Destructive lumbosacral clear cell meningioma mimicking malignant vertebral tumor: Case report and review of the literature

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Background Clear cell meningioma (CCM) is a rare histological subtype of meningioma classified as a World Health Organization (WHO) grade II tumor and is associated with a higher risk of recurrence compared with conventional meningiomas. Spinal CCM is particularly uncommon and may present with nonspecific clinical and radiological features, occasionally leading to diagnostic uncertainty. Case description A 56-year-old woman presented with a one-year history of progressive lower-extremity weakness and urinary incontinence, which eventually resulted in inability to ambulate. Magnetic resonance imaging revealed a large intradural lesion extending from L3 to S1 causing marked compression of the thecal sac and crowding of the cauda equina. Computed tomography demonstrated extensive multilevel cortical thinning and pressure-related erosive changes of the posterior vertebral elements and pedicles, raising initial suspicion for aggressive primary osseous tumors or metastatic disease. The patient underwent posterior laminectomy and microsurgical tumor resection Histopathological examination was highly suggestive of clear cell meningioma. Postoperative imaging demonstrated no obvious residual enhancing mass, and the patient showed partial neurological improvement during follow-up. Conclusion Spinal clear cell meningioma is a rare entity that may present with atypical radiological findings. The prominent thinning osseous changes observed in this case mimicked aggressive bone tumors and created a significant preoperative diagnostic challenge. Recognition of such unusual presentations is important for accurate diagnosis and surgical planning. Resection with no obvious MRI-enhancing remnants remains the mainstay of treatment, and long-term radiological surveillance is recommended due to the known risk of tumor recurrence.

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