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Criteria: NEUR Found: 13 cases
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Case 1 - ecp22, Neuropathology
Presented by: Andreas von Deimling, Heidelberg, Germany

Classification of meningeal tumors

Andreas von Deimling

Tumors of the meninges include a plethora of different neoplasms. WHO Classification of the Central Nervous system subgroups in tumors of meningothelial cells (meningiomas), mesenchymal tumors, primary melanocytic lesions and other neoplasms related to the meninges. However, metastases of carcinoma are quite frequent and occasionally primary CNS tumors infiltrate the meninges. Most frequent meningeal tumors are meningiomas which come in three different malignancy grades. Therefore, in this presentation priority will be given to the morphology and genetics of meningiomas. They are subdivided into several variants and their dignity is variable corresponding to WHO grades I, II and III. The vast majority of meningiomas are cytological benign tumors, however, in approximately 8% an increased mitotic activity requires the diagnosis of atypical meningiomas WHO grade II shown to have a higher probability to recur. Less then 2% of meningiomas are outright malignant and fulfill the criteria for WHO grade III tumors. Some variants are by definition of higher grade such as the clear cell meningiomas WHO grade II or the rhabdoid meningiomas WHO grade III. Because meningiomas in most instances can either be cured or sufficiently controlled by surgical intervention, the need of identifying molecular targets for therapy has been less pressing than in diffusely infiltrating primary brain tumors. However, several markers have been discovered which either belong to the molecular fingerprint of these tumors, or which are of prognostic value in respect to meningioma recurrence. Another topic to be discussed is the controversy of separating hemangiopericytoma from solitary fibrous tumor.

Fig 1Fig 2
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Case 2 - ecp22, Neuropathology
Presented by: Giannini Caterina, Rochester Minnesota, United States

26-year-old man with a right posterior fossa extraaxial enhancing mass, 5.3 cm in greatest dimension thought to be a meningioma.
H&E stainH&E stain high powerSlide 1
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Case 3 - ecp22, Neuropathology
Presented by: Federico Roncaroli, London, United Kingdom

A 52 year old female presented with a 2 week history of abnormal behaviour and headache. On admission to the local hospital the patient was confused. A CT-scan showed a slightly hyperdense, peripherally enhancing, focally calcified heterogenous mass of about 5.5cm in the right temporo-parietal region. She underwent surgical debulking, deteriorated post-operatively and died three days later of ischemia in the posterior cerebral and middle cerebral arterial territories.

figure 1 - CT-scanfigure 2 - macroslide 1figure 3 - HEfigure 4 - HEfigure 5 - HEfigure 6 - HE
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Case 4 - ecp22, Neuropathology
Presented by: Felice Giangaspero, Rome, Italy

Female new-born with hydrocephalus and large enhancing mass in the posterior fossa attached to the tentorium with compression of the cerebellum. Partial surgical resection followed by adjuvant chemotherapy. Despite of the treatment the lesion continued to growth. The baby died three months later.
Slide 1aSlide 1bFigure 1Figure 2Figure 3Figure 4vimentin
INI1
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Case 5 - ecp22, Neuropathology
Presented by: Annamaria Buccoliero, Florence, Italy

A 3-year-old boy, with a recent history of seizures, was admitted to the Neurosurgery Unit of the Meyer Children’s Hospital. He was the full-term result of a normal pregnancy. His weight was 17 kilograms and his cranial circumference was 50 cm. There were no neurological focal deficits or signs and symptoms of cranial hypertension. Neurocutaneous stigmata were absent. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a right fronto-temporal inhomogeneous, hypervascularized and calcified mass measuring about 4 cm in diameter. It involved the orbital fissure and the lesser sphenoidal wing and entirely occupied the temporal fossa incorporating the ipsilateral middle cerebral artery. The lesion determined mass effect with consequent midline shift and was accompanied by basal hyperostosis. A right pterional craniotomy was performed. During the surgery, the mass, which arose from the meninges, appeared not well demarcated from the perilesional parenchyma particularly in the sylvian area. Post surgical radiological studies documented a sub-total excision. Due to the young age of the patient he was treated with chemotherapy. The lesion remained stable after 18 months of follow-up.

