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Liang Q, Ge P, Liu Y, Zhu X, Lu S, Pan C, Ji Z, Wang Q, Wang Y. Central nervous system clear cell meningioma: a systematic literature review. Neurosurg Rev 2024; 47:35. [PMID: 38183517 DOI: 10.1007/s10143-023-02251-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
Clear cell meningiomas are a rare histological subtype of World Health Organization (WHO) grade II meningioma. Despite its relatively low frequency, clear cell meningioma has attracted considerable attention because of its unique pathological characteristics, clinical behavior, and challenging management considerations. The purpose of our systematic review is to provide clinicians with a better understanding of this rare disease. PubMed was searched for articles in the English language published from 1988 to 2023 June. The keywords were as follows: "clear cell meningioma," "clear cell" and "meningioma." We analyzed clinical manifestations, radiological manifestations, pathological features, comprehensive treatment strategies, and prognosis to determine the factors influencing recurrence-free survival (RFS). Recurrence-free survival curves of related factors were calculated by the Kaplan‒Meier method. The log-rank test and Cox univariate analysis were adopted to assess the intergroup differences and seek significant factors influencing prognosis and recurrence. Fifty-seven papers met the eligibility criteria, including 207 cases of clear cell meningioma (CCM), which were confirmed by postoperative pathology. The fifty-seven articles involved 84 (40.6%) males and 123 (59.4%) females. The average age at diagnosis was 27.9 years (range, 14 months to 84 years). Among the symptoms observed, headache, neurologic deficit, and hearing loss were the most commonly reported clinical manifestations. Most tumors (47.8%) were located in the skull base region. Most tumors showed significant enhancement, and homogeneous enhancement was more common. A total of 152 (74.1%) patients underwent gross total resection (GTR), and 53 (25.9%) patients underwent subtotal resection (STR). During the follow-up, the tumor recurred in 80 (39.4%) patients. The log-rank test and the Cox univariate analysis revealed that tumor resection range (GTR vs. STR) and adjuvant treatment (YES vs. NO) were significant predictors of recurrence-free survival (RFS). Clear cell meningioma is a rare type of meningioma with challenging diagnosis and therapy. The prognosis of this disease is different from that of regular meningiomas. Recurrence remains a possibility even after total tumor resection. We found that the surgical resection range and adjuvant treatment affected the recurrence period. This finding provides significant guidance for the treatment of clear cell meningioma.
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Affiliation(s)
- Qi Liang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Pengfei Ge
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yanhua Liu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Xiaoxi Zhu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Shan Lu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Chengliang Pan
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Zhilin Ji
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Qingxuan Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China.
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Yang J, Wan W, Liu W, Jiao J, Jia Q, Zhong N, Yang X, Xiao J. Two novel cases of spinal clear cell meningioma with vertebra involvement. J Orthop Sci 2021; 26:919-925. [PMID: 30545721 DOI: 10.1016/j.jos.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/04/2018] [Accepted: 11/05/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Jian Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China
| | - Wei Wan
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China
| | - Weibo Liu
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China; Department of Spine Surgery, Qingdao Central Hospital, Siliunan Rd 127#, Shibei District, Qingdao, Shandong Province, China
| | - Jian Jiao
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China
| | - Qi Jia
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China
| | - Nanzhe Zhong
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China
| | - Xinghai Yang
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China.
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Navy Medical University, Fengyang Rd 415#, Huangpu District, Shanghai, China.
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TSUCHIYA T, IKEDA S, ISOO A, SAKAKIBARA H, KUMADA S, KOMORI T, TAKAI K. Intraoperative Anatomical Findings in Pediatric Clear Cell Meningioma of the Lumbar Spine: Case Report and Literature Review. NMC Case Rep J 2021; 8:519-527. [PMID: 35079512 PMCID: PMC8769484 DOI: 10.2176/nmccrj.cr.2020-0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Clear cell meningioma (CCM) is a WHO classification Grade II meningioma. It is a very rare disease, of which only 41 cases of spinal cord CCM in children have been reported to date. CCMs sometimes do not have the “dural attachment” that is usually found in meningiomas, and our understanding of the origin of CCMs is therefore controversial. We hereby present a case of pediatric CCM of the lumbar spine, in which we examined intraoperatively, the detailed anatomical location of the tumor. The case is a 10-year-old boy, who presented to our hospital with a 2-month history of lower back and bilateral lower extremity pain upon waking, which gradually worsened. Lumbar spine CT and MRI revealed an intradural extramedullary tumor at the L3 vertebral level, and surgery was performed to remove it. The tumor was in close contact with the dura mater, and also in contact with the cauda equina via the arachnoid. The tumor was likely located primarily between the dura mater and arachnoid. The pathological diagnosis was CCM, with an MIB-1 index of less than 1%. His back pain and bilateral lower extremity pain improved after surgery, and he was discharged from our hospital. Postoperative radiation therapy was not performed. Based on this case, we suggest that intraoperative examination of the anatomical location of these tumors and accumulation of relevant experience are important to elucidate the embryological mechanisms of this rare disease.
