Ependymoma and intraparenchymal calcifying pseudoneoplasm of the neural axis: Incidental collision or unique reactive phenomenon?

The so-called "calcifying pseudoneoplasm of the neural axis" is a rare tumefactive lesion presumed to be reactive in nature. To our knowledge, association with a true neoplasm has not been previously reported. We recently encountered the case of a 67-year-old woman who underwent resection of an incidentally discovered cerebellar cystic mass with a distinct, calcified component. Histology demonstrated a partially ossified, lobulated, chondrocalcific lesion surrounded by chronic inflammation, spindle to epithelioid cells, and occasional multinucleated giant cells - all features of calcifying pseudoneoplasm of the neural axis. A low-grade ependymoma associated with marked piloid gliosis was found contiguous to the lesion. The unique combination of an ependymoma with marked reactive gliosis and a calcifying pseudoneoplasm supports the reactive nature of the latter.