Meningioma with rhabdoid component

Case contributed by A.Prof Frank Gaillard

Presentation

Headaches and falls.

Patient Data

Age: 50 years
Gender: Female

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Annotated image

The large extra-axial mass ( * ) results in significant midline shift with displacement of the anterior falx towards the right along with anterior subfalcine herniation (blue arrows). Previous craniotomy is best seen on bone window (green arrows). 

The patient went on to have a repeat craniotomy and excision of this large mass. 

Histology

MICROSCOPIC FEATURES: The sections show a moderately hypercellular meningioma. A well developed syncytial architecture is present in the majority of the tumour and tumour cells overall, have uniform nuclear features. However, approximately 5% of tumour cells have rhabdoid features with enlarged eccentrically located nuclei and a moderate amount of eosinophilic cytoplasm and have a diffuse sheeted arrangement. No mitotic figures or areas of necrosis are identified and there is no evidence of brain invasion. Strong progesterone receptor expression is seen in >90% of tumour cells including those with rhabdoid features. The topoisomerase labelling index varies between 6-8%.

COMMENT: Although the features in this meningioma fall short of those required for a diagnosis of atypical meningioma, the focal presence of rhabdoid features in tumour cells and the slightly elevated topoisomerase labelling index indicates a higher than usual likelihood of local recurrence 

FINAL DIAGNOSIS: Meningioma with focal rhabdoid features 

Case Discussion

Meningiomas are usually cured when complete excision is achieved, however even in such cases recurrence either at the site of resection or somewhere else along the dura (field effect) is not infrequently encountered, particularly if there are atypical histological features. As such many surgeons elect to follow these patients for many many years if not for ever with yearly or biyearly MRIs. 

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Case information

rID: 19443
Case created: 10th Sep 2012
Last edited: 23rd Jan 2016
Inclusion in quiz mode: Included

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