Presentation
Vague headaches.
Patient Data
Pre and post IV contrast multiplanar imaging of the brain has been performed demonstrating a right posterior frontal convexity extraxial mass. It has high T2 signal but is otherwise typical for a meningioma. No adjacent bony or parenchymal changes. Study other wise normal.
MICROSCOPIC DESCRIPTION: The sections show a moderately cellular meningioma with infiltration into the attached dura. The tumor forms scattered whorls. The background contains abundant mucoid material, in which embedded cords of tumor cells are seen, imparting a chordoid-like appearance. The chordoid pattern occupies more than 50% of the total area. Microcystic change is also focally seen. The tumor cells have ovoid nuclei with no nuclear pleomorphism. Mitoses are inconspicuous. The tumor cells are progesterone receptor positive. The Ki-67 index is about 2% (not shown).
There is no necrosis. No brain parenchyma is seen. In one specimen tumor invades into, but not through, the cortical bone. There is no malignant change.
FINAL DIAGNOSIS:
Chordoid meningioma with bone invasion (WHO Grade II).
Case Discussion
Meningiomas with increased risk of recurrence and/or aggressive behavior include:
- Atypical meningioma (Grade II)
- Chordoid meningioma (Grade II)
- Clear cell meningioma (Grade II)
- Papillary meningioma (Grade III)
- Rhabdoid meningioma (Grade III)
- Anaplastic (malignant) meningioma (Grade III)