Atypical meningioma (grade II) - en plaque

Case contributed by RMH Neuropathology



Patient Data

Age: 59
Gender: Male

The right greater wing sphenoid mass with intracranial and intraorbital components is noted.

No acute intracranial pathology is identified. The paranasal sinuses and mastoid air cells are clear.

Post contrast T1 volumetric acquisition through the brain for the purposes of stereotaxis has been obtained. The right greater wing sphenoid presumed meningioma with intracranial and intraorbital components is visualized. Please refer to previous diagnostic studies for futher details.


The sections show a variably hypercellular meningioma. A predominant syncytial architecture with areas of fibroblastic meningioma is noted in the sphenoidal wing component (specimens 2 and 3) and this component shows full thickness infiltration of dura and extensive invasion of skeletal muscle. The orbital component (specimen 4) is densely hypercellular and is composed of diffuse sheets of cells with overlapping pleomorphic vesicular nculei, many with conspicuous nucleoli. Moderate numbers of mitotic figures are noted in this component (6/10HPF). No areas of necrosis are identified. There is no evidence of invasion of brain parenchyma. Immunohistochemistry shows patchy moderate expression of PgR in tumor cells. There is weak membrane staining for epithelial membrane antigen (EMA). The topoisomerase labeling index is approximately 15%. The features are of atypical meningioma (WHO Grade II)

5. The section shows that the entire specimen consists of atypical meningioma (WHO Grade II) with features as seen in specimens


  • 1-4: Sphenoid wing and orbital tumor: Atypical meningioma (WHO Grade II)
  • 5: Anterior inferior orbital margin: Atypical meningioma (WHO Grade II)

Case Discussion

Typical appearances of an en plaque meningioma with hyperostosis and transosseous extension. Histology has more aggressive features, sufficient to denote an atypical meningioma (grade II). 

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Case information

rID: 29633
Published: 12th Jun 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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