Utilizing squash cytology and histodiagnosis to detect lipomatous metaplasia in meningiomas: A diagnostic approach

Squash smears provide with preliminary cytological diagnosis in central nervous lesions. Reporting features of uncommon lesions is important for correct identification of them. We herewith present a case of meningioma with lipomatous metaplasia. A 37-year-old male presented with weakness in lower limbs for 4 months, loss of sensation in lower limbs for 3 months. Radiology revealed a space occupying lesion at C7 to the T3 with altered signal intensity. Laminectomy was performed. The squash cytology displayed mature adipocytic tissue along with a small cluster of round cells with homogenous chromatin. Cytology was reported as benign, and the possibility of teratoma to be considered. On histology, the tumor was composed of predominantly adipocytes and interspersed whorls and nests of meningothelial cells showing uniform bland nuclei and abundant cytoplasm with foci of psammomatous and dystrophic calcification were seen. Hence, reported as lipomatous meningioma. On review, it was found that the cytology was consistent with lipomatous meningioma; the lack of morphological description and no clinical suggestion led to a possible opinion of teratoma.