Multiple high grade rhabdoid papillary meningiomas in 26 years old female patient : A case report

Meningiomas are a group of tumors with meningothelial origin and wide spectrum of histological appearances. Rhabdoid meningioma first described in 1998 and then categorized as grade III meningioma in 2000. They account for about 1-3% of total meningiomas. Rhabdoid papillary meningioma is an uncommon aggressive variant ofmeningioma which has potential to metastasize and spread throughout the brain and even out of the cranium. The case was a 26 years old woman who presented withunilateral central facial nerve palsy and tinnitus. She had history of surgery for two lesions in right temporal lobe and left cerebellopontine angle previously. She wasdiagnosed as ependymoma and choroid plexus carcinoma in previous surgery. In follow-up period, her evaluations showed new lesions in the brain. Imaging showed three lesions in right temporal lobe, right occipital horn wall, and left cerebellopontine angle which were consistent with multiple meningiomas. In surgical view, mass was solid-cystic reddish Cauliflower-shaped in right temporal lobe attaching to the temporal horn. Macroscopically, the lesion was well circumscribed brownish-tan and microscopic examination showed a well-circumscribed cellular neoplasm with sheet-like growth pattern. Individual cells have vesicular nuclei some with prominent nucleoli and eosinophilic cytoplasm. The tumor cells are frequently arranged around the blood vessels (perivascular pseudo-rosette like). Areas of tumor cells with round eccentric nuclei and prominent nucleoli with eosinophilic cytoplasm (rhabdoid cells) with mitotic figures also noted. Immunohistochemistry studies showed positivity of tumor cells with vimentin, EMA, S100 and PR and negativity for Cytokeratinin, GFAP, Myogenin, desmin and synaptophysin. Ki67 was positive in about 5% of tumor cells. These findings are compatible with high grade rhabdoid papillary meningiomas. To date, less than 20 cases of rhabdoid papillary meningioma have been reported in English language literature. Presentation of this case may help pathologists to be aware of this rare entity in differential diagnosis of choroid plexus carcinoma.

Keywords:

rhabdoid , papillary , meningioma