Non-dura based intaspinal clear cell meningioma

Abstract

A 34-year-old female patient was presented with leg and hip pain for 6 months as well as voiding difficulty for 1 year. Magnetic resonance imaging revealed a well-demarcated mass lesion at L2-3. The mass was hypo-intense on T1- and T2-weighted images with homogeneous gadolinium enhancement. Surgery was performed with the presumptive diagnosis of intradural extramedullary meningioma. Complete tumor removal was possible due to lack of dural adhesion of the tumor. Histologic diagnosis was clear cell meningioma, a rare and newly included World Health Organization classification of meningioma usually affecting younger patients. During postoperative 2 years, the patient has shown no evidence of recurrence. We report a rare case of cauda equina clear cell meningioma without any dural attachment.

Keywords: Cauda equina; Clear cell meningioma; Spinal meningioma; World Health Organization classification; Younger patients.

Fig. 1

Sagittal magnetic resonance imaging shows a well-demarcated mass lesion at L2-3. The mass lesion is hypo-intense on T1-weighted (A) and T2-weighted (B) images and shows homogenous enhancement with gadolinium (C). There is a cystic lesion within the spinal cord on the cranial side of the mass at T12-L2. The cyst is iso-intense with cerebrospinal fluid (A, B and C).

Fig. 2

Photomicrograph showing patternless sheets of polygonal cells with clear glycogen-rich cytoplasm and small clusters of cells in a meningothelial pattern with whorl formation (A, H&E ×200) (B, H & E ×400).

Fig. 3

Photomicrograph of Periodic acid-Schiff stain showing positive reactions in the cytoplasm of tumor cells containing glycogen (×400).

Fig. 4

Tumor cells staining positive for vimentin (×400).

Fig. 5

Postoperative (1 year after surgery) magnetic resonance imaging shows reduction of the previously dilated central spinal canal and no residual tumor.