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Affiliation(s)
- Takahiro TSUCHIYA
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Syunsuke IKEDA
- Department of Neurosurgery, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Ayako ISOO
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Hiroshi SAKAKIBARA
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Satoko KUMADA
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Takashi KOMORI
- Laboratory Medicine and Pathology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Keisuke TAKAI
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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Hao Z, Hu S, Yu NZ. Rare intraspinal clear cell meningioma in children: a case report and literature review. J Int Med Res 2020; 48:300060520952266. [PMID: 33135529 PMCID: PMC7780564 DOI: 10.1177/0300060520952266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Meningioma of the spinal canal is very rare. Clear cell meningioma (CCM) with special histological features occurs more commonly in the spinal cord. A review of the published English-language literature identified 40 reported cases of children with intraspinal CCM and this current report presents an additional case of a 3-year-old child with confirmed lumbar CCM. The current case underwent gross total resection of the CCM. At 9 months after the operation, lumbar magnetic resonance imaging was undertaken and confirmed the absence of tumour recurrence. The child was able to walk normally again. During this period, the child did not receive adjuvant treatments such as radiotherapy and chemotherapy. An evaluation of the 41 cases demonstrated the following: (i) there was no significant difference between the recurrence rate of females and males; (ii) there was a significant difference in the recurrence rate based on the extent of resection (gross total resection versus partial resection); (iii) the recurrence rate in patients where the number of involved segments ≥3 levels was significantly higher than that in patients where the number of involved segments was 1–2 levels. For children with CCM, complete surgical resection might be an important characteristic for predicting the risk of the recurrence of CCM.
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Affiliation(s)
- Zheng Hao
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China.,Department of Emergency Trauma Centre, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Si Hu
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Nian-Zu Yu
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
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Zhang H, Ma L, Shu C, Dong LQ, Ma YQ, Zhou Y. Spinal Clear Cell Meningiomas: Clinical Features and Factors Predicting Recurrence. World Neurosurg 2019; 134:e1062-e1076. [PMID: 31765868 DOI: 10.1016/j.wneu.2019.11.093] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE As a World Health Organization grade II tumor of the nervous system, clear cell meningioma (CCM) is an uncommon histologic variant of meningioma. Spinal CCMs are even rarer, with <100 spinal CCMs reported in the English literature. We present this study to characterize clinical manifestations of spinal CCMs and determine the factors predicting recurrence. METHODS A literature search was performed for relevant case reports and series in PubMed and Embase until September 1, 2019. These articles were reviewed to identify clinical features, treatment modalities, and prognosis of patients with spinal CCMs. RESULTS Eighty-four spinal CCMs were analyzed. Of these patients, 36 (42.9%) were young (age ≤18 years), and the mean age at resection was 24 years. Fifty-three patients (63.1%) were female and 31 (36.9%) were male. Most of the tumors (56/84, 66.7%) were located in the lumbar region. In 31 patients (36.9%) >2 segments in the craniocaudal direction were involved (number of involved segments ≥3 levels). Gross tumor resection was performed in 77 patients (91.7%). Twenty patients (23.8%) showed radiographic evidence of recurrence during follow-up. Recurrence-free survival at 1, 5, and 10 years after resection of spinal CCM was 87%, 71%, and 47%, respectively. Multivariate analysis showed that age ≤18 years (hazard ratio [HR], 3.64; P = 0.024), subtotal resection (HR, 3.43; P = 0.031), and segments involving ≥3 levels (HR, 5.66; P = 0.002) were associated with increased recurrence. CONCLUSIONS Spinal CCMs have their own unique clinical features compared with conventional spinal meningiomas and intracranial CCMs. Spinal CCMs have a predilection to affect younger patients, are prone to appear in the lumbar region, and have a high recurrence rate. Age ≤18 years, subtotal resection, and involvement of long segments (≥3 levels) are positive predictors of recurrence.
