Brain Tumor Res Treat.  2015 Oct;3(2):147-150. 10.14791/btrt.2015.3.2.147.

Crush Cytology of Secretory Meningioma: A Case Report

• Kim NR
• Yee GT
• Cho HY

• KMID: 2114664
• DOI: http://doi.org/10.14791/btrt.2015.3.2.147

Abstract

Secretory meningioma, a histologic subtype of meningioma of World Health Organization grade 1, is clinically significant because it is frequently accompanied by peritumoral brain edema. The patient was a 53-year-old woman suffering from dysarthria and motor weakness of the right arm. Enhanced magnetic resonance images showed an enhancing mass measuring 2.5 cm in size located in the right parietal convexity. Intraoperative squash cytology showed moderately cellular smears composed mainly of clusters of ovoid cells with scattered whorl formations. The cells had round nuclei and a moderate amount of eosinophilic cytoplasm with ill-defined cell borders. Neither atypia nor mitosis was observed. Some scattered round shaped eosinophilic refractile hyaline globules, measuring from 5 to 25 microm, were observed, and a periglobular halo was occasionally observed. The diagnosis of secretory meningioma should be made as early as possible so that neurosurgeons can prevent postoperative aggravation of peritumoral edema. We emphasize that cytologic findings including eosinophilic, non-fibrillary cytoplasm with eosinophilic refractile hyaline globules are helpful in differentiating secretory meningioma from other subtypes of meningioma, primary and metastatic brain tumors.

Keyword

Meningioma, secretory; Cytology; Brain

MeSH Terms

Arm
Brain
Brain Edema
Brain Neoplasms
Cytoplasm
Diagnosis
Dysarthria
Edema
Eosinophils
Female
Humans
Hyalin
Meningioma*
Middle Aged
Mitosis
Rabeprazole
World Health Organization

Figure

• 

  Fig. 1 T1-weighted MR image shows an enhancing mass located in the right parietal convexity with peritumoral edema.

• 

  Fig. 2 Intraoperative crush and squash cytology of the resected mass. A: Cellular smear shows sheets of cohesive polygonal tumor cells forming occasional whorls (hematoxylin and eosin stain, ×200). Arrow and inset indicate eosinophilic globules (hematoxylin and eosin stain, ×1,000). B: Intracytoplasmic inclusions of variable size (white arrows) have a centrally located eosinophilic homogeneous core and a well-defined, thin, clear rim. Note frequent nuclear pseudoinclusions (black arrows, hematoxylin and eosin stain, ×1,000). C: Left: a resected mass is composed of large lobules of syncytially arranged ovoid shaped cells with periodic acid-Schiff-positive eosinophilic granular bodies in aggregated or singly scattered form. Note a periglobular thin halo-like rim (periodic acid-Schiff stain, ×400). Right: cells containing cytoplasmic secretory inclusions are occasionally positive for pancytokeratin (pancytokeratin immunostain, ×400).

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