Related Experiment Videos
Clear cell meningioma: report of a spinal case
1Institute of Anatomy, Humboldt University, Berlin, Germany.
Abstract:
A sacrococcygeal case of clear cell meningioma in a 38-year-old man is reported. Compared to the seven spinal clear cell meningiomas described so far, this case demonstrated the highest recurrency rate. Multiple recurrences were most likely due to the extensive infiltrative growth pattern of the tumor hindering complete microscopic surgical resection. Histologic parameters were not relevant to predict recurrences, since cellular anaplasia was lacking and growth fraction was low in the first operation and all subsequent recurrences. In view of what is now known of clear cell meningiomas, the tumor showed all histologic and immunohistochemical features which are typical for this tumor entity. However, the tumor was first diagnosed by capable pathologists and neuropathologists as fibroma-like mesenchymal tumor, metastatic renal carcinoma, chordoma, chondroma untypical osteosarcoma, and microcystic meningioma. Correct diagnosis was made by electron microscopy which has revealed comparable findings to those of other rare electron microscopical cases reported so far; high content of cytoplasmic glycogen diffusely distributed throughout the cytoplasm or aggregated within vacuoles, intermediate filaments, desmosomes, interdigitation of cell membranes and large amounts of collagen fibers, some of which were of the giant amianthoid type. Since meningiomatous features of clear cell meningiomas are not obvious light microscopically and the tumors may be confused with nonmeningiomatous neoplasms, electron microscopical investigation is highly recommended in each case of suspected clear cell meningioma.
Insights
This report details a sacrococcygeal clear cell meningioma with a high recurrence rate due to infiltrative growth. Electron microscopy is crucial for accurate diagnosis of this rare tumor.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Clear cell meningiomas are rare tumors with distinct histological features.
- Spinal meningiomas, particularly the clear cell subtype, present diagnostic challenges.
- This case highlights a sacrococcygeal clear cell meningioma with aggressive behavior.
Observation:
- A 38-year-old male presented with a sacrococcygeal clear cell meningioma exhibiting an unusually high recurrence rate.
- The tumor's infiltrative growth pattern complicated complete surgical resection, leading to multiple recurrences.
- Initial diagnoses varied, including mesenchymal tumors and carcinomas, highlighting diagnostic difficulties.
Findings:
- Histological parameters like cellular anaplasia and growth fraction did not predict recurrence in this case.
- Electron microscopy confirmed typical clear cell meningioma features, including abundant glycogen and collagen.
- Diagnostic confusion arose because light microscopic features were not overtly meningiomatous.
Implications:
- Electron microscopy is vital for definitive diagnosis of clear cell meningiomas, especially when light microscopy is inconclusive.
- Understanding the infiltrative nature of these tumors is key for surgical planning and managing recurrences.
- This case underscores the importance of advanced diagnostic techniques for rare neoplasms.