Myxoid meningioma: a rare metaplastic meningioma variant in a patient presenting with intratumoral hemorrhage

Case report

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Myxoid (metaplastic) meningioma is a rare WHO Grade I meningioma subtype arising from the leptomeninges. It has unique Alcian blue stromal staining and distinctive cellular interdigitations, junctional complexes, and nucleolar pseudoinclusions on ultrastructural pathology that help to distinguish it from other meningioma variants. The authors describe the case of a rare left middle fossa, extraaxial myxoid meningioma in a 50-year-old woman to emphasize the important histological characteristics and observations essential for making a precise diagnosis. To their knowledge this is the seventh reported case of a myxoid meningioma in the literature and the sixth case in an adult; however, it is the first reported instance of myxoid meningioma in a patient presenting with intratumoral hemorrhage.

Abbreviation used in this paperGTR = gross-total resection.

Article Information

Address correspondence to: William T. Couldwell, M.D., Ph.D., Department of Neurosurgery, University of Utah, 175 North Medical Drive East, Salt Lake City, Utah 84132. email: neuropub@hsc.utah.edu.

Please include this information when citing this paper: published online January 20, 2012; DOI: 10.3171/2011.12.JNS111020.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial head CT scan (A) revealing a left middle cranial fossa, extraaxial low-density mass with areas of hyperdensity concerning for intratumoral hemorrhage. There is significant mass effect, midline shift, uncal herniation, and pending entrapment of the right lateral ventricle. The mass appears to be avidly enhancing on T1-weighted MR images (B–C) after the administration of Gd and demonstrates a broad-based dural margin along the tentorium and the floor of the left middle cranial fossa, which is best seen in the coronal series. Magnetic resonance image (D) obtained after GTR, showing improvement in midline shift and mass effect.

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    Photomicrographs (A–C) showing a myxoid, spindle cell neoplasm of moderate cellularity. The neoplastic cells exhibit oval to irregularly shaped nuclei with occasional nuclear pseudoinclusions. No significant mitotic figures or tumor necrosis were identified. Photomicrograph (D) showing the myxoid background. H & E (A–C) and Alcian blue, pH 2.5 (D). Original magnification × 400.

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    Photomicrographs obtained in the patient, showing the presence of small amounts of stainable material associated with the neoplastic cells (A). The neoplastic cells exhibit strong membranous staining for epithelial membrane antigen (B). Ultrastructural examinations (C and D) revealing the presence of extensive interdigitating cell processes and desmosomal junctional complexes. Silver stain (A) and uranyl acetate and lead citrate (C and D). Original magnification × 250 (A and B), × 8770 (C), and × 87,840 (D).

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