LAUSR

BACKGROUND Meningiomas are common Central Nervous System tumors with wide range of morphological variants, the pathogenesis being its complex embryogenesis. Intracranial meningiomas with heterogenous histopathology in the same lesion are common in low grade meningiomas but less frequent in recurrent and high grade variants. CASE DESCRIPTION A 75 year old male presented elsewhere a year ago with complaints of slurred speech. A Magnetic Resonance Imaging (MRI) done revealed a left frontotemporal dural based extra-axial solid cystic lesion with doubtful infiltration into the adjacent brain parenchyma .A subtotal excision was done. A diagnosis of meningioma with an aggressive biological behavior was rendered on histology but the grade was deferred, in view of a single focus of small cell formation and no adjacent brain parenchyma to comment upon invasion. The patient presented here with recurrence of his original symptoms.MRI brain with contrast revealed two dural based solid cystic enhancing lesions of sizes 29x25x24mm and 25x16mm seen at the left frontal region, indenting the adjacent brain parenchyma with diffuse meningeal thickening in the postoperative bed. Microscopy revealed a hypercellular meningeal neoplasm with increased mitosis and pseudopapillary pattern with lipomatous changes. CONCLUSION To date there are no case reports in current literature with such rare combinations in a recurrent meningioma. This highlights the multipotency of phenotypic transformation of primary meningothelial cells. The presence of papillary features even if focal should be quantified in the diagnosis. This is of importance since the most current literature suggests that meningioma harboring a papillary component has an increased risk of recurrence and progression to aggressive behavior.