Third ventricular chordoid meningioma in a child

Case report

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Meningiomas are rare in children. Chordoid meningioma is a very rare variant, as only 16 cases in children have been reported. The authors report the first case of a chordoid meningioma in the third ventricle.

A 12-year-old boy presented with headache, abnormal behaviors, and ataxia. Brain MR imaging revealed a 2-cm, well-enhanced mass in the third ventricle and hydrocephalus. Positron emission tomography with [18F]fluorodeoxyglucose showed that the mass was hypermetabolic. Gross-total removal of the mass was performed using a left frontal transcortical and transventricular approach. The mass originated from the left caudate head and was connected to the choroid plexus. A chordoid meningioma was diagnosed on the basis of the histological characteristics of the tumor, which was composed of cords and nests of eosinophilic vacuolated cells with an abundant myxoid matrix, similar to the features of a chordoma. A typical focal meningiomatous pattern was observed. The tumor cells were immunoreactive for vimentin and epithelial membrane antigen. The patient's headache and gait disturbance improved after the tumor was removed. The tumor showed no signs of recurrence during 12 months of follow-up.

Abbreviations used in this paper: EMA = epithelial membrane antigen; FDG = [18F]fluorodeoxyglucose; WHO = World Health Organization.

Article Information

Address correspondence to: Seung-Ki Kim, M.D., Ph.D., Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea. email: nsthomas@snu.ac.kr.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative MR images showing a 2-cm, well-enhanced mass in the third ventricle. This mass obstructed the foramen of Monro and caused hydrocephalus with periventricular edema. A: Axial T2-weighted image. B: Axial T1-weighted image. C: Coronal T1-weighted image with Gd enhancement.

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    A coronal FDG-PET image showing a hypermetabolic lesion in the third ventricle.

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    Photomicrographs illustrating the histopathological findings. Upper: The tumor was composed of sheets of loosely arranged polygonal tumor cells and infiltrating lymphoplasma cells. Lower: The tumor cells had a trabecular arrangement against a myxoid background and contained cytoplasmic vacuoles. H & E, original magnification × 200 (A) and × 400 (B).

References

1

Abenoza PSibley RK: Chordoma: an immunohistologic study. Hum Pathol 17:7447471986

2

Arima TNatsume AHatano HNakahara NFujita MIshli D: Intraventricular chordoid meningioma presenting with Castleman disease due to overproduction of interleukin-6. Case report. J Neurosurg 102:7337372005

3

Civit TBaylac FTaillandier LAuque JHepner H: [Chordoid meningiomas. Clinical, neuroradiological and anatomopathological aspects. Apropos of a new case and review of the literature.]. Neurochirurgie 5:3083131997. (Fr)

4

Couce MEAker FVScheithauer BW: Chordoid meningioma: a clinicopathologic study of 42 cases. Am J Surg Pathol 24:8999052000

5

Epari SSharma MCSarkar CGarg AGupta AMehta VS: Chordoid meningioma, an uncommon variant of meningioma: a clinicopathologic study of 12 cases. J Neurooncol 78:2632692006

6

Glasier CMHusain MMChadduck WBoop FA: Meningiomas in children: MR and histopathologic findings. AJNR Am J Neuroradiol 14:2372411993

7

Hug EBDeVries AThornton AFMunzenrider JEPardo FSOjemann R: Management of atypical and malignant meningiomas: role of high dose, 3D-conformal radiation therapy. J Neurooncol 48:111602000

8

Jaaskelainen J: Seemingly complete removal of histologically benign intracranial meningioma––late recurrence and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 26:4614691986

9

Katz TSAmdur RJYachnis ATMendenhall WMMorris CG: Pushing the limits of radiotherapy for atypical and malignant meningioma. Am J Clin Oncol 28:70742005

10

Kepes JJChen WYConnors MHVogel FS: “Chordoid” meningeal tumors in young individuals with peritumoral lymphoplasmacellular infiltrates causing systemic manifestations of the Castleman syndrome. A report of seven cases. Cancer 62:3914061988

11

Kobata HKondo AIwasaki KKusaka HIto HSawada S: Chordoid meningioma in a child. Case report. J Neurosurg 88:3193231998

12

Kumar STatke MHusain Z: Chordoid meningioma associated with chronic subdural hematoma. Indian Pediatr 33:7837851996

13

Lee DKKim DGChoe GChi JGJung HW: Chordoid meningioma with polyclonal gammopathy. Case report. J Neurosurg 94:1221262001

14

Louis DNOhgake HWiestler ODCavenee WKBurger PCKleihues P: The 2007 WHO classification of tumors of the central nervous system. Acta Neuropathol 114:971092007

15

Miettinen MLehto VPDahl DVirtanen I: Differential diagnosis of chordoma, chondroid, and ependymal tumors as aided by anti-intermediate filament antibodies. Am J Pathol 112:1601691983

16

Mullassery DO'Brien DFWilliams DCrooks DMallucci CPizer B: Malignant disseminated chordoid meningioma in a 12-year-old child: a role for early cranial and spinal radiation treatment after subtotal resection. Childs Nerv Syst 22:134413502006

17

Ozen OSar AAtalay BAltinors NDemirhan B: Chordoid meningioma: rare variant of meningioma. Neuropathology 24:2432472004

18

Perry ADehner LP: Meningeal tumors of childhood and infancy. An update and literature review. Brain Pathol 13:3864082003

19

Rohringer MSutherland GRLouw DFSima AA: Incidence and clinicopathological features of meningioma. J Neurosurg 71:6656721989

20

Rushing EJOlsen CMena HRueda MELee YSKeating RF: Central nervous system meningiomas in the first two decades of life: a clinicopathological analysis of 87 patients. J Neurosurg 103:4894952005

21

Yeon JYLee JIKim JHSuh YL: Chordoid meningioma: a case report. J Korean Med Sci 18:7687712003

22

Zuppan CWLiwnicz BHWeeks DA: Meningioma with chordoid features. Ultrastruct Pathol 18:29321994

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