Week 46: Case 4

Clinical History: Images: Image 1 42-year-old male with a scalp mass.

presented by Pedram Argani, M.D.

Image 2

Image 3

Image 4

Choose the correct diagnosis:

a. b. c. d. Ectopic meningioma Lipoma Nevus with Lipomatous Metaplasia Perineurioma

Submit Diagnosis

Case prepared by: Bahram R. Oliai, M.D. boliai@jhmi.edu

Contact Us | Johns Hopkins Medical Laboratories | Pathology Consultation | Pathology Homepage | Conference Home Copyright 2000-2006 The Johns Hopkins University All rights reserved. No part of this website may be reproduced in any form or by any means or incorporated into any information retrievel system, electronic or mechanical, without the written permission of JHU.

Your Answer is CORRECT You answered: Ectopic meningioma

Review the Slides

presented by Pedram Argani, M.D. The correct diagnosis is: Ectopic meningioma

Histology:

The lesion infiltrates the subcutaneous tissue and underlying fascia. The lesion has the characteristic histology of meningioma in that it features plump ovoid cells with intranuclear inclusions forming whorls. The tumor is immunoreactive EMA, but not for S100 protein. A lipoma would lack the cellular component described above. Ancient nevus can show fatty replacement, but would be immunoreactive for S100 and not for EMA. Perineuriomas would label for EMA; however, they typically have a spindled morphology and form either onion bulbs when intraneural or storiform or fascicular patterns when in soft tissue. Extra-cranial meningiomas can occur in three settings. First, in children, they represent developmental abnormalities related to neural tube closure defects. These seem to have a similar pathogenesis as meningoceles and are associated with a good prognosis when excised. Second, they may occur as primary soft tissue meningiomas derived from arachnoid nests associated with cranial or spinal nerves. Third, they may represent extracranial extension of primary CNS meningiomas. Clinical correlation is required to exclude the third possibility. In the current case, the lesion most likely represents the second type of cutaneous meningioma, one which is neither congenital nor of cranial origin.

Discussion:

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Case prepared by: Bahram R. Oliai, M.D. boliai@jhmi.edu

Contact Us | Johns Hopkins Medical Laboratories | Pathology Consultation | Pathology Homepage | Conference Home Copyright 2000-2006 The Johns Hopkins University All rights reserved. No part of this website may be reproduced in any form or by any means or incorporated into any information retrievel system, electronic or mechanical, without the written permission of JHU.