PMC5820881_01
(a) Magnetic resonance imaging scan of the brain showing the initial left temporal mass prior to surgery. (b) Magnetic resonance imaging scan of the brain showing tumor recurrence 5 months after initial surgery. (c) Computed tomography scan of the brain showing tumor recurrence 6 months after diagnosis and after two separate tumor resections
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F1
A magnetic resonance imaging (MRI) scan of the brain revealed a 5.7 cm left temporal mass with significant left cerebral edema and midline shift [Figure 1a]. Five months following the initial surgery, a routine follow-up MRI scan of the brain showed tumor recurrence in the left middle cranial fossa measuring 7.9 cm with a midline shift, marked sulcal effacement, basal cistern distortion and left uncal herniation [Figure 1b]. A CT scan of the brain revealed recurrence of a 7.9 cm left frontotemporal tumor with associated perilesional edema [Figure 1c] while a CT scan of the abdomen revealed moderate amounts of ascites with diffuse peritoneal enhancement suggestive of ongoing peritonitis [Figure 3].
(a) Histology of brain tumor showing meningothelial tumor composed predominantly of cells with abundant eosinophilic cytoplasm, and enlarged eccentrically placed nuclei, with occasional prominent nucleoli, consistent with rhabdoid meningioma (H and E, x400). (b) Extensive geographical tumor necrosis in the tumor (H and E, x100). (c) Positive immunostaining of the tumor cells with epithelial membrane antigen (x200)
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F2
Histopathological examination of the resected specimen revealed a meningothelial tumor predominantly consisting of cells with eccentrically placed nuclei, occasional prominent nucleoli, and abundant eosinophilic cytoplasm, consistent with a diagnosis of a meningioma with predominant rhabdoid features [Figure 2a]. Extensive tumor necrosis was also noted [Figure 2b]. Immunohistochemically, the tumor cells showed diffuse strong positivity to vimentin with focal expression of epithelial membrane antigen (EMA) and cytokeratins AE1/3 [Figure 2c].
Computed tomography scan of the abdomen showing ascites with diffuse peritoneal enhancement with diffuse omental thickening and stranding
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F3
A CT scan of the brain revealed recurrence of a 7.9 cm left frontotemporal tumor with associated perilesional edema [Figure 1c] while a CT scan of the abdomen revealed moderate amounts of ascites with diffuse peritoneal enhancement suggestive of ongoing peritonitis [Figure 3].
(a) Histology of omental biopsy showing tumor composed of predominantly epithelioid cells with moderate amount of clear or eosinophilic cytoplasm and markedly pleomorphic, irregular, hyperchromatic nuclei with prominent nucleoli, consistent with anaplastic meningioma (H and E, x400). (b): Cells with rhabdoid appearance characterized by eccentric nuclei displaced by rounded intracytoplasmic eosinophilic inclusions (H and E, x400). (c) Positive immunostaining of the tumor cells with epithelial membrane antigen (x200)
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F4
Histopathological examination of a segment of greater omentum revealed adipose tissue coated and infiltrated by an extensively necrotic tumor which was composed of predominantly epithelioid cells with moderate amount of clear or eosinophilic cytoplasm and marked pleomorphic, irregular, and hyperchromatic with prominent nucleoli [Figure 4a]. Some tumor cells had a rhabdoid appearance [Figure 4b], with eccentric nuclei displaced by rounded intracytoplasmic eosinophilic inclusions, and some had a spindled appearance. The tumor cells stained strongly with vimentin and EMA [Figure 4c].