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FNA of Meningioma with Rhabdoid Features Presenting as a Lateral Neck Mass

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Abstract

Primary meningioma at extracranial head and neck sites is uncommon. Since fine needle aspiration (FNA) is often the first line diagnostic modality for the evaluation of masses in the head and neck, extracranial meningiomas can create a significant diagnostic pitfall for FNA. We report a case of meningioma with rhabdoid features and BAP1 loss in a 26-year-old woman, presenting as a large neck mass along the carotid sheath. FNA biopsy of the mass demonstrated a highly cellular specimen with clusters of uniform, epithelioid cells with round to ovoid nuclei and moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel performed on cell block sections showed that the tumor cells were weakly EMA positive, progesterone receptor was focally positive, and SSTR2A was diffuse and strongly positive. BAP1 immunohistochemistry showed a diffuse loss of expression in the tumor cells. After the cytologic diagnosis of meningioma, a tissue biopsy was performed, and the diagnosis of meningioma with rhabdoid features and BAP1 loss was confirmed. We also perform a literature review of meningioma cases presenting as a neck mass and evaluated by FNA. Our case highlights the significant diagnostic challenges that can be caused by extracranial meningiomas on FNA and the importance of ancillary studies to avoid diagnostic pitfalls.

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Authors and Affiliations

  1. Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA

    Levent Trabzonlu, Maria Martinez-Lage & William C. Faquin

  2. Department of Otolaryngology, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA

    Daniel Deschler

  3. Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA

    Jonathan J. Paly

Authors
  1. Levent Trabzonlu
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  2. Maria Martinez-Lage
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  3. Daniel Deschler
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  4. Jonathan J. Paly
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  5. William C. Faquin
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Contributions

L. Trabzonlu - case data analysis, writing first draft, photographs M. Martinez-Lage - case analysis, neuropath consultation, immunostain consultation, manuscript editing D. Deschler - clinical consultation, manuscript editing J. Paly - clinical and radiology consultations, figure preparation, manuscript editing W. Faquin - overall concept, case data analysis, manuscript writing and editing

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Correspondence to William C. Faquin.

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Authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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All materials were treated in accordance with the ethical standards of the institutional and/or the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This work is approved by the Massachusetts General Brigham Institutional Review Board.

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Trabzonlu, L., Martinez-Lage, M., Deschler, D. et al. FNA of Meningioma with Rhabdoid Features Presenting as a Lateral Neck Mass. Head and Neck Pathol 18, 32 (2024). https://doi.org/10.1007/s12105-024-01644-3

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