[Chordoid meningiomas. Clinical, neuroradiological and anatomopathological aspects. Apropos of a new case and review of the literature].
A 21-year old woman underwent surgery in December 1996 for the removal of a presumed tuberculum sellae meningioma. However, some radio-clinical findings were proved somewhat intriguing:the patient's age, the presence of inflammatory and febrile syndromes together with the diagnosis of aseptic meningitis associated with perilesional edema intensity (an unusual feature in such cases) made us challenge the initial neuroradiological diagnosis evoked in connection with the tumoral location and dural attachment pattern. A right sub-fronto-temporal approach allowed complete tumor resection (confirmed with a postoperative MRI) and clinical recovery of the patient. But while pathological examination suggested a chordoma, the study of immunohistochemical stains revealed a meningioma. The final diagnosis was chordoid meningioma. Our review of the literature has shown that chordoid meningiomas display several areas of physaliferous cells which give the tumor a chordoma-like aspect. However, the results of immunohistochemical studies along with the location of the tumor were not consistent with the diagnosis of chordoma. Eight cases of chordoid meningiomas are reviewed in the literature. They are described as inducing systemic symptoms, particularly anemia. They could also be linked to Castleman's syndrome according to Kepes et al. After careful evaluation, we retained the hypothesis of a cause and effect relationship between the local and generalised inflammatory syndrome and chordoid meningioma.
Service de Neurochirurgie, Hôpital Saint-Julien, Nancy.
T
T
Civit
F
F
Baylac
L
L
Taillandier
J
J
Auque
H
H
Hepner
D000328:Adult; D002817:Chordoma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D008579:Meningioma / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D011859:Radiography