Spinal meningioma (L3/4)
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A well circumscribed vividly enhancing eccentric intrathecal extra-medullary mass is present, displacing the cauda equina to the left, and compressing it. On both T1 and T2 weighted images it is isointense to cord.
The patient went on to have resection.
The sections show a moderately cellular tumor. The tumor forms sheets and nests in a fibrous background. No whorls are seen. The tumor 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 tumor 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 tumor: 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.