Slide 1Hemathoxilin-eosin globoid cellsHematoxilin -eosin papilleHematoxilin-eosin spindle shaped cellsHematoxylin-eosin organoid 1Immunohistochemistry EMAImmunohistochemistry HHF35
Immunohistochemistry INI1Immunohistochemistry progesteron receptorsImmunohistochemistry vimentin
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Case 6 - ecp22, Neuropathology
Presented by: Teresa Ribalta, Barcelona, Spain

A 67-year-old woman presented in 2006 with an extra-axial, parasagittal, contrast-enhancing mass attached to the dura of the left frontal lobe and falx cerebri, measuring 3.3 cm in greatest diameter as assessed by MR imaging. The tumour invaded the superior sagittal sinus, and produced some mass effect and peritumoral brain edema. The radiographic and surgical impression was atypical meningioma.

MRIFig 2Fig 3Fig 4Fig 5Fig 6Fig 7
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Case 1 - ecp21, Neuropathology
Presented by: Marco Gessi

Clinical and neuroradiological findings
This 45-year-old female presented to clinical examination for headache. MRI displayed a 3 cm lesion affecting the pineal region, causing hydrocephalus.
Slide 1
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Case 2 - ecp21, Neuropathology
Presented by: Arie Perry

Clinical History
A two-year old boy was admitted to the hospital with macrocephaly and global developmental delay. Family history was significant for consanguinity (parents were first cousins) and a sibling with Trisomy 21. Several abnormalities were noted on clinical exam. Head circumference was 57 cm ( 5 cm above the 98 th percentile). He could crawl in an abnormal “commando” style although unable to stand without support. CT revealed a large heterogeneous, partially calcified and cystic mass within the left cerebral hemisphere. An MRI localized the 12.5 x 10 x 5.5 cm mass to the temporo-parietal area. The mass was predominantly isointense on T1 and slightly hyperintense on T2. Only minimal enhancement was seen. Due to the hydrocephalus, the cerebral mantle was severely thinned and a thin rim of hyperintensity on T2 suggested transependymal CSF flow. The tumor was debulked and after one year, a large recurrence was seen in the posterior fossa by MRI. Further progression of the tumor was detected 5 months after the second surgery and the patient died several months later.
Slide 2
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Case 3 - ecp21, Neuropathology
Presented by: Figen Soylemezoglu

Clinical History
A 9-year-old boy was admitted to the hospital with complaints of head and back pain. He had been having headaches and nausea attacks for the 15 days with progressive worsening. His neurological examination was normal except for bilateral papilledema. Magnetic resonance (MR) images revealed a third ventricular mass lesion with obstructive hydrocephalus. The lesion seen in the anterior recesses of the third ventricle was mildly hyperintense relative to CSF on T1 weighted images and heterogenously hyperintense on FLAIR images relative to the brain tissue. No contrast enhancement was observed. The tumor was best defined in TRACE images of DWI. Subtotal resection of the tumor was performed by anterior interhemispheric transcallosal approach. Diffuse leptomeningeal contrast enhancement at the spinal MR images was regarded as seeding. Regardless of the subtotal resection and the spinal lesions, the patient is doing well one year after the operation.
Slide 3
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Case 4 - ecp21, Neuropathology
Presented by: Dominique Figarella Branger

Clinical History
A 23-year old man was admitted for a 4-week history of constant headaches. He also complained of visual disturbances, horizontal diplopia, dorsialgias, difficulties in comprehension and expression and unsteady gait. Clinical examination showed a paresis of the VIth cranial nerve and an abolition of the tendon reflexes. MRI showed a cystic tumor with a mural nodule enhanced after gadolinium injection, located in the left parieto-occipital lobe. Peritumoral oedema was obvious. The patient underwent a craniotomy and total excision. On macroscopic examination, the tumor was greyish and friable. The wall of the cyst was yellow, suggesting an old haemorrhage.
Slide 4
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