MEETING No. 25, NOVEMBER 15th, G. PINI HOSPITAL, MILANO

Case 1
Case 2
Case 3
Case 4

Case 1

"SUSPECTED MENINGIOMA"
M. LEUTNER - Novara Hospital
(Pictures by M. Leutner)

Clinical history: a 59y.o. woman, with a 25 years history of myelofibrosis and a 4 weeks history of right hemi paresis, underwent surgery to remove a 3.5 cm nodule from the left brain frontal region. The clinical suspicion, supported by an NMR investigation, was of meningioma (pict. 1) - (pict. 2) - (pict. 3).
Macroscopic description: a whitish, elastic, lobulated mass (pict. 4).
Microscopic description: the tumor consists of epithelioid, medium to large cells with basophilic cytoplasm and 1 to 3 nucleoli, arranged in scarcely cohesive nests or rows (pict. 5) - (pict. 6) - (pict. 7).
Immunohistochemical staining for CK pool, Chromogranin A, S100, Actin 1A4, Desmin and CD79 are all negative as well as PAS histochemical stain. There is focal positivity for Vimentin, NSE and LCA (pict. 8).
Following clinical history: in the third day after surgery the patient presented with a pleural effusion and nearly 400 cc. turbid, yellowish liquid were removed.
She presented also melena because of the anticoagulant therapy. A gastroscopy shows a bleeding duodenal ulcer and because of the worsening clinical symptoms (dyspnea, confusion and anemia), they decided to perform an urgent duodenotomy.
The abdominal exploration reveals a hard pancreatic mass and multiple, superficial and parenchymal, bleeding liver nodules. A biopsy of one of the liver nodule is performed.
Cytological description of the pleural effusion: the cytological-inclusion shows numerous poorly differentiated neoplastic cells, similar to the meningeal ones (pict. 9); there are also large cells with abundant, finely vacuolated cytoplasm (pict. 10).
Microscopic description of the liver nodule: the lesion consists of fibrous tissue containing nests of poorly differentiated cells (pict. 11); there are also numerous neutrophils and megacaryocytes with features of altered maturation (pict. 12).
A review of the meningeal lesion reveals the presence of a few megacaryocytes also in this site (pict. 13).
Immunohistochemical staining of the neoplastic cells shows diffuse but weak positivity for CD3 (pict. 14), doubtful positivity for CD7 (pict. 15), negative results for myeloperoxidase, lysozime, CD68, CD20, CD15, CD34; CD10 and CD2 are not assessable.

Diagnosis

Pict. 1	Pict. 2
Pict. 3	Pict. 4
Pict. 5	Pict. 6
Pict. 7	Pict. 8
Pict. 9	Pict. 10
Pict. 11	Pict. 12
Pict. 13	Pict. 14
Pict. 15

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