11/27/2007 Case 3: Meningioma (spindle cells areas) and lymphoplasmacytic infiltrate

Clinical History:

Histologically, this was a meningioma with some whorling. Dr. Doug Miller described a second finding in each of many slides in the case, with small-cell perivascular areas with large atypical cells as well as reactive lymphocytes. Many atypical cells were immunoreactive for CD20, and some smaller reactive T cells were also present. This region had Ki-67 -50%. In general, the more inflammation in a meningioma the higher the Ki-67. However, this was said to be focal here with the increases in the atypical cells. Dr. Miller's diagnosis: NonHodgkin's lymphoma, large B-cell type, arising in meningioma. The clinical decision was that this lesion would not be treated at present
since it seemed to be totally removed. Comment was also made at the meeting that meningiomas may have extensive chronic inflammatory infiltration and that caution should be exercised before calling a lesion malignant.

Diagnostic Notes:

Dr. Yvonne Milewski showed gross findings in a preliminary (no microscopics yet) discussion of a very abnormal brain of a 15-year-old boy with a previously operated encephalocele and with a shunt. He was an epileptic with subtherapeutic levels of antiepileptic drugs. Many gross photographs of the autopsy brain were discussed. A large DandyWalker cyst was possibly present, with significant brain distortion due not only to the cyst but to the earlier surgery for encephalocele repair. The possible cyst seemed to impinge on one hemisphere more than the other to give significant asymmetry. Otherwise, the radiologic finding of dysplasia of the brain was appreciated, since
gyral abnormalities seemed somewhat generalized in the gross pictures.

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