The patient went on to have resection.
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.
L3/4 spinal tumour: Clear cell meningioma (WHO Grade II).
The signal intensity similar to cord on T2 is helpful in suggesting the diagnosis of meningioma over a schwannoma or myxopapillary ependymoma despite the somewhat atypical location.