The cytology of intracranial clear cell meningioma with an unusual scalp presentation

Intracranial meningiomas are not often aspirated unless they erode the skull and present as swelling in the head and neck region. We describe the cytologic findings of fine needle aspiration cytology in a clear cell variant of intracranial meningioma presenting with swelling in the left parietal region of the scalp in a 45-year-old woman. The diagnosis was confirmed by histopathology. Clear cell meningioma is characterized by patternless sheets of clear polygonal cells. Clear cell meningioma is a rare distinctive cytological subtype of meningioma with high recurrence rate and increased mortality, which necessitate frequent follow-up after surgical excision. The recognition of clear cell meningiomas is important here and should be distinguished from other clear cell lesions of the scalp. If clear cell epithelial neoplasm is encountered on fine needle aspiration, it is reasonably possible to provide at least a differential diagnosis of meningioma based upon the focal whorls, sparce vascularity on low magnification, along with the presence of pseudoinclusion and inconspicuous nucleoli at high magnification.