Crush Cytology of a Primary Intraspinal Rhabdoid Papillary Meningioma: A Case Report

Abstract

Background: Both rhabdoid and papillary meningioma are rare variants of meningioma categorized as WHO grade III. Here, we report a rare case of combined rhabdoid papillary meningioma with discussion of its differential intraoperative cytologic diagnoses. Case: The patient was a 72-year-old female who presented with a huge mass at the cervical spine on MRI. The crush smears showed a radially arranged pattern of elongated tumor cells centered around the vessels, which formed a pseudorosette-like papillary structure, as well as singly scattered large gemistocyte-like rhabdoid cells with distinct cell borders. Rhabdoid cells had eccentrically placed vesicular nuclei with plump, fibrillary-to-hyaline cytoplasm with short broad processes. Nuclei had occasional nuclear inclusions with no nuclear grooves. Conclusion: Rhabdoid papillary meningiomas, encountered less often, should be distinguished from metastatic tumors of rhabdoid or papillary configuration, astrocytomas, ependymomas and atypical teratoid/rhabdoid tumor. Search for eosinophilic hyaline cytoplasm, rather than a fibrillary one, is critical for distinguishing it from other commonly encountered spinal cord tumors in the total absence of meningothelial whorls, like the present case. We also emphasize that the present case is the first case of rhabdoid papillary meningioma with primary manifestation in the spinal cord.

Squash Cytology of a Dural-Based High-Grade Chondrosarcoma May Mimic That of Glioblastoma in the Central Nervous System

“…Low-grade chondrosarcoma should be distinguished from chordoid meningioma, especially when showing frequent nuclear inclusions or grooves as in the present case [15,16,17]. Nuclear inclusions are commonly found in meningioma or ependymoma in intraoperative cytologic smears [1,18,19]. Epithelioid cells having partly vacuolar changes and a myxomucinous gelatinous background are shared features [20].…”

Papillary meningioma: Diagnosis by intraoperative crush smear cytology

“…The extent of resection is regarded as the important prognostic factor in papillary meningioma. Gross total resection results in less recurrence and mortality . Postoperative radiotherapy is associated with improved survival in papillary meningioma .…”

“…It is seen most frequently in the supratentorial compartment with cerebral convexities and parasagital region being the most preferred sites . Histopathologic features of papillary meningioma are well described, but cytological features are rarely been described …”

“…2,3 Histopathologic features of papillary meningioma are well described, but cytological features are rarely been described. 4,5 We describe the crush cytology features of papillary meningioma, which may help in the rapid intraoperative diagnosis of this rarely encountered, aggressive variant of meningioma.…”

Rhabdoid meningioma lacking malignant features: Report of a rare case with review of literature

“…Recently Jeong et al . [ 13 ] have reported a case of primary intraspinal rhabdoid papillary meningioma with primary manifestation in the spinal cord of a 72-year-old female. They concluded that search for eosinophilic hyaline cytoplasm, rather than a fibrillary one, is critical for distinguishing it from other commonly encountered spinal cord tumors in the total absence of meningothelial whorls.…”