Diagnostic challenges in orbital meningioma: A case series of six patients

Meningiomas are the most common primary intracranial neoplasms. Most meningiomas arise in intracranial or intraspinal locations. Meningiomas involving the orbits are much rarer. They can be further classified as primary, of orbital origin or secondary, arising intracranially and extending into the orbit. Diagnosing meningiomas can be relatively easy on resection specimens with classic morphology; however, it can be difficult when tissue is received as smaller biopsies. This study aimed to describe the challenges faced in diagnosing meningiomas in unusual locations and on smaller tissue biopsies. This retrospective study from the pathology department of a tertiary care hospital describes a series of six cases of orbital meningioma diagnosed over a period of 2 years. Four of these cases were of primary orbital origin, and two were secondary. There was a wide variation in the age of the patients, ranging from 10–70 years. The male-to-female ratio was 4:2. We encountered diagnostic challenges in two cases because the histopathological features seen on smaller biopsies appeared to overlap with those of other tumors. Our article aims to share with pathologists and clinicians the characteristics of this rare location of meningiomas and apprise them about the various challenges faced in diagnosing such tumors, owing to their uncommon location, as well as when faced with smaller tissue biopsies with a lack of classical morphology. A combination of clinicopathological correlation and immunohistochemistry can be useful in overcoming these diagnostic hurdles.