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Clear cell meningioma in a child: A case report and review of literature.

Kumar R, Das KK, Jaiswal AK, Mehrotra A, Sahu RN, Srivastava AK, Jaiswal S, Behari S - Asian J Neurosurg (2015 Jan-Mar)

Bottom Line: Histopathology was suggestive of clear cell meningioma (CCM).Supratentorial pediatric CCM is a rare entity.The case is discussed along with review of literature on this rare clinico-pathological entity.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India.

ABSTRACT
An 11-year-old boy presented with holocranial headache associated with vomiting and heaviness in right paranasal region. On examination, he had left sided upper motor neuron type facial palsy along with a subtle ipsilateral hemiparesis (grade 4/5 Medical Research Council). Magnetic resonance imaging brain revealed a contrast enhancing large well-defined extra-axial mass lesion in right middle cranial fossa with extension into the infratemporal fossa. The mass was excised in two stages. Histopathology was suggestive of clear cell meningioma (CCM). Supratentorial pediatric CCM is a rare entity. The case is discussed along with review of literature on this rare clinico-pathological entity.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance imaging brain: T2-weighted coronal section (a), sagittal section (b) and T1-weighted contrast sagittal section (c), showing T2-weighted hyperintense and heterogeneously contrast enhancing, well defined extra-axial mass lesion in right middle cranial fossa with extension into the infratemporal fossa
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Figure 1: Magnetic resonance imaging brain: T2-weighted coronal section (a), sagittal section (b) and T1-weighted contrast sagittal section (c), showing T2-weighted hyperintense and heterogeneously contrast enhancing, well defined extra-axial mass lesion in right middle cranial fossa with extension into the infratemporal fossa

Mentions: An 11-year-old boy presented with holocranial headache associated with vomiting for the last 1-month. He also complained of heaviness in right paranasal region for the last 10 days. On examination, he was conscious, oriented with intact higher mental functions. There was left upper motor neuron type of facial palsy along with ipsilateral subtle hemiparesis (grade 4/5 Medical Research Council). Magnetic resonance imaging (MRI) of the brain revealed a large well-defined extra-axial mass lesion in the right middle cranial fossa with extension into the infratemporal fossa. The lesion was isointense on T1 and T2-weighted images and was heterogeneously enhancing in postgadolinium scan. There was perilesional edema causing mass effect in the form of effacement of ipsilateral lateral ventricle and midline shift [Figure 1a–c]. He was planned for surgical excision of the tumor in two stages. In the first stage, intracranial tumor was excised with right fronto-temporal craniotomy with zygomatic osteotomy approach. Intraoperatively the tumor was extra-axial, greyish pink and highly vascular. The tumor was involving the dura of middle fossa base through which it was extending into the infratemporal fossa. The intracranial part of the tumor was excised completely at the first setting. The infratemporal part was removed at a later stage by trans facial trans maxillary approach. Postoperative MRI brain revealed no residual tumor [Figure 2a and b]. Histopathological examination showed tumor dispersed in diffuse sheets and in nests separated by thick fibrovascular septa. The tumor cells were round to polygonal in shape, had round nucleus, dispersed nuclear chromatin, inconspicuous nucleoli and moderate amount of clear cytoplasm, entrapped bony trabeculae were also seen in between the tumor cells with occasional mitotic activity. Tumor cells were positive for vimentin, S-100 and focally positive for epithelial membrane antigen. On imunohistochemistry, Ki-67 index was 7% suggestive of CCM (aggressive variant) [Figure 3a and b]. Following surgery weakness on the left side improved. In view of complete excision, no radiotherapy was advised, and patient was kept in close follow-up. At follow-up of 9 months patient, was doing well.


Clear cell meningioma in a child: A case report and review of literature.

Kumar R, Das KK, Jaiswal AK, Mehrotra A, Sahu RN, Srivastava AK, Jaiswal S, Behari S - Asian J Neurosurg (2015 Jan-Mar)

Magnetic resonance imaging brain: T2-weighted coronal section (a), sagittal section (b) and T1-weighted contrast sagittal section (c), showing T2-weighted hyperintense and heterogeneously contrast enhancing, well defined extra-axial mass lesion in right middle cranial fossa with extension into the infratemporal fossa
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352640&req=5

Figure 1: Magnetic resonance imaging brain: T2-weighted coronal section (a), sagittal section (b) and T1-weighted contrast sagittal section (c), showing T2-weighted hyperintense and heterogeneously contrast enhancing, well defined extra-axial mass lesion in right middle cranial fossa with extension into the infratemporal fossa
Mentions: An 11-year-old boy presented with holocranial headache associated with vomiting for the last 1-month. He also complained of heaviness in right paranasal region for the last 10 days. On examination, he was conscious, oriented with intact higher mental functions. There was left upper motor neuron type of facial palsy along with ipsilateral subtle hemiparesis (grade 4/5 Medical Research Council). Magnetic resonance imaging (MRI) of the brain revealed a large well-defined extra-axial mass lesion in the right middle cranial fossa with extension into the infratemporal fossa. The lesion was isointense on T1 and T2-weighted images and was heterogeneously enhancing in postgadolinium scan. There was perilesional edema causing mass effect in the form of effacement of ipsilateral lateral ventricle and midline shift [Figure 1a–c]. He was planned for surgical excision of the tumor in two stages. In the first stage, intracranial tumor was excised with right fronto-temporal craniotomy with zygomatic osteotomy approach. Intraoperatively the tumor was extra-axial, greyish pink and highly vascular. The tumor was involving the dura of middle fossa base through which it was extending into the infratemporal fossa. The intracranial part of the tumor was excised completely at the first setting. The infratemporal part was removed at a later stage by trans facial trans maxillary approach. Postoperative MRI brain revealed no residual tumor [Figure 2a and b]. Histopathological examination showed tumor dispersed in diffuse sheets and in nests separated by thick fibrovascular septa. The tumor cells were round to polygonal in shape, had round nucleus, dispersed nuclear chromatin, inconspicuous nucleoli and moderate amount of clear cytoplasm, entrapped bony trabeculae were also seen in between the tumor cells with occasional mitotic activity. Tumor cells were positive for vimentin, S-100 and focally positive for epithelial membrane antigen. On imunohistochemistry, Ki-67 index was 7% suggestive of CCM (aggressive variant) [Figure 3a and b]. Following surgery weakness on the left side improved. In view of complete excision, no radiotherapy was advised, and patient was kept in close follow-up. At follow-up of 9 months patient, was doing well.

Bottom Line: Histopathology was suggestive of clear cell meningioma (CCM).Supratentorial pediatric CCM is a rare entity.The case is discussed along with review of literature on this rare clinico-pathological entity.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India.

ABSTRACT
An 11-year-old boy presented with holocranial headache associated with vomiting and heaviness in right paranasal region. On examination, he had left sided upper motor neuron type facial palsy along with a subtle ipsilateral hemiparesis (grade 4/5 Medical Research Council). Magnetic resonance imaging brain revealed a contrast enhancing large well-defined extra-axial mass lesion in right middle cranial fossa with extension into the infratemporal fossa. The mass was excised in two stages. Histopathology was suggestive of clear cell meningioma (CCM). Supratentorial pediatric CCM is a rare entity. The case is discussed along with review of literature on this rare clinico-pathological entity.

No MeSH data available.


Related in: MedlinePlus