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Case 9 History: A 24 year-old male presented with a frontal enhancing extra-axial tumor.

Diagnostic Challenge Pathology for Neurosurgery & Neurology Residents Department of Pathology University of Oklahoma Health Sciences Center, Oklahoma City, OK, U.S.A. Case 9 History: A 24 year-old male presented with a frontal enhancing extra-axial tumor.

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Case 9 History: A 24 year-old male presented with a frontal enhancing extra-axial tumor.

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  1. Diagnostic ChallengePathology for Neurosurgery & Neurology ResidentsDepartment of PathologyUniversity of Oklahoma Health Sciences Center,Oklahoma City, OK, U.S.A. Case 9 History: A 24 year-old male presented with a frontal enhancing extra-axial tumor. Contributor: Kar-Ming Fung, M.D., Ph.D., karming-fung@ouhsc.edu Last updated: 1/9/2008

  2. Cytologic Preparation Frozen Section A Frozen Section B C

  3. Paraffin Section D

  4. Paraffin Section Paraffin Section E F

  5. What is your diagnosis?

  6. Diagnosis: Atypical Meningioma (WHO grade II). • Discussion: • The cellular whorls illustrated in Panel A is practically diagnostic of a meningeal tumor. • A meningothelial pattern is maintained in this tumor (Panel B to F). • Focal brain invasion is illustrated and mitosis are not uncommon. These features are diagnostic of an atypical meningioma. • It should be emphasized tumor with low-grade histology and well preserved meningothelial pattern may have mitosis and brain invasion. These features are not, and often not, associated with high grade pleomorphism. A high index of suspicion is always a safe practice. Arrow points to brain invasion. Arrow points to mitosis.

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