Transitional meningioma of the clivus

Case contributed by Dr Antonio Rodrigues de Aguiar Neto

Presentation

Neck pain for one month, atypical gait and reduced strength on the right side.

Patient Data

Age: 60 years
Gender: Male

MRI

Contrast-enhanced MRI demonstrates an expansive extra-axial tumor formation with implantation throughout the clivus, obliterating the pre-pontine cistern and promoting brainstem compression, which is displaced posteriorly. Such lesion is well enhanced, has defined limits and lobulated contours, measuring about 4.1 x 2.6 x 2.0 cm. The tumor is close related to the V4 branches of the vertebral arteries.

Pathology

Pathology

Macroscopy: In formalin, several irregular, elastic, brownish-brown tissue fragments, measuring the most extensive 1.4 x 0.6 x 0.5 cm. The cuts are compact, of the same color.

Microscopy: There are indistinct cytoplasmic boundaries, cellular whorls, mixed cellular spindling, and a fascicular or storiform architecture, consistent with WHO I transitional meningioma, with bone infiltration.

Conclusion: Excision product, intracranial tumor (clivus) - transitional meningioma (WHO I).

Case Discussion

Meningiomas are extra-axial lesions and the most common dural tumors, which are commonly found on neuroimaging 1,2. Most meningiomas are benign and classified as WHO grade I. A few are WHO grade II – atypical, or III - anaplastic/malignant 1,3. The most common histological subtypes are the meningothelial meningioma, followed by fibrous and transitional subtypes 3. Clival meningiomas are uncommon and arise close to the midline of the clivus, which are related to the brainstem, vertebral arteries, basilar artery, perforating arteries, and multiple cranial nerves 2,3,4.

This case illustrates the radiological characteristics of a clival meningioma of the transitional histological subtype, WHO I.

Case courtesy

  • Luiz Gonzaga do Nascimento Neto, MD - PGY-3, Radiology Resident, Department of Radiology
  • Erick Cavalcante, MD – PGY-3, Radiology Resident, Department of Radiology
  • Ana Lúcia A Brito, MD – Pathologist, Departamento of Pathology
  • Antonio Rodrigues de Aguiar Neto, MD - Radiologist, Department of Radiology

 Hospital da Restauração – Recife, PE – Brazil

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Case information

rID: 75688
Published: 6th Apr 2020
Last edited: 6th Apr 2020
Inclusion in quiz mode: Included
Institution: Real Hospital Português de Pernambuco - Recife, PE - Brazil

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