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Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, Air Force Medical Center of the Chinese PLA, Beijing, China
| | - Li Ma
- Department of Anesthesiology, 7th Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Cheng Shu
- Department of Neurosurgery, Air Force Medical Center of the Chinese PLA, Beijing, China
| | - Lian-Qiang Dong
- Department of Neurosurgery, Air Force Medical Center of the Chinese PLA, Beijing, China
| | - Ya-Qun Ma
- Department of Anesthesiology, 7th Medical Center of the Chinese PLA General Hospital, Beijing, China.
| | - Yan Zhou
- Department of Neurosurgery, Air Force Medical Center of the Chinese PLA, Beijing, China
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Li J, Zhang S, Wang Q, Cheng J, Deng X, Wang Y, Hui X. Spinal Clear Cell Meningioma: Clinical Study with Long-Term Follow-Up in 12 Patients. World Neurosurg 2018; 122:e415-e426. [PMID: 30342264 DOI: 10.1016/j.wneu.2018.10.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clear cell meningioma (CCM) is a rare histologic subtype of meningioma. The features of CCMs have commonly been based on intracranial cases. However, CCMs in the spinal cord are even rarer, and their natural history, management, and prognosis remain ill-defined. METHODS From January 2006 to January 2018, 12 patients with spinal CCM were treated in our hospital. The clinical features, radiologic findings, diagnosis, treatment, and outcome of these patients were analyzed retrospectively. Additionally, we performed a review of the reported data on spinal CCMs. RESULTS CCMs accounted for 2.8% of all the spinal meningiomas treated in our hospital. The most common localization of this disease was the lumbar region (7 of 12). The mean age at diagnosis was significantly younger than that of patients with spinal meningiomas (28.8 ± 13.4 years vs. 54.0 ± 14.4 years). During the follow-up period, 5 patients (41.7%) experienced tumor recurrence. Kaplan-Meier analysis showed that younger patients had a significantly shorter progression-free survival time than older patients. The review of the reported data showed that 55 cases of spinal CCMs had been reported. Nineteen patients (38.0%) had developed local recurrence, with a 5-year progression-free survival rate of 33.3%. CONCLUSIONS Spinal CCMs are extremely rare tumors with a predilection to affect younger patients and have a high recurrence rate. Although gross total resection is considered to be the optimal treatment, radiotherapy could be considered for patients who had undergone subtotal resection or for younger patients, regardless of the extent of removal. Close follow-up of the entire neuraxis for years is crucial.
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Affiliation(s)
- Jiuhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Qiguang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Jian Cheng
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Xueyun Deng
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Yanchao Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China.
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7
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Kawasaki Y, Uchida S, Onishi K, Okanari K, Fujiki M. Pediatric nondura-based clear cell meningioma of the cauda equina: case report and review of literature. Br J Neurosurg 2018; 34:215-218. [PMID: 29363346 DOI: 10.1080/02688697.2018.1429565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although spinal meningiomas are uncommon in children, clear cell meningioma has been described as the most common variant of spinal meningiomas in the pediatric age group. 24 cases of pediatric spinal clear call meningioma have been reported in the literature. We report one case and review the literature regarding pediatric spinal clear cell meningioma.
