An unusual case of clear cell meningioma

Abstract

Clear-cell meningioma (CCM) is an uncommon, aggressive variant of meningioma, usually affecting younger females and having predilection for infratentorial locations. We present a rare case of recurrent supratentorial CCM in a 58-year-old male. Ten years back, he had an intra-axial tumor in the left occipital lobe, which was managed by surgical excision and radiotherapy. Currently, the patient presented with sudden severe headache along with speech and vision disturbances. Neuroimaging revealed an extra-axial parietooccipital tumor, with intratumoural bleed. Histopathology of both tumors showed features of CCM, immunopositive for epithelial membrane antigen (EMA) and vimentin. This case illustrates multiple unusual features of a rare variant of meningioma in the form of affection of an adult age group, supratentorial location, recurrence, and intratumoral bleed. It also highlights the importance of incorporating immunohistochemistry in the diagnostic workup, to exclude CCM mimics, each having distinctive biological behavior, and prognostic outcome, and warranting different therapeutic protocols.

Suprasellar Clear Cell Meningioma in an Infant: Case report

“…1 However, in the present case, the tumour was located in the suprasellar region; this location accounted for only 4.3% of meningiomas reported in a previous study conducted at the Lagos University Teaching Hospital. 7 Other rare tumour locations that have been reported include the foramen magnum and the fourth ventricle.…”

“…5 Clear cell meningiomas, as with other meningiomas, show a slight female predominance. 1 The current case was unusual in view of the very early age of tumour occurrence and the supratentorial location of the tumour. Clear cell meningiomas are more commonly seen in younger children and adolescents.…”

“…2 The tumour cells are usually immunoreactive to EMA, S100 protein and vimentin-as was the case for the current patientand are usually negative for synaptophysin, glial fibrillary acidic protein, cytokeratins and desmin. 1 In ultrastructural studies, the clear cell meningioma cells should have intercellular junctions, interdigitating processes and intermediate vimentin filaments. 14 Unlike other WHO grade II meningiomas, which tend to have a mitotic count greater than four per 10 highpower fields, clear cell meningiomas often have low mitotic activity; moreover, mitosis has been shown to be of no value in predicting the aggressiveness of the neoplasm.…”

“…5 Deb et al reported a MIB-1 labelling index of <1% in a case of recurrent clear cell meningioma. 1 Proliferating cell nuclear antigen proliferative indices, percentage S-phase determination and DNA ploidy have been linked with aggressiveness in clear cell meningiomas. 6,13 Closer follow-up is therefore required for these cases.…”

Molecular Progression in Unusual Recurrent Non-Pediatric Intracranial Clear Cell Meningioma

“…Clear cell meningioma (ccm) classified as grade 2 is a rare, potentially aggressive entity that represents about 0.2% of all meningiomas, with most cases being described in young women [1][2][3][4][5] . Surgical resection and postoperative radiotherapy are the standard treatment for primary disease and local recurrences.…”