A 5-year-old boy was referred with a history of headache, vomiting, abnormal body movements and altered sensorium for 2 days. The past and family history was not significant. Neurological examination revealed features of raised intracranial tension—that is, intermittent tonic posturing of the body, asymmetric non-reacting pupils and blurring of the nasal margin of the fundus. In addition, he had increased tone in the right upper and lower limbs and upgoing plantar reflex. The child was intubated and treatment with mannitol and phenytoin was commenced. The provisional diagnosis was acute febrile encephalopathy; ceftriaxone and acyclovir were commenced. CT scan showed a mass lesion (7×5.5×4 cm) in the left parieto-temporal region with haemorrhage inside it. There was midline shift and the lesion was abutting the trigone of the left lateral ventricle (fig 1). He underwent surgery and the lesion was examined by histopathology.

Light microscopy revealed multiple fragments of a tumour admixed with blood clots. The tumour cells were arranged in cords and small clusters and were lying in a mucinous vacuolated background. The cells were relatively uniform, oval to polygonal, and had abundant eosinophilic cytoplasm (fig 2). No mitotic figures were seen. A few fragments showed limited glial differentiation in the form of coarsely fibrillar processes. No histological features of meningioma such as whorls, psammoma bodies or nuclear pseudoinclusions were …