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Affiliation(s)
- Yukari Kawasaki
- Department of Neurosurgery, Graduate School of Medicine, Oita University, Oita, Japan
| | - Susumu Uchida
- Department of Neurosurgery, Graduate School of Medicine, Oita University, Oita, Japan
| | - Kouhei Onishi
- Department of Neurosurgery, Graduate School of Medicine, Oita University, Oita, Japan
| | - Kazuo Okanari
- Department of Pediatrics, Graduate School of Medicine, Oita University, Oita, Japan
| | - Minoru Fujiki
- Department of Neurosurgery, Graduate School of Medicine, Oita University, Oita, Japan
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8
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Wu L, Yang C, Liu T, Fang J, Yang J, Xu Y. Clinical features and long-term outcomes of pediatric spinal meningiomas. J Neurooncol 2017; 133:347-355. [DOI: 10.1007/s11060-017-2441-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/15/2017] [Indexed: 10/19/2022]
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9
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Anunobi CC, Bankole O, Ikeri NZ, Adeleke NA. Suprasellar Clear Cell Meningioma in an Infant. Sultan Qaboos Univ Med J 2016; 16:e364-7. [PMID: 27606120 DOI: 10.18295/squmj.2016.16.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/15/2016] [Accepted: 03/17/2016] [Indexed: 02/04/2023] Open
Abstract
Clear cell meningiomas are an uncommon subtype of meningioma rarely seen in infancy. We report a case of clear cell meningioma in an 8-month-old male infant. He presented at the Lagos University Teaching Hospital, Lagos, Nigeria, in 2015 with persistent vomiting, poor feeding and failure to thrive over a four month period. Generalised hypertonia and hyperreflexia were noted on examination. Computed tomography of the brain revealed a huge largely isodense suprasellar mass with a hypodense core. The tumour, which measured 6 × 5 × 4 cm, enhanced non-uniformly with contrast injection and extended to occlude the third ventricle. The patient underwent a bifrontal craniotomy with subtotal tumour excision. Six hours postoperatively, he went into cardiac arrest and could not be resuscitated. A histological diagnosis of clear cell meningioma was made as the tumour cells were immunoreactive to epithelial membrane antigen, S100 protein and vimentin. This case of clear cell meningioma was unusual due to its early occurrence and supratentorial location.
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Affiliation(s)
- Charles C Anunobi
- Department of Anatomic & Molecular Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olufemi Bankole
- Departments of Neurosurgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nzechukwu Z Ikeri
- Anatomic & Molecular Pathology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nurudeen A Adeleke
- Departments of Neurosurgery, Lagos University Teaching Hospital, Lagos, Nigeria
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Evans LT, Van Hoff J, Hickey WF, Smith MJ, Evans DG, Newman WG, Bauer DF. SMARCE1 mutations in pediatric clear cell meningioma: case report. J Neurosurg Pediatr 2015; 16:296-300. [PMID: 26114992 DOI: 10.3171/2015.3.peds14417] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clear cell meningioma (CCM) is an uncommon variant of meningioma. The authors describe a case of a pediatric CCM localized to the lumbar spine. After resection, sequencing revealed an inactivating mutation in the SWI/SNF chromatin remodeling complex subunit SMARCE1, with loss of the second allele in the tumor. The authors present a literature review of this mutation that is associated with CCM and a family history of spine tumors.
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Affiliation(s)
| | - Jack Van Hoff
- Department of Pediatrics, and.,Norris Cotton Cancer Center;,Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire; and
| | - William F Hickey
- Department of Pathology, Dartmouth-Hitchcock Medical Center;,Norris Cotton Cancer Center
| | - Miriam J Smith
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), St. Mary's Hospital, University of Manchester, United Kingdom
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), St. Mary's Hospital, University of Manchester, United Kingdom
| | - William G Newman
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), St. Mary's Hospital, University of Manchester, United Kingdom
| | - David F Bauer
- Section of Neurosurgery.,Department of Pediatrics, and.,Norris Cotton Cancer Center;,Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire; and
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Balogun JA, Halliday W, Bouffet E, Kulkarni AV. Spinal clear cell meningioma in a 3-year-old: a case report. Pediatr Neurosurg 2013; 49:311-5. [PMID: 25377168 DOI: 10.1159/000366452] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022]
Abstract
Clear cell meningioma (CCM) is an aggressive meningioma variant with a tendency to early recurrence posing a challenge to its treatment. Although spinal meningiomas are uncommon in children, this rare entity has been described as the most common variant of spinal meningiomas in the pediatric age group. We present the case of a 3-year-old with a confirmed lumbar spine CCM and discuss the problems encountered in the management of this disease.
