PMC4899864_01
72-year-old woman with clear-cell meningioma. Axial CT, bone algorithm. Right external auditory canal (EAC) and middle ear. Soft-tissue mass filling and expanding the EAC and middle-ear cavity with involvement of the ossicles (black arrow). The mastoid air cells are infiltrated, and there is erosion of the lateral wall of the mastoid with dystrophic calcification involving the postauricular component of the mass (white arrow).
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The pre-auricular soft-tissue component of the mass contained multiple small, calcified fragments (Fig. 1).
72-year-old woman with clear-cell meningioma. Axial T1 post-Gadolinium MRI. Lateral arrow indicates the enhancing soft-tissue mass involving the peri-auricular subcutaneous tissues. Note peri-auricular soft-tissue infiltration (curved arrow), middle ear involvement incorporating the facial nerve (straight arrow), and intracranial extension involving the sigmoid sinus (arrowhead).
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Abnormal enhancement of the tympanic and mastoid segments of the facial nerve was observed, suggestive of perineural spread of disease (Figure 2, Figure 3, Figure 4, Figure 5).
72-year-old woman with clear-cell meningioma. Coronal T1 post-Gadolinium MRI demonstrating the intracranial and extracranial extension of the meningioma. Arrow indicates leptomeingeal enhancement involving the right middle cranial fossa.
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Abnormal enhancement of the tympanic and mastoid segments of the facial nerve was observed, suggestive of perineural spread of disease (Figure 2, Figure 3, Figure 4, Figure 5).
72-year-old woman with clear-cell meningioma. Axial T2 MRI. CSF cleft surrounding the mass confirms the extra-axial location of the disease (straight arrow). Note vasogenic edema within the right temporal lobe (curved arrow).
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Abnormal enhancement of the tympanic and mastoid segments of the facial nerve was observed, suggestive of perineural spread of disease (Figure 2, Figure 3, Figure 4, Figure 5).
72-year-old woman with clear-cell meningioma. Axial DWI MRI demonstrates diffusion restriction within the right temporal mass consistent with high cellularity (straight arrow). Restricted diffusion was confirmed on ADC.
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Abnormal enhancement of the tympanic and mastoid segments of the facial nerve was observed, suggestive of perineural spread of disease (Figure 2, Figure 3, Figure 4, Figure 5).
72-year-old woman with clear-cell meningioma. Hematoxylin- and eosinstained sections of biopsy core show an infiltrative clear-cell neoplasm at 200X (A) and 400X (B) magnification. Immunohistochemical staining for epithelial membrane antigen (C) and p63 (D) show cytoplasmic membrane and nuclear reactivity, respectively.
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Histologic sections of the biopsy cores showed neoplastic cells with clear cytoplasm and relatively bland, uniform nuclei (Fig. 6, A and B). A diagnosis of myoepithelial carcinoma was supported by strong nuclear immunoreactivity for p63 (Fig. 6D); however, cells did not stain with antibodies directed against low-molecular-weight cytokeratin and smooth-muscle actin, making this diagnosis much less likely. Fig. 6C), and by positive cytoplasmic staining with periodic acid-Schiff (PAS) stain. Furthermore, there was weak nuclear immunoreactivity for progesterone receptor, also typical of meningiomas.