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<p class="ql-align-justify">Sections show a cellular meningeal tumor formed of plump spindle meningeal cells with indistinct cellular borders. Tumor cells are focally arranged in whorly fibrotic patterns with focal areas showing sheet-like growth. Mitosis is not active. Areas of necrosis are seen. Tumor cells appear to invade the underlying brain tissue. No evidence of malignancy. However, this is a WHO grade II meningioma which is liable for local recurrence. </p>
<p>Rt. frontal mass post radio and chemotherapy.</p>
<p>Soft tissue mass measured 6x3.5x3 cm> No evidence of surrounding tissue clearance. </p>
<p><strong><em><u>Rt. frontal mass, biopsy:</u></em></strong></p><ul><li><strong>Recurrent atypical meningioma (WHO grade II). </strong></li></ul><p><br></p><p><strong><u>COMMENT:</u></strong></p><ul><li>Recurrent meningioma that invades brain and shows necrosis is concerning for more aggressive behavior and a higher risk of recurrence. In published series, the combination of <strong>brain invasion plus necrosis</strong> has been associated with worse progression-free survival and greater radio-resistance than either feature alone.</li><li>Brain invasion is one of the histologic features used to upgrade meningioma to WHO grade 2, and necrosis is also a marker that often tracks with more aggressive biology. Recurrent disease itself already raises the likelihood of residual tumor or higher-grade behavior, especially if prior resection was incomplete.</li></ul><p><br></p>
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