Papillary meningioma: Diagnosis by intraoperative crush smear cytology

Abstract

Papillary meningioma is a rare, aggressive variant of meningioma. It accounts for less than 1% of all meningiomas. It is categorized as WHO grade III due to high rate of recurrence and metastasis. Histopathologic features of papillary meningioma are well described, but cytomorphology is rarely been described. We report a case of papillary meningioma, diagnosed on intraoperative crush cytology and later confirmed on histopathology. Papillary meningioma possesses characteristic cytological features. Along with the cellular meningothelial features, radial arrangement of cells around thin and thick walled hyalinised blood vessels gives the diagnostic clue. In addition, knowledge of clinical and radiological features is extremely helpful to arrive at the correct diagnosis and to differentiate it from other papillary lesions involving central nervous system. Due to aggressive clinical course and poor prognosis of papillary meningioma, a timely recognition of the diagnosis is desirable and helpful for rationalizing approaches to therapy.

Cytologic features of meningioma: An analysis of common and uncommon subtypes and diagnostic difficulties during intraoperative procedures

“…• A striking radial arrangement of tumour cells around blood vessels is necessary to consider this subtype. 21 Occasional fragments showing pseudopapillary or angiocentric arrangement of cells are common in many meningiomas and should not be considered as evidence of papillary differentiation (Figure 6C).…”

Papillary Meningioma: Case Presentation with Emphasis on Surgical and Medical Therapy of a Rare Variant of Meningioma

“…Meningiomas are most frequently diagnosed in women and usually express progesterone receptors [ 1 , 3 ]. Among the different histopathological variants, papillary meningioma (PM) constitutes <1% of all meningiomas and is classified as a rare variant, histologically corresponding to WHO grade III, known as malignant meningiomas [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

“…It is important to underline that other meningioma subtypes can also exhibit a papillary pattern, but that the histological diagnosis of PM should only be made when almost the entire mass has this type of histological pattern [ 1 , 7 ]. Furthermore, given the high incidence of being faced with the possibility of an impromptu, it can be very difficult to discriminate this type of meningioma from high-grade glial lesions [ 9 ]. Recently, some authors as Cheng and Al.…”