J Pathol Transl Med.  2020 Nov;54(6):508-512. 10.4132/jptm.2020.05.21.

Intraoperative frozen cytology of intraosseous cystic meningioma in the sphenoid bone

• Kim NR
• Yie GT

• KMID: 2509505
• DOI: http://doi.org/10.4132/jptm.2020.05.21

Abstract

Meningiomas in bone are rarely subjected to fine-needle aspiration diagnosis, and those arising in the skull bone with a cystic presentation are rare. A 24-year-old woman presented with subdural hemorrhage, and subsequent radiology depicted an osteolytic mass-like lesion in the sphenoid bone. Intraoperatively, a solid and cystic hemorrhagic lesion mimicking an aneurysmal bone cyst was observed in the sphenoid bone with dural tearing. Frozen cytology showed singly scattered or epithelioid clusters of round to elongated cells intermixed with many neutrophils. Tumor cells had bland-looking round nuclei with rare prominent nucleoli and nuclear inclusions and eosinophilic granular to globoid cytoplasm in capillary-rich fragments. Histology revealed intraosseous meningothelial and microcystic meningioma (World Health Organization grade 1) in right lesser wing of the sphenoid bone. Considering its unusual location and cytologic findings, differential diagnoses included chordoma, chondroma, chondrosarcoma, and aneurysmal bone cyst. The present case posed a diagnostic challenge due to possible confusion with these entities.

Keyword

Meningioma; Skull; Sphenoid bone; Osteolysis; Bone cysts, aneurysmal

Figure

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  Fig. 1. (A) Brain magnetic resonance image shows a slightly enhanced lesion (arrow) at the right sphenoid bone. (B) Intraoperative gross examination of the lesion shows cystic spaces filled with blood and solid texture.

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  Fig. 2. (A–D) Frozen cytology. (A) The cystic portion of the right sphenoid bone shows singly scattered eosinophilic round to elongated cells with occasional nuclear hyperchromasia. Inset shows thick refractile collagenous cytoplasm with nuclear hyperchromasia. (B) Moderately cellular smears shows sheets of epithelioid cells in a bloody and inflammatory cell–rich background. Inset shows intermixed inflammatory cells in meningothelial whorls. (C) Cellular sheets of round-shaped epithelioid cells with moderate amounts of eosinophilic granular cytoplasm and euchromatic round nuclei, just apposed to the capillary (left). High magnification shows indistinct cell borders (right). (D) High power view shows occasional nuclear inclusions (arrows). (E–H) Histology. (E) Low power view shows sheets of spindle to round-shaped tumor cells, filling the bone. Note the lamellated bone and osteoblastic rimming. (F) Nests of meningothelial cells form microcystic cobweb-like arrangement. Note the microcystic and bubbly cytoplasm. (G) Sheets of spindle-shaped tumor cells are intermixed with inflammatory cells (left). Note the perivascular sclerosis (right). (H) The tumor cells are immunoreactive for vimentin (left) and epithelial membrane antigen (right).

Reference

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