Papillary Meningioma: A Case Report of A Rare and

Aggresive WHO Grade III Variant

Muhammad Rasyid Ridho, Nita Sahara, Rita Cempaka
Department of Anatomical Pathology,
Faculty of Medicine, Public Health, and Nursing,
Gadjah Mada University, Yogyakarta, Indonesia

BACKGROUND

Papillary Meningioma (PM) is a rare variant of Fig 1. Left

meningioma, aggressive and reported has parietal lobe
invasive tendency in 75 % of cases with death mass with
of disease in about half. It is defined by the perifocal edema,
presence of a perivascular pseudopapillary which constricts
pattern constituting most of the tumour.1 Lack the posterior
of large sample size case studies, make many corns of the left
of the specific characteristics of PM are unclear. lateral ventricle
2 Some of the CNS tumors also have papillary-
causing
like pattern such as papillary ependymoma, subfalcine
makes it difficult to distinguish from other herniation
entities. Therefore, histopatholgy and
immunohistochemistry (IHC) staining is
required for the diagnosis.3,4

CASE DESCRIPTION

A 44-year-old female presented with headache,

seizure, weakness of right limbs, slurred
speech, for the past three months. A computed
tomography (CT) scan of the head revealed
left parietal lobe mass leading to the
appearance of Glioblastoma. The resected
tumor was performed. Histopathology showed 40x 100x
the tumor with perivascular pseudopapillary
pattern and tipically with perivascular nucleus Fig 2. Papillary Meningioma, WHO grade 3, showed
free zone. The cells is polymorphic with round perivascular pseudopapillary pattern , nuclear atypia and
nuclei, rough chromatin, visible nucleoli with mitosis activity.
mitosis >20/ 10 HPF. In IHC staining, EMA
stained strongly positive in membrane and
Fig 3.
sitoplasm of the tumor cell. The Ki-67 labeling
EMA stained
index (LI) was > 20%.
strongly
positive in
DISCUSSION & CONCLUSION
membrane
• Histopathology examination of mass and
exclude Papillary Ependymoma. sitoplasm of
Nevertheless, because of rarity of the cases the tumor
and the similarity of histopathological cell
appearance, IHC panels such as EMA are
very helpful in convince the diagnosis.2,3,4 Fig 4.
High Ki-67LI of this case indicates poor The tumor
prognosis.4 cell were
• Papillary meningioma appears to be highly positive
aggressive. Diagnosis of PM in routine >20% for
pathology practice relies on typical KI67
morphology and adjunctive
immunohistochemistry.

References
1. Louis, Davit et al. WHO Classification of Tumours of the Central Nervous System 4ed. International Agency for Research on Cancer (IARC). Lyon. 2016.
2. Dai-Jun W, Ming-Zhe Z, et al. Original Article Papillary meningioma: clinical and histopathological observations. Int J Clin Exp Pathol 2013;6(5):878-888
3. Ishita P, Sujata C .Diagnostic Approach to Histopathology of Central Nervous System Papillary Tumors.Astrocyte,Jul-Sep 2014, Volume 1, Issue 2
4. Singh A, Sarvjot V, et al. Case Report:Papillary meningioma: a rare but distinct variant of malignant meningioma.Diagnostic Pathology 2007, 2:3 doi:10.1186/1746-1596-2-3

PERTEMUAN ILMIAH REGIONAL IAPI JATENG-DIY 2019