Clear cell meningioma of the lumbar spine

Case contributed by RMH Neuropathology

Patient Data

Age: 50 years
Gender: Female

A subtle soft tissue density nodule is seen at the level of L3/4 without bony destruction or remodeling. 

Vividly enhancing intradural mass is present at the level of L3/4, below the tip of the conus. It displaces the majority of the cauda equina to the left, and does not clearly arise from never roots. 

Differential includes: meningioma or a neurogenic tumour (e.g. schwannoma) or a myxopapillary ependymoma. Its signal intensity and apparent thecal base favours a meningioma. 

MACROSCOPIC APPEARANCE:

"L3/4 spinal tumour": An ovoid piece of rubbery tan and pink tissue 20x14x11mm.

MICROSCOPIC DESCRIPTION: The sections show a moderately cellular tumour. The tumour forms sheets and nests in a fibrous background. No whorls are seen. The tumour cells have round hyperchromatic nuclei, inconspicuous nucleoli and moderate amounts of clear cytoplasm. There is no nuclear pleomorphism. Mitoses are inconspicuous. There is no necrosis. The tumour cells are focally PAS positive. They are EMA and progesterone receptor positive. The Ki-67 index is about 8%. They are CAM5.2 and CD10 negative. The features are those of clear cell meningioma, which is classified as WHO grade II. DIAGNOSIS: 1-3. L3/4 spinal tumour: Clear cell meningioma (WHO Grade II).

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Case information

rID: 27624
Case created: 11th Feb 2014
Last edited: 24th Feb 2016
Tag: spine
Inclusion in quiz mode: Included

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