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From

Invasive Recurrent Meningioma with Extracranial Tissue Involvement: A Case Report

Neeraj Salhotra, Sheikhan Al Hashmi, Aml Eid Mohammad Saleh, Mahmood Marhoon Al Hatalli, Simin Laiq, Zahra Al Hajri, Kauther Al Zakwani

American Journal of Medical Case Reports. 2020, 8(12), 467-470 doi:10.12691/ajmcr-8-12-9
  • Figure 1. Preoperative images of the patient
  • Figure 2. A. Anaplastic meningioma with sheeting architecture (10x magnification). B. Anaplastic meningioma with increased mitosis (black arrows) and nuclei showing prominent nucleoli (20x magnification). C. Chordoid meningioma areas with cells arranged in cords and trabeculae, surrounded by mucoid background (20x magnification). D. Alcian Blue/PAS special stain highlights mucous-rich matrix (light blue color) in Chordoid meningioma areas (20x magnification). E. Focal invasion of brain parenchyma (black star) by meningioma (10x magnification). F. Focal invasion of subcutaneous tissue by meningioma (black arrows), no infiltration into above dermis/epidermis (5x magnification)
  • Figure 3. Immunohistochemical stains: G. Epithelial membrane antigen (EMA) shows positive membranous and cytoplasmic staining of tumor cells (10x magnification). H. Glial fibrillary acidic protein (GFAP) highlights invaded brain parenchyma by meningioma (10x magnification). Progesterone receptor (PR) is negative in the tumor cells (10x magnification). J. Ki-67 proliferation index is up to 15% (10x magnification)
  • Figure 4. Intraoperative picture prior to excision of the lesion
  • Figure 5. Intraoperative image after excision of the tumor and duraplasty
  • Figure 6. Scalp flap raised for covering the skin defect
  • Figure 7. Final reconstruction after scalp flap and split skin graft covering the donor area