Cytology of chordoid meningioma: a series of five cases with emphasis on differential diagnoses

Abstract

Background: Chordoid meningioma is a rare meningioma variant characterised by epithelioid cord-like tumour cells in a myxoid stroma. It is classified as grade II (World Health Organization) tumours, as they have a tendency to behave more aggressively than traditional meningiomas and have a greater likelihood of recurrence. Aims: To report the features of intraoperative imprint smears of five cases of chordoid meningioma. Methods: The intraoperative squash smears were reviewed for cellularity, cellular atypia, mitotic figure, cytoplasmic vacuolation, intranuclear inclusion, presence of a cohesive cord of tumour cells, whorl-like structure, psammoma bodies, chronic inflammatory cells (lymphocytes and plasma cells), background mucin and necrosis. Results: All cases were of moderate to high cellularity, with cohesive cords of bland tumour cells possessing uniformly round nuclei with smooth nuclear outline, stippled chromatin and small nucleoli, with cytoplasmic vacuolation and chronic inflammatory cells in the background. Intranuclear inclusions (80%) and whorl-like structures (60%) were also common. Necrotic background, psammoma bodies or mitotic figures were consistently absent. Conclusions: The cytological features of chordoid mengiomas are distinctive, and intraoperative imprint diagnosis is feasible. C hordoid meningioma is a rare variant of meningioma characterised by epithelioid cord-like tumour cells in a myxoid stroma. It is classified as grade II (World Health Organization (WHO)) tumours, as they have a tendency to behave more aggressively than traditional meningiomas and have a greater likelihood of recurrence. Five cases of chordoid meningiomas were retrieved. The clinical features, intraoperative imprint smears and subsequent histological sections showed distinctive and characteristic findings. MATERIALS AND METHODSFive cases with chordoid meningioma with intraoperative squash smears and confirmed by subsequent formalin-fixed paraffin-wax-embedded sections were identified from the archives of the Department of Pathology, Kwong Wah Hospital, Kowloon, Hong Kong (n = 2); Princess Margaret Hospital, Kwai Chung, Hong Kong (n = 2); and Prince of Wales Hospital, Shatin, Hong Kong (n = 1) over a period of 5 years. The clinical information, presentation, treatment and follow-up were retrieved.Squash smears were made from the intraoperative frozen section material and stained with H&E stain. The remaining materials and the follow-up specimens were fixed in formalin and embedded in paraffin wax.In all cases, the following components were assessed from the smear: cellularity, cellular atypia, mitotic figure, cytoplasmic vacuolation, intranuclear inclusion, presence of a cohesive cord of tumour cells, whorl-like structure, psammoma bodies, chronic inflammatory cells (lymphocytes and plasma cells), background mucin and necrosis. Cellular atypia was defined as tumour cells with high nucleocytoplasmic ratio, with or without prominent nucleoli. All the other cytomorphological parameters were taken as present or absent i...

Chordoid meningiomas: Incidence and clinicopathological features of a case series over 18 years

“…Meningiomas in general occur less often in the pediatric population as compared to the adult population . The age range of our patient population with CM was 19–85 years (mean 60 years), which is in accordance with the wide age range observed in several large case series …”

“…Nine patients were reviewed from 1743 total meningioma patients in a 1995 to 2013 time period at St. Michael's Hospital in Toronto. To the best of our knowledge, 221 cases of CM have been reported in the English literature worldwide in the form of single case reports and/or case series …”

“…Furthermore, mucinous carcinoma exhibits positivity to cytokeratin and it is possible to observe cytological atypia and intracellular mucin . Chordoid glioma exhibits positivity for S‐100 and GFAP and is not dura‐based as opposed to meningioma . A panel of immunological markers is useful for correct histological differential diagnosis between meningeal tumor subtypes.…”

Crush Cytology of Microcystic Meningioma with Extensive Sclerosis

“…The nature of the myxoid materials has been proven as a transudate of a low-protein component and several theories have been suggested, including recapitulation of subarachnoid structure, simple degenerative change, and disordered vascular permeability 5. To the best of our knowledge, these findings were not described in the case reported by Fukuoka et al3 Cytoplasmic vacuolation and bluish myxoid materials in the background are features shared by chordoid meningioma 6. However, the latter is frequently associated with chronic inflammatory cells and cord-like epithelioid cells.…”

Distinguishing Chordoid Meningiomas From Their Histologic Mimics

“…Meta-analysis results of previously reported immunohistochemical findings in chordoid meningioma 6,17,21,22,24,30,35,36,38,40,42,43,45,47– 49,51–54,61,62,70,75,77,80,82,86 (published in English language) are shown in Figure 7. Additional immunohistochemical staining results in chordoid meningioma reported in the literature (which were not included in Fig.…”