Non-Dura Based Intaspinal Clear Cell Meningioma

Abstract

findings. The motor power of her lower limbs was normal, and rectal examination revealed normal anal tone.Magnetic resonance (MR) imaging showed a well-demarcated 1.5×1.9×2.9 cm sized mass lesion at L2-3. The mass was hypo-intense on T1-and T2-weighted images with homogeneous gadolinium enhancement. There was also a cystic lesion within the spinal cord on the cranial side of the mass at T12-L2. The cyst was isointense to the cerebrospinal fluid and was diagnosed to be tumor associated syrinx (Fig. 1). Myelography of the lumbar spine revealed obstruction of contrast flow due to the intradural mass. Operation was conducted with the presumptive diagnosis of intradural extramedullary meningioma. An L1-3 laminectomy and intradural exposure revealed a yellowish pink, well-encapsulated, elliptical mass of firm consistency. The tumor was found to be draped by and adhered to the nerve roots at its upper pole near the conus medullaris and cauda equina at its lower pole without dural attachment. However, the tumor was successfully dissected from the nerve roots and removed completely. The patient recovered uneventfully after the operation. The postoperative MR imaging showed no residual tumor with marked reduction of the syrinx. All of the patient's preoperative symptoms improved after surgery.The histology of the tumor showed patternless sheets of polygonal cells with clear glycogen-rich cytoplasm and small clusters of cells in a meningothelial pattern with whorl formation (Fig. 2). A Periodic acid-Schiff (PAS) stain showed a positive reaction in the cytoplasm of tumor cells containing glycogen (Fig. 3). Tumor cells were stained positive for vimentin (Fig. 4) and epithelial membrane antigen (EMA). These findings were compatible with the diagnosis of clear cell meningioma. Postoperatively, the patient's symptoms were dramatically alleviated. Ad- INTRODUCTIONClear cell meningioma is a very rare histological type of meningioma that is included in the World Health Organization (WHO) classification as a peculiar variant affecting younger patients 10,14,24,25) . Clear cell meningiomas have been reported in only 0.2% of meningioma cases and have a more aggressive and complicated course due to their histological nature and anatomical locations 25) . Most meningiomas are attached to the dura mater and very seldomly they grow without dural attachment. To the best of our knowledge, only several cases of intraspinal nondura based clear cell meningioma have been reported 2,5,17,19,20) . In this article, we present an unusual case of intraspinal clear cell meningioma characterized by the absence of dural attachment. CASE REPORTA 34-year-old female patient was admitted with complaints of pain in her lower limbs and both hips for 6 months and voiding difficulty for 1 year. She had also experienced numbness in her lower limbs. Her symptoms worsened over time. One year prior to admission, she visited a local obstetrics and gynecology clinics complaining voiding difficulty and was treated conservatively under the diagnosis of cystitis with...

Loss of SMARCE1 expression is a specific diagnostic marker of clear cell meningioma: a comprehensive immunophenotypical and molecular analysis

“…This is consistent with the low mean (30.9 years) and median (26 years) age of patients with CCM (from 8 months to 88 years) relative to the median age of meningioma in general (65 years) . In the literature, the female‐to‐male ratio of patients with CCM was 1.1 (124 females and 110 males) (, cf. review in ).…”

“…In the literature, SMARCE1 ‐deficient CCMs have been particularly described in children (approximately 36% of reported CCMs, from 8 months to 17 years of age) (, cf. review in ) and young adults (approximately 21% of reported CCMs, from 18 to 30 years of age) (, cf. review in ).…”

Non-Dural-Based Spinal Meningioma : The First Case Report of a Fibrous Subtype and a Review of the Literature

“…Spinal meningiomas typically attach to the dura, and non-dural spinal meningiomas are rare 1 , 7 , 10 , 12) . Eighteen cases of non-dural based spinal meningiomas have been reported to date ( Table 1 ) 2 , 3 , 4 , 6 , 8 , 9 , 11 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22) . Most tumors in these cases occur in the lumbo-sacral region (16 cases), including the thoraco-lumbar junction (two cases) 2 , 3 , 4 , 6 , 8 , 9 , 11 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 22) .…”

“…Most of histopathologic subtype of non-dural-based spinal meningiomas was clear cell meningioma (15 cases) 2 , 3 , 4 , 6 , 8 , 11 , 13 , 14 , 16 , 18 , 20 , 21 , 22) , whereas the remaining three cases were angiomatous, transitional, and meningotheliomatous meningiomas 9 , 17 , 19) . The clear cell meningiomas were quite predominant, as high as approximately 83.3%.…”

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“…Several studies were carried out to tune its microwave dielectric properties. However, either the s f value was still quite positive (*50 ppm/°C) or the Q 9 f values decreased seriously [10][11][12]. Recently, Zhang et al [1] reported that they had efficiently modified the microwave dielectric properties of BTN ceramics by substituting (Zn 1/3 Nb 2/3 ) 4? for Ti 4?…”