Best Post of August 2012: A case of renal cell carcinoma metastatic to a meningioma

The next in our "Best of the Month" series is from August 9, 2012:A 74-year-old woman with a history of a seizure disorder had been followed for several years with a stable and unsymptomatic left parasagittal dural-based brain tumor presumed to be a benign meningioma. Recently, though, the lesion increased in size and hemorrhaged, leaving her significantly paretic on the right side. Neurosurgery thereupon performed a craniotomy for tumor removal. Intraoperative frozen section diagnosis was meningioma. But, upon receipt of the permanent sections, I was impressed by the staghorn vessels at low power and hemangiopericytoma immediately came to mind. Staghorn vessels prominent in region below dot marksPsammoma body consistent with original impression that this was simply a meningiomaWhirled architecture consistent with meningiomaI was obviously dealing with a meningioma, but something else was going on in that area featuring the staghorn vessels. This region exhibited a different histomorphology:Clear cellsHigh-power view of clear cell portion of specimenThis dual morphology puzzled me. I then discovered that back in 2003 the patient had undergone a radical nephrectomy for renal cell carcinoma. Surgical margins of the nephrectomy specimen were free of tumor. I retrieved the 2003 nephrectomy specimen, which looked quite similar to the clear cell portion of the brain tumor:Nephrectomy specimen from 2003 showing renal cell carcinoma, clear cell typeI thereupon went back...
Source: neuropathology blog - Category: Pathologists Tags: neoplasms Best of the Month series Source Type: blogs