This 50-year-old patient presented with visual changes and word-finding difficulties. Brain MRI demonstrated a 4.6 x 4.5 x 3.5 cm well-circumscribed contrast-enhancing dural-based extra-axial mass, with dural tail and mass effect on the left frontal lobe. The lesion was gross totally resected.
What is your diagnosis based on Figures #1 through #4?
A. Chordoid meningioma
B. Pilocytic astrocytoma
C. Glioblastoma
D. Lymphoma
Answer: Chordoid meningioma
The morphologic features are consistent with the pathologic diagnosis of chordoid meningioma. This meningioma subtype has a propensity for local recurrence and is therefore considered a WHO grade 2 lesion.
The overall morphologic features of this dural-based extra-axial mass are not those of glioblastoma, pilocytic astrocytoma, or lymphoma. Other considerations, in this case, include tumor-to-meningioma metastasis (a rare phenomenon), chordoma (cytokeratin, S100 protein, and brachury positive), and chordoid glioma of the third ventricle (GFAP and TTF1 positive).
References/Additional Reading
Sangoi AR, Dulai MS, Beck AH, Brat DJ, Vogel H. Distinguishing chordoid meningiomas from their histologic mimics: an immunohistochemical evaluation. Am J Surg Pathol. 2009 May;33(5):669-81. doi: 10.1097/PAS.0b013e318194c566. PMID: 19194275; PMCID: PMC4847145.
Couce ME, Aker FV, Scheithauer BW. Chordoid meningioma: a clinicopathologic study of 42 cases. Am J Surg Pathol. 2000 Jul;24(7):899-905. doi: 10.1097/00000478-200007000-00001. Erratum in: Am J Surg Pathol 2000 Sep;24(9):1316-7. PMID: 10895812.
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