J Korean Neurosurg Soc.  2013 Sep;54(3):257-260. 10.3340/jkns.2013.54.3.257.

Totally Ossified Metaplastic Spinal Meningioma

• Ju CI
• Hida K
• Yamauchi T
• Houkin K

• KMID: 2190910
• DOI: http://doi.org/10.3340/jkns.2013.54.3.257

Abstract

A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma.

Keyword

Ossified spinal tumor; Metaplastic meningioma; Grossly total resection

MeSH Terms

Female
Gadolinium
Humans
Magnetic Resonance Imaging
Meningioma*
Middle Aged
Spinal Canal
Spinal Cord
Spinal Cord Diseases
Gadolinium

Figure

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  Fig. 1 Computed tomographic scan without enhancement show a large totally ossified intradural round mass occupying the whole spinal canal on T9-T10 level. Axial view on T9 (A),10 level (B) and sagittal view (C).

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  Fig. 2 Magnetic resonance image showing the tumor was very low signal intensity on T2-weighted image and mainly low intensity compared to spinal cord on T1-weighted image (A and B). T1-weighted imaging gadolinium showed a round homogenously enhanced tumor and the lower signal intensity of central tumor portions were less enhanced compared with the other portions of the masses (C).

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  Fig. 3 In the totally ossified metaplastic meningioma. It is difficult to find the arachnoid membrane that acts a natural barrier and provides a dissection plane during surgery (A). This tumor has been dissected meticulously through the adhesive peritumoral arachnoid membrane with microsurgical scissor and en-bloc technique (B).

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  Fig. 4 Histologic examination of the initially resected tumor specimen stained with hematoxylin and eosin shows metaplastic (osseous) meningioma. A : The tumor cells which have delicate oval nuclei, inconspicuous nucleoli, and lightly eosinophilic cytoplasm, proliferate forming cellular whorls (×40). B : Within the tumor, marked heterotopic ossification occurs without psammoma bodies (×10).

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