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Affiliation(s)
- James A Balogun
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ont., Canada
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12
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Küster O, Schittenhelm J, Schwartz O, Meyermann R, Schuhmann MU. Paediatric clear cell meningioma with multiple distant recurrences after presumed intra-operative cell spread. Childs Nerv Syst 2012; 28:925-31. [PMID: 22218777 DOI: 10.1007/s00381-011-1669-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/21/2011] [Indexed: 12/01/2022]
Affiliation(s)
- Onno Küster
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tübingen, Tübingen, Germany
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13
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Wang XQ, Zeng XW, Zhang BY, Dou YF, Wu JS, Jiang CC, Zhong P, Chen H. Spinal meningioma in childhood: clinical features and treatment. Childs Nerv Syst 2012; 28:129-36. [PMID: 21947034 DOI: 10.1007/s00381-011-1570-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/11/2011] [Indexed: 01/31/2023]
Abstract
OBJECT The purpose of this retrospective study is to determine the clinical characteristics and the prognosis of the spinal meningioma in childhood (under 18 years of age) based on the treatment at our institution. METHODS Ten spinal meningioma cases in children were treated during the last 9 years. The clinical data was retrospectively analyzed and the results were compared with those in the literature. RESULTS The series included eight males and two females and the mean age was 13.2 years. The most common initial symptoms were pain (6/10) and the common signs were limb weakness (4/10) and gait disturbance (2/10) and distal paresthesia (1/10) and bladder disturbance (1/10). Four patients had other clinical signs of neurofibromatosis type II (NF-2) such as tumors elsewhere. All the tumors were located in cervical and thoracic vertebrae. Resection according to Simpson Grade I (6/10), II (2/10), III (1/10), and IV (1/10) were performed. Grade II meningiomas accounted for 3/10 in this series. All patients were followed up with mean follow-up period of 43 months. Seven patients had recurrence of the tumor in that period and one had died. CONCLUSIONS Spinal meningioma is an uncommon pediatric neoplasm and has a poor prognosis. It has a male predominance and is inclined to be associated with NF-2, and those that are associated with higher pathologic subtypes and NF-2 have more unfavorable outcome. Every effort should be made to achieve total removal which may decrease the incidence of recurrence.
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Affiliation(s)
- Xiao-Qiang Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
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14
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Ko JK, Choi BK, Cho WH, Choi CH. Non-dura based intaspinal clear cell meningioma. J Korean Neurosurg Soc 2011; 49:71-4. [PMID: 21494369 DOI: 10.3340/jkns.2011.49.1.71] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 04/20/2010] [Accepted: 01/13/2011] [Indexed: 11/27/2022] Open
Abstract
A 34-year-old female patient was presented with leg and hip pain for 6 months as well as voiding difficulty for 1 year. Magnetic resonance imaging revealed a well-demarcated mass lesion at L2-3. The mass was hypo-intense on T1- and T2-weighted images with homogeneous gadolinium enhancement. Surgery was performed with the presumptive diagnosis of intradural extramedullary meningioma. Complete tumor removal was possible due to lack of dural adhesion of the tumor. Histologic diagnosis was clear cell meningioma, a rare and newly included World Health Organization classification of meningioma usually affecting younger patients. During postoperative 2 years, the patient has shown no evidence of recurrence. We report a rare case of cauda equina clear cell meningioma without any dural attachment.
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Affiliation(s)
- Jun Kyeung Ko
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Mekitarian Filho E, Horigoshi NK, Carvalho WBD, Hirscheimer MR, Bresolin AU, Leme RJDA, Flores JAC. Primary spinal meningioma in a 10-year-old boy. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:804-6. [DOI: 10.1590/s0004-282x2010000500025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Clear Cell Meningioma: A Clinicopathologic Study of 18 Tumors and Examination of the Use of CD10, CA9, and RCC Antibodies to Distinguish Between Clear Cell Meningioma and Metastatic Clear Cell Renal Cell Carcinoma. Appl Immunohistochem Mol Morphol 2010; 18:422-8. [DOI: 10.1097/pai.0b013e3181dd35d2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Colen CB, Rayes M, McClendon J, Rabah R, Ham SD. Pediatric spinal clear cell meningioma. Case report. J Neurosurg Pediatr 2009; 3:57-60. [PMID: 19119906 DOI: 10.3171/2008.10.17668] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this report the authors describe a unique case of spinal clear cell meningioma in a 13-year-old girl. Clear cell meningiomas (CCMs) are not uncommon. To the authors' knowledge, 14 cases of pediatric CCM occurring in the spinal canal have been reported. Factors lending resistance to meningioma initiation and invasion are analyzed. This 13-year-old girl presented with pain radiating down her left leg. Admission MR imaging showed an inhomogeneous enhancing intradural-extramedullary mass at the L4-5 level. Resection revealed a CCM, and radiotherapy was subsequently administered. Postoperatively there has been no recurrence in > 2 years. In this paper the authors report a case of CCM and provide a comprehensive literature review on this disease. Current recommendations for its management are still debatable, especially in the pediatric population, and the authors propose an algorithm for its treatment and surveillance.
