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Extradural spinal meningioma as a source of plasmacytoid cells. A case report
Marlo M Nicolas1, Rami Kaakaji, Eric J Russell
1Department of Pathology and Radiology, Feinberg School of Medicine, Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois, USA. mmnicola@mdanderson.org
Background:
Meningiomas, tumors that often affect middle-aged and elderly people, occasionally arise in the spine, typically at the thoracic level. The cytologic findings in meningiomas include whorls and syncytial clusters of bland-looking cells with scattered, psammomatous calcifications and intranudclear cytoplasmic inclusions. However, in many cases, not all these findings are seen, and in rare cases, unusual cytomorphologic features are observed.
Case:
A case of spinal meningioma was located in the extradural compartment and composed predominantly of singly scattered cells with a plasmacytoid appearance, demonstrated on fine needle aspiration biopsy smear preparations. The cell block showed more typical features of meningioma, and the diagnosis was supported by the results of immunohistochemical staining.
Conclusion:
The diagnosis of spinal meningioma is readily made by employing magnetic resonance imaging. The diagnosis can be difficult to confirm pathologically when atypical histologic findings are present, as in this case, with prominent plasmacytoid features. Sections from the cell block and immunohistochemical stains as well as clinical and radiologic findings were extremely helpful in arriving at the final diagnosis.
Insights
Spinal meningiomas can present with unusual cell appearances. Advanced diagnostic tools like immunohistochemistry aid in confirming these rare tumors when typical features are absent.
Area of Science:
- Neuropathology
- Oncology
- Neurosurgery
Background:
- Meningiomas are tumors often affecting middle-aged and elderly individuals.
- Spinal meningiomas, typically thoracic, can exhibit varied cytomorphologic features.
- Classic cytologic findings include whorls, syncytial clusters, psammomatous calcifications, and intranuclear inclusions.
Observation:
- A rare case of spinal meningioma presented with singly scattered cells showing a plasmacytoid appearance on fine needle aspiration biopsy.
- The extradural tumor exhibited atypical cytomorphology, deviating from typical meningioma presentations.
- Cell block preparations revealed more characteristic meningioma features.
Findings:
- Immunohistochemical staining was crucial in supporting the diagnosis of spinal meningioma.
- Prominent plasmacytoid features in histology can complicate pathological confirmation.
- Magnetic resonance imaging (MRI) is effective for initial diagnosis of spinal meningiomas.
Implications:
- Accurate pathological diagnosis of spinal meningiomas requires integrating various diagnostic modalities.
- Recognizing unusual cytomorphologic variants like plasmacytoid features is essential for correct diagnosis.
- Multidisciplinary approaches combining imaging, cytology, and histology improve diagnostic confidence in challenging cases.