Diagnostic Challenge
Pathology for Neurosurgery & Neurology
Residents
Department of Pathology
University of Oklahoma Health Sciences Center,
Oklahoma City, OK, U.S.A.
Case 12
History: A 55 year-old woman with a recurrent extra-axial
parietal tumor.
Contributor: Kar-Ming Fung, M.D., Ph.D., karming-fung@ouhsc.edu Last updated: 5/5/2008
Paraffin Section
A
Paraffin Section
B
Paraffin Section
C
Paraffin Section
D
Paraffin Section
E
Paraffin Section
F
Paraffin Section
G
Alcian blue
H
Epithelial membrane antigen
I
What is your diagnosis?
Diagnosis: Recurrent chordoid meningioma, WHO
grade II.
Discussion:
• In this particular case, there are areas with higher cellularity and areas with lower
cellularity (Panel A).
• While the areas with high cellularity are composed of solid sheets of epitheliloid
(Panel B), the moderately cellular areas have a chordoid or chondroid type of
intercellular substance. (Panel C) A small gap can be seen in between many
tumor cells (Panel D and E). Pseudonuclear inclusion are also present (Panel E).
• In this particular case, there are areas with higher
cellularity and areas with lower cellularity (Panel A).
• Many large intercellular vacuoles are present in some
areas (Panel F). Panel G shows the high magnification
in areas with chordoid or chondroid type of substance.
Also note that the cells have bubbly cytoplasm. (Panel
G) These chorodoid or chondroid appearing matrix are
positive for Alcian blue (Panel H).
• The tumor cells are positive for epithelial membrane
antigen. (Panel I) Mitotic figures are not significantly
increased.
• The overall histology is suggestive of a chordoid
meningioma (WHO grade II).
Continue on next slide….
Discussion:
• In the first resection, there are only small areas with chordoid component have
already been recognized. Their proportion expands on the second resection
specimen. This is not an uncommon phenomenon. Iis important to recognize
these components.
• Mitotic figures is not always significantly increased in chordoid meningioma as in
this case.
• Some type of meningiomas have peculiar patterns that would predict aggressive
behavior. The mnemonics is as follow:
C- chordoid meningioma, clear cell meningioma (WHO grade II)
P- papillary meningioma (WHO grade III)
R- rhabdoid meningioma (WHO grade III)