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Affiliation(s)
- Chaim B Colen
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, Michigan 48225, USA.
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Vural M, Arslantaş A, Ciftçi E, Artan S, Atasoy MA. An unusual case of cervical clear-cell meningioma in pediatric age. Childs Nerv Syst 2007; 23:225-9. [PMID: 17021731 DOI: 10.1007/s00381-006-0181-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Revised: 03/16/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND BACKGROUND A 4-year-old girl was admitted with complaints of diplegia, right lower limb monoplegia, and left lower limb monoparesia. Cervical magnetic resonance imaging revealed an intradural-extramedullary tumor at the level of C1-C2. The tumor was resected totally. Histopathologic diagnosis revealed clear-cell meningioma. DISCUSSION Intraspinal clear-cell meningioma (ICCM) is a rare aggressive variant of meningioma. There are only 25 cases reported to date, and only 13 of them are in pediatric age group. Of these 25 ICCM cases, only two are at cervical region. This report is the first ICCM case at upper cervical region (C1-C2) in both adult and pediatric age populations.
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Affiliation(s)
- Murat Vural
- Department of Neurosurgery, Eskişehir Osmangazi University Medical Faculty, Eskisehir, Turkey.
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Abstract
Meningeal derived tumors of the first 2 decades of life are often diagnostically challenging due to the wide morphologic spectrum encountered and the rarity of most individual entities. The 2 most common patterns include the dural/leptomeningeal-based mass and neoplastic meningitis. Both primary and secondary meningeal presentations may occur, either early or late in the course of various meningothelial, mesenchymal, embryonal, glial, hematopoietic, histiocytic, melanocytic, and inflammatory tumors. As in other areas of pediatric pathology, there are significant differences between this patient cohort and adults, differences which will be emphasized in this review.
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Affiliation(s)
- Arie Perry
- Division of Neuropathology, Washington University School of Medicine, St. Louis, Mo 63110-1093, USA.
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20
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Epstein NE, Drexler S, Schneider J. Clear cell meningioma of the cauda equina in an adult: case report and literature review. ACTA ACUST UNITED AC 2006; 18:539-43. [PMID: 16306847 DOI: 10.1097/01.bsd.0000173314.98401.b5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the pediatric population, clear cell meningiomas are more frequently intracranial than intraspinal in location. Tumors recur in up to 40% of cases within 15 postoperative months and are often managed with repeated resection with or without radiation therapy. The management strategy for adults with clear cell meningiomas involving the lumbar spinal canal (cauda equina) is less clearly defined. A 41-year-old woman presented with mild, right greater than left, lower extremity paresis. An enhanced magnetic resonance (MR) scan revealed a homogeneously enhancing intradural lesion filling the spinal canal at the L3-L4 level. Preoperative noncontrast MR studies of the brain and cervical and thoracic spine were negative. An L2-L5 laminectomy was performed for gross total excision of the intradural lesion, which was adherent to one nerve root of the cauda equina. Frozen-section diagnosis confirmed clear cell tumor. Differential diagnoses included meningioma versus renal cell carcinoma. Negative postoperative chest, abdominal, and pelvic computed tomography studies ruled out tumor of renal cell origin. Enhanced MR studies of the neuraxis proved negative. Consultations with multiple oncologists and radiation therapists recommended neither radiation nor chemotherapy following this initial surgery. She remains disease-free 1 year postoperatively. The high recurrence rate for clear cell meningiomas in children requires repeated tumor resection with or without secondary radiation therapy. Following gross total resection of lumbar tumors in adults, reserving radiation therapy for secondary recurrences provides optimal management.
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Affiliation(s)
- Nancy E Epstein
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, NY, USA.
