Clear cell variants of intracranial tumors: meningioma and ependymoma.

Abstract

We report two cases of rare histological types of intracranial clear cell tumor. Case 1: The tumor, on the left frontal convexity in a 64-year-old woman, consisted largely of polygonal cells with clear cytoplasm which were divided into lobules of uneven size by abundant fibrous connective tissue. Most of the tumor cells were immunopositive for epithelial membrane antigen and vimentin. Ultrastructurally, the tumor cells showed conspicuous interdigitations of their plasma membranes with frequent junctional complexes, and contained numerous glycogen granules in the cytoplasm and its processes. Occasionally, amianthoid collagen fibers were found in the fibrous stroma. Our diagnosis of this tumor was clear cell meningioma. Case 2: The tumor, in the right cerebellar hemisphere in a 64-year-old woman, consisted of round, clear cells with a honeycomb-like pattern. The tumor cells were positive for glial fibrillary acidic protein, vimentin and S-100 protein. Ultrastructurally, the tumor was composed of round cells arranged in a cell-to-cell pattern, and the adjacent cells often formed microrosettes containing microvilli in their lumina. There were scattered cells with accumulatios of glycogen granules in their cytoplasm. Our diagnosis of this tumor was clear cell ependymoma. From the light microscopic features of these tumors, it does not necessarily seem easy to discriminate them from other intracranial tumors composed of similar clear cells, such as oligodendroglioma, central neurocytoma, hemangioblastoma and metastic renal cell carcinoma. Ultrastructural examination is crucial in the identification of the clear cell variants of meningioma and ependymoma.