Pineal chordoid meningioma complicated by repetitive hemorrhage during pregnancy: Case report and literature review

Abstract

Chordoid meningioma is an uncommon variant of meningioma, and is very rarely found in the pineal region. We report a case of pineal region chordoid meningioma occurring in a young woman complicated by repetitive hemorrhages in the setting of pregnancy. A 23-year-old woman, 28 weeks pregnant, was transferred to our hospital for further management of a multi-septated, hemorrhagic pineal region mass and hydrocephalus. MRI revealed a heterogeneous T2-hyperintense lesion measuring 1.7 × 1.7 cm in the pineal gland. Resection of the tumor through an occipital transtentorial approach was performed. Histopathologic examination of the lesion confirmed the diagnosis of chordoid meningioma demonstrating cords and clusters of eosinophilic cells with rare cytoplasmic vacuolation arranged in a mucinous stroma. Additionally, there was abundant lymphoplasmacytic infiltration within the tumor. The details of this case are presented with a review of the literature.

Chordoid meningiomas: Incidence and clinicopathological features of a case series over 18 years

“…The finding is concordant with the work of others . Other CM cases occur in the infratentorial region and unusual sites, notably the ventricular system, the jugular foramen, the orbit, the cervical spine and the pineal region . A greater rarity is attributed to extracranial and extraskeletal CM, such as the lung .…”

“…Nine patients were reviewed from 1743 total meningioma patients in a 1995 to 2013 time period at St. Michael's Hospital in Toronto. To the best of our knowledge, 221 cases of CM have been reported in the English literature worldwide in the form of single case reports and/or case series …”

“…2,3,8,9,60,61 Other CM cases occur in the infratentorial region and unusual sites, notably the ventricular system, 3,15,48,56,64,65,78 the jugular foramen, 60 the orbit, 25,44,50,54 the cervical spine 26,40,78 and the pineal region. 21,23,27,35 A greater rarity is attributed to extracranial and extraskeletal CM, such as the lung. 52,53 The most common presenting symptoms included gait disturbances and headache, the latter often related to the anatomical localization of the lesion and combined with other symptoms.…”

Endovascular Embolisation of Hepatic Pseudoaneurysm Causing Massive Hemorrhage in a Blunt Hepatic Trauma Patient

“…Bu lokalizasyondaki meningiomların gebelikte manifest hale gelmesinde pitüiter bezde gebelik sırasında görülen ve hormonal uyarıya yanıt olarak geliştiği düşünülen boyut artışının etkisinin olabileceği de düşünülmektedir [2]. Hızlanmış büyüme özelliğine bağlı kitle etkisi dışında, gebelik sırasında, tümöral kanama ve hidrosefali gibi akut komplikasyonların oluşturduğu mekanizmalarla semptomatik hale gelmiş meningiom olguları da mevcuttur [9,10].…”

Pineal region chordoid meningioma

“…To our knowledge, only six cases the pineal region CMs were previously reported (Table1) 6,9,10,13 . Small series and case reports of CMs located on other intracranial sites have been described showing higher incidence in younger age group with a slight female predominance 3,5,11,15,16,17 . The clinical signals and symptoms of pineal region CMs are thought to be a result of mass effect associated with a peritumoral lymphoplasmacellular infiltrate and include obstructive hydrocephalus (headache, vomiting, papilledema, and gait disturbances), altered mental changes and ocular abnormalities 14 .…”