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21
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Dhall SS, Tumialán LM, Brat DJ, Barrow DL. Spinal intradural clear cell meningioma following resection of a suprasellar clear cell meningioma. Case report and recommendations for management. J Neurosurg 2005; 103:559-63. [PMID: 16235691 DOI: 10.3171/jns.2005.103.3.0559] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on 32-year-old woman with a history of a previously resected suprasellar clear cell meningioma (CCM), who returned to their institution after 3 years suffering from progressively worsening leg and back pain associated with leg weakness and bowel and bladder dysfunction. A magnetic resonance image of the thoracic and lumbar spine demonstrated a homogeneously enhancing intradural mass that filled and expanded the thecal sac. The patient underwent multiple-level laminectomies for resection of the lesion. Results of pathological studies confirmed distant recurrence of a CCM. Since its initial recognition as a rare but aggressive histological variant of meningothelial tumors, the body of literature on CCMs has grown to include more than 40 cases. Nevertheless, the natural history of this neoplastic entity remains ill defined, as are the recommendations for management. Of particular concern is the treatment of patients who have undergone subtotal resection or present with recurrence. To the authors' knowledge, the present case represents the sixth distant recurrence of CCM reported in the literature. The radiographic and histological studies are reviewed along with the current literature on this subtype of meningioma. Recommendations for surveillance and treatment are made.
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Affiliation(s)
- Sanjay S Dhall
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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22
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Oviedo A, Pang D, Zovickian J, Smith M. Clear cell meningioma: case report and review of the literature. Pediatr Dev Pathol 2005; 8:386-90. [PMID: 16010490 DOI: 10.1007/s10024-005-0119-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2004] [Accepted: 02/17/2005] [Indexed: 10/25/2022]
Abstract
Clear cell meningioma (CCM) is a rare variant of meningioma. Only 17 cases have been previously reported in children. Although it has bland cytologic features, it has a higher rate of recurrence than does conventional meningioma. This variant has been reported in sites such as spinal/intradural (lumbar and thoracic), cerebellopontine angle, and supratentorial. The differential diagnosis of CCM includes microcystic meningioma, hemangioblastoma, and clear cell ependymoma. The characteristic histology and immunohistochemistry leads to the diagnosis. We present a case of a 7-year-old boy with a CCM of the cauda equina and a review of pediatric CCM.
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Affiliation(s)
- Angelica Oviedo
- Department of Pathology, Kaiser Foundation Hospital, Oakland, CA 94611, USA.
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23
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Boet R, Ng HK, Kumta S, Chan LC, Chiu KW, Poon WS. Lumbosacral clear-cell meningioma treated with subtotal resection and radiotherapy. J Clin Neurosci 2004; 11:432-6. [PMID: 15080967 DOI: 10.1016/j.jocn.2003.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2003] [Accepted: 10/10/2003] [Indexed: 10/26/2022]
Abstract
We wish to report a rare case of clear-cell meningioma in the lumbosacral region in a 34-year-old male patient who presented to us with lower back pain and leg pain. The management of the patient will be reported and histological appearance discussed. This rare tumour in a difficult anatomical position presents a challenge that requires management in a multidisciplinary fashion.
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Affiliation(s)
- Ronald Boet
- Division of Neurosurgery, Department of Surgery, Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
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Carlotti CG, Neder L, Colli BO, dos Santos MB, Garcia AS, Elias J, Chimelli LC. Clear cell meningioma of the fourth ventricle. Am J Surg Pathol 2003; 27:131-5. [PMID: 12502936 DOI: 10.1097/00000478-200301000-00015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clear cell meningioma (CCM) has been identified and included in the World Health Organization classification of CNS tumors recently. CCMs are histologically characterized by sheets of polygonal cells with clear cytoplasm, which is the expression of high glycogen concentration. Compared with other variants of meningiomas, CCMs occur in younger patients and usually are located in the spinal canal and posterior fossa, the last ones mainly in the cerebellopontine angle. Some reports suggest that CCMs have high recurrence rate and potentially aggressive behavior. Poor outcome has been shown in intracranial and spinal tumor location, but indicators that predict outcome have not been established. The authors present two cases of intracranial CCMs, with excellent outcome in patients harboring tumor location (restricted to the fourth ventricle) and some clinical particular features (young age, gender, obesity, and moderate impairment of intellectual capacity). To the best of our knowledge, these are the two first reported cases of clear cell meningioma located primarily in the fourth ventricle.
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Affiliation(s)
- Carlos G Carlotti
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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