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Clear-cell meningioma: diagnosis by fine-needle aspiration biopsy
S P Imlay1, T E Snider, S S Raab
1Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, USA.
Abstract:
Clear-cell meningiomas have a more aggressive behavior than other meningioma subtypes and the cytologic features of clear-cell meningioma have not been described. A fine-needle aspiration biopsy (FNAB) of a sacral clear-cell meningioma was performed in a 28-yr-old woman. This tumor was a metastasis from a posterior fossa meningioma that had been unresectable, but had been present for 7 yr. Cytologically, clear-cell meningiomas have a whorled, syncytial architecture and spindled to polygonal, bland-appearing nuclei. In contrast to the more classic meningioma, the clear-cell variety has vacuolated cytoplasm. The differential diagnosis includes a number of other neoplastic processes. Separation of clear-cell meningioma from these other entities may be difficult because of its rather unusual cytoplasmic features and its occurrence in unusual sites.
Insights
Clear-cell meningiomas, a rare and aggressive subtype, exhibit distinct cytologic features including vacuolated cytoplasm. This case highlights the diagnostic challenges of clear-cell meningioma on fine-needle aspiration biopsy.
Area of Science:
- Neurosurgery
- Cytopathology
Background:
- Clear-cell meningiomas are an aggressive subtype of meningioma.
- Cytologic features of clear-cell meningioma have not been previously described.
Observation:
- A fine-needle aspiration biopsy (FNAB) was performed on a sacral clear-cell meningioma in a 28-year-old woman.
- This tumor represented a metastasis from a posterior fossa meningioma present for 7 years.
Findings:
- Cytologically, clear-cell meningiomas show a whorled, syncytial architecture with bland-appearing nuclei.
- A key distinguishing feature is vacuolated cytoplasm, contrasting with classic meningiomas.
- Differential diagnosis is challenging due to unusual cytoplasmic features and uncommon locations.
Implications:
- Accurate cytologic diagnosis of clear-cell meningioma is crucial for appropriate patient management.
- Recognition of these specific cytologic features aids in differentiating clear-cell meningioma from other neoplastic processes.
- This description expands the cytologic understanding of meningioma subtypes, particularly in challenging cases.