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Crush preparations of meningiomas: can grading be accomplished?
Sarfraz Ali1, Aziza Nassar, Momin T Siddiqui
1Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia 30322, USA.
Abstract:
Crush preparations (CP) for the diagnosis of meningioma are routinely performed in the frozen section suite when tissue is submitted for intraoperative consultation. The goal of this study was to examine the cytologic features of meningiomas in CP and evaluate if benign meningioma (Grade 1), atypical meningioma (Grade 2), and malignant meningioma (Grade 3) can be diagnosed on CP. All cases of meningioma (1999-2007), which were submitted for frozen section at our institution, were retrospectively reviewed. These cases were examined intraoperatively by frozen section and CP. The final histologic diagnosis was taken as the gold standard. A total of 107 meningiomas cases were reviewed. The cytological features of all these cases were studied, and features such as pleomorphism, hemorrhage, necrosis, mitosis, and presence or absence of nucleoli were recorded. Using the final histopathologic diagnosis as the gold standard, there were 72 (Grade 1), 22 (Grade 2), and 13 (Grade 3) meningioma cases, which were studied. In conclusion, this study reviews the salient cytologic features of Grades 1-3 meningiomas. It demonstrates that it is difficult to separate Grade 1 from Grade-2 meningioma on CP, and last, Grade-3 meningioma can be easily diagnosed on CP.
Insights
Crush preparations (CP) aid in diagnosing meningiomas intraoperatively. While Grade 3 meningiomas are easily identified, differentiating Grade 1 from Grade 2 meningiomas using CP remains challenging.
Area of Science:
- Neuropathology
- Cytopathology
- Surgical Pathology
Background:
- Crush preparations (CP) are standard for intraoperative meningioma diagnosis.
- Accurate grading of meningiomas is crucial for patient management and prognosis.
Purpose of the Study:
- To evaluate the cytologic features of meningiomas in crush preparations.
- To determine the feasibility of diagnosing meningioma grades (1-3) on CP.
Main Methods:
- Retrospective review of 107 meningioma cases (1999-2007) diagnosed via frozen section and CP.
- Analysis of cytologic features including pleomorphism, hemorrhage, necrosis, mitosis, and nucleoli.
- Comparison with final histopathologic diagnosis as the gold standard.
Main Results:
- 72 Grade 1, 22 Grade 2, and 13 Grade 3 meningiomas were analyzed.
- Malignant (Grade 3) meningiomas were readily diagnosed on CP.
- Distinguishing between benign (Grade 1) and atypical (Grade 2) meningiomas on CP proved difficult.
Conclusions:
- CP provides valuable cytologic features for meningioma assessment.
- CP is highly effective for diagnosing Grade 3 meningiomas.
- Differentiation between Grade 1 and Grade 2 meningiomas requires caution and may be limited on CP.
