Diagnostic Challenge Pathology for Neurosurgery & Neurology Residents Department of Pathology University of Oklahoma Health Sciences Center, Oklahoma City,

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Diagnostic Challenge Pathology for Neurosurgery & Neurology Residents Department of Pathology University of Oklahoma Health Sciences Center, Oklahoma City, OK, U.S.A. Case 9 History: A 24 year-old male presented with a frontal enhancing extra-axial tumor. Contributor: Kar-Ming Fung, M.D., Ph.D., Last updated:

Cytologic Preparation Frozen Section A BC

Paraffin Section D

EF

What is your diagnosis?

Arrow points to brain invasion.Arrow points to mitosis. Diagnosis: Atypical Meningioma (WHO grade II). Discussion: The cellular whorls illustrated in Panel A is practically diagnostic of a meningeal tumor. A meningothelial pattern is maintained in this tumor (Panel B to F). Focal brain invasion is illustrated and mitosis are not uncommon. These features are diagnostic of an atypical meningioma. It should be emphasized tumor with low-grade histology and well preserved meningothelial pattern may have mitosis and brain invasion. These features are not, and often not, associated with high grade pleomorphism. A high index of suspicion is always a safe practice.