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Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 398-399
Fine-needle aspiration cytology of jugular foramen meningioma presenting as parapharyngeal mass


Department of Pathology, Government Medical College, Nagpur, India

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Date of Web Publication27-May-2011
 

How to cite this article:
Gupta AP, Parate R C. Fine-needle aspiration cytology of jugular foramen meningioma presenting as parapharyngeal mass. Indian J Pathol Microbiol 2011;54:398-9

How to cite this URL:
Gupta AP, Parate R C. Fine-needle aspiration cytology of jugular foramen meningioma presenting as parapharyngeal mass. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Dec 15];54:398-9. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/398/81639


Meningiomas are benign tumors derived from arachnoid cells. Most commonly intracranial lesions, meningiomas may be found extracranially in various anatomic sites. Meningiomas are not often aspirated unless they erode the skull, in intraorbital location, or when they present as swellings in the head and neck region. [1] Ectopic meningiomas may pose a diagnostic challenge to clinicians and cytopathologists. Ectopic meningioma in a region containing salivary gland(s) may mimic benign and low-grade malignant salivary gland tumors on fine-needle aspiration cytology (FNAC). [2] We describe here a case misdiagnosed as salivary acinic cell tumor. Repeat computed tomography (CT) and good cytological smears diagnosed it to be a case of meningioma extending through the jugular foramen into parapharyngeal region.

A 28-year-old female was referred from another hospital as a case of salivary acinic cell tumor. Clinically she presented with a mass in the left submandibular region since 5 years. Because of cytomorphologic disagreement with salivary acinic cell tumor, the patient was called for repeat FNAC. Clinical examination revealed a 3 × 2cm mass in left submandibular region, which was also protruding inside the oral cavity, bidigitally palpable with deviation of uvula. Better quality smears revealed lobular and syncytial cellular fragments with areas of calcification [Figure 1]a. Cells arranged in concentric whirls were also seen [Figure 1]b and c. Nuclei were bland, round to oval to spindle and showed intranuclear pseudoinclusions [Figure 1]d. Cytodiagnosis was offered as meningioma. CT revealed a heterogenous mass having both intracranial and extracranial components, protruding from the jugular foramen and extending into the parapharyngeal region with hyperdense areas suggestive of calcification [Figure 2]. Diagnosis was confirmed on histopathology after the patient underwent surgical excision.
Figure 1: Smears show lobular cellular fragments with calcification (a, hematoxylin and eosin, ×400). Cells arranged in syncytial fragments and in concentric whorls were also seen (b, May-Grunwald-Giemsa (MGG), ×400). Higher magnification of concentric whirl (c, MGG, ×1000). Intranuclear inclusion shown by black arrow (d, MGG, ×1000)

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Figure 2: CT scan coronal section showing heterogenous mass with both intracranial and extracranial components protruding through the jugular foramen

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   Discussion Top


Meningiomas comprise 18% of primary intracranial tumors and 25% of primary intraspinal tumors. Extracranial and extraspinal meningiomas are rare with an incidence of 1%-2%. Extension into the neck of a posterior fossa meningioma is most likely to occur through a skull base foramen and of these the jugular foramen in the most common route. [3]

The clinical diagnosis of cervical meningiomas can be difficult as more common cervical tumors, such as metastatic epithelial tumors, schwannomas, or paragangliomas are likely to be suspected first. [4] These possibilities had to be excluded through correlation with radiologic and intraoperative findings. The most common sites of extracranial presentation are skin, orbit, nose, and sinuses, either from direct extension from an anterior fossa tumor or de novo. [3]

Extracranial meningiomas may also occur in the neck by direct extension from posterior or middle fossa mass into the infratemporal fossa, the parapharyngeal space, and the parotid gland and even inside the lumen of the internal jugular vein. [3] Michel has reported a case in the posterior fossa by extension through the hypoglossal canal to the cervical region. [3] Tan has reported a case of parapharyngeal meningioma. [5]

Hence we conclude that the possibility of meningioma should be considered in the cytologic differential diagnosis of parapharyngeal tumors .Good quality cytology smears and CT scan are helpful in the preoperative diagnosis of meningioma with extracranial extension and presenting at an unusual site.


   Acknowledgment Top


Postgraduate students and technical staff of cytology, Department of Pathology, GMC, Nagpur.

 
   References Top

1.Bose S, Kapila K, Sarkar C, Verma K. Fine-needle aspiration cytology of meningiomas with unusual presentations. Diagn Cytopathol 1988;4:258-61.  Back to cited text no. 1
[PUBMED]    
2.Hameed A, Gokden M, Hanna EY. Fine-needle aspiration cytology of a primary ectopic meningioma. Diagn Cytopathol 2002;26:297-300.   Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Michel N, Elif B, Jarrod H, James G, Richard R. Intracranial/Extracranial Meningioma arising in the hypoglossal canal: Case Report. Skull Base 2007;17:325-30.   Back to cited text no. 3
    
4.Solares J, Lacruz C. Fine needle aspiration cytology diagnosis of an extracranial meningioma presenting as a cervical mass. Acta Cytol 1987;3:502-4.  Back to cited text no. 4
    
5.Tan LH. Meningioma presenting as a parapharyngeal tumor: Report of a case with fine needle aspiration cytology. Acta Cytol 2001;45:1053-9.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Anupama P Gupta
203, Shyam Dham, Central Avenue Road, Nagpur- 440008, MS
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.81639

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    Figures

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