5/15/2007 Case 2: Papillary meningioma

Clinical History:

A 45 year old man with a sacral mass. Additional information shown at the meeting was the MRI of the tumor, which was within the thecal sac but appeared dural-based.

Diagnostic Notes:

The submitted H&E stained section showed a neoplasm with prominent perivascular growth patterns, resembling pseudorosettes or papillae, as well as more solid lobulated areas. The tumor cells were of moderate size with more or less centrally placed irregular nuclei, many with intranuclear pseudoinclusions. Mitotic figures were easily found. Discussion centered around a differential diagnosis of ependymoma and papillary meningioma. Brief mention was made of gangliocytic paraganglioma of
the cauda equina, but only to say that no ganglion cells were found and the tumor did not appear to be a paraganglioma. The nuclear features and overall architecture favored a diagnosis of meningioma.

Immunostains shown at the meeting demonstrated that the tumor cells were strongly vimentin positive, and there was weak focal EMA positivity. All o~her stains done, including GFAP, were negative. The final diagnosis was Papillary Meningioma.

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