Myxopapillary ependymoma is grade 2 in WHO CNS5.
PFA (H3 K27me3 loss) and MYCN-amplified spinal ependymomas behave worst.

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