Meningeal Hematopoietic Tumors – Demasquerading by Intraoperative Stimulated Raman Histology: A Case Series

Hematopoietic brain tumors represent approximately 4% of all brain tumors. Rare dural presentations may mimic more common extra-axial tumors such as meningiomas, leading to diagnostic challenges. We report four cases of CNS hematopoietic tumors (three lymphomas, one plasmacytoma), all initially suspected of being meningioma or metastasis based on MRI. In each case, complete microsurgical resection was performed. Intraoperative frozen sections were obtained in all cases, and stimulated Raman histology (SRH) was used in three cases, suggesting lymphoma in two patients and plasmacytoma in one. These cases highlight a clinically relevant diagnostic pitfall: hematopoietic tumors may closely mimic common extra-axial tumors on MRI. Our experience suggests that, while SRH provides rapid intraoperative information, its current diagnostic performance for hematologic malignancies remains limited. Conventional frozen section analysis therefore continues to play a central role in intraoperative assessment. Dural-based hematopoietic tumors should be considered in the differential diagnosis of atypical extra-axial lesions. While SRH represents a promising technology, further validation is required before it can reliably influence intraoperative surgical strategy.