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Primary Type I Cutaneous Meningioma of the Scalp: Cytohistological and Immunohistochemical Features of a Rare Neoplasm

Primary cutaneous meningioma of scalp is a rare lesion and often clinically misdiagnosed. As clinical features are nonspecific, the diagnosis is often perplexing in this exceptional site. We report a case of a 7-year-old girl presenting with a nodule over occipital region of scalp since birth. No bony defect was noted on X-ray. On fine needle aspiration cytology, smears were cellular consisting mostly cohesive clusters of cells having pale pink granular cytoplasm, round to oval nuclei with unassuming nucleoli along with psammomatous calcification suggestive of cutaneous meningioma. Histology and immunohistochemistry with epithelial membrane antigen (EMA) confirmed the diagnosis. Histological sections revealed a proliferation of a spindle-shaped cell in the dermis, arranged in whorls or individually amid collagen fibers and psammoma bodies. Immunohistochemical study revealed positivity for EMA. A diagnosis of Type I cutaneous meningioma was finally rendered based on characteristic clinical, intraoperative, morphological, and immunohistochemical observations.