1
|
Bridges J, Brougham J, Terrell D, Whipple S, Lee S. Posterior fossa microcystic meningioma mimicking an arachnoid cyst. Radiol Case Rep 2024; 19:1284-1287. [PMID: 38292808 PMCID: PMC10825519 DOI: 10.1016/j.radcr.2023.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Microcystic meningioma is an uncommon subtype of World Health Organization grade 1 meningiomas often associated with a shorter progression-free survival. Diagnosis through imaging alone can often be challenging due to atypical characteristics, especially when found in unexpected locations. Here, we present a 55-year-old woman who was diagnosed, based on imaging, with a posterior fossa arachnoid cyst 5 years prior after complaints of headaches and gait imbalance. After surgical resection of the "arachnoid cyst," the diagnosis of microcystic meningioma was made. This case report emphasizes the clinical importance and challenges associated with diagnosing microcystic meningiomas.
Collapse
Affiliation(s)
- James Bridges
- School of Medicine, LSU Health Shreveport , Shreveport, LA, USA
| | - Jared Brougham
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Danielle Terrell
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Stephen Whipple
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA
| | - Sungho Lee
- Department of Neurosurgery, LSU Health Shreveport, Shreveport, LA, USA
| |
Collapse
|
2
|
Jun Y, Park YW, Shin H, Shin Y, Lee JR, Han K, Ahn SS, Lim SM, Hwang D, Lee SK. Intelligent noninvasive meningioma grading with a fully automatic segmentation using interpretable multiparametric deep learning. Eur Radiol 2023; 33:6124-6133. [PMID: 37052658 DOI: 10.1007/s00330-023-09590-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/30/2022] [Accepted: 02/09/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To establish a robust interpretable multiparametric deep learning (DL) model for automatic noninvasive grading of meningiomas along with segmentation. METHODS In total, 257 patients with pathologically confirmed meningiomas (162 low-grade, 95 high-grade) who underwent a preoperative brain MRI, including T2-weighted (T2) and contrast-enhanced T1-weighted images (T1C), were included in the institutional training set. A two-stage DL grading model was constructed for segmentation and classification based on multiparametric three-dimensional U-net and ResNet. The models were validated in the external validation set consisting of 61 patients with meningiomas (46 low-grade, 15 high-grade). Relevance-weighted Class Activation Mapping (RCAM) method was used to interpret the DL features contributing to the prediction of the DL grading model. RESULTS On external validation, the combined T1C and T2 model showed a Dice coefficient of 0.910 in segmentation and the highest performance for meningioma grading compared to the T2 or T1C only models, with an area under the curve (AUC) of 0.770 (95% confidence interval: 0.644-0.895) and accuracy, sensitivity, and specificity of 72.1%, 73.3%, and 71.7%, respectively. The AUC and accuracy of the combined DL grading model were higher than those of the human readers (AUCs of 0.675-0.690 and accuracies of 65.6-68.9%, respectively). The RCAM of the DL grading model showed activated maps at the surface regions of meningiomas indicating that the model recognized the features at the tumor margin for grading. CONCLUSIONS An interpretable multiparametric DL model combining T1C and T2 can enable fully automatic grading of meningiomas along with segmentation. KEY POINTS • The multiparametric DL model showed robustness in grading and segmentation on external validation. • The diagnostic performance of the combined DL grading model was higher than that of the human readers. • The RCAM interpreted that DL grading model recognized the meaningful features at the tumor margin for grading.
Collapse
Affiliation(s)
- Yohan Jun
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hyungseob Shin
- School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Yejee Shin
- School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Jeong Ryong Lee
- School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
| | - Soo Mee Lim
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Dosik Hwang
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
- School of Electrical and Electronic Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
- Center for Healthcare Robotics, Korea Institute of Science and Technology, Seoul, Korea.
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea.
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| |
Collapse
|
3
|
Ren L, Hua L, Bao Z, Deng J, Wang D, Chen J, Chen H, Juratli TA, Wakimoto H, Gong Y. Distinct clinical outcome of microcystic meningioma as a WHO grade 1 meningioma subtype. J Neurooncol 2023; 161:193-202. [PMID: 35612696 DOI: 10.1007/s11060-022-04034-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the clinicopathological characteristics, radiology, and long-term outcomes of microcystic meningiomas (MM) and compare it with other subtypes of meningiomas managed at a single neurosurgical center. METHODS A total of 87 consecutive patients who underwent surgical resection and were diagnosed as MM between 2005 and 2016 were enrolled for analysis. Clinicopathological, radiology, and prognostic information was collected and analyzed. Progression free survival (PFS) was compared with 659 patients with other subtypes of WHO grade 1 meningiomas and 167 patients with atypical meningiomas treated during the same period. RESULTS Fifty six females and 31 males with MM were analyzed. Peri-tumor brain edema was frequent on T2 WI (85%).12 patients (13.8%) experienced tumor progression during the mean follow-up of 101.66 ± 40.92 months. The median PFS was unavailable, and the 5, 10, and 15 year progression-free rates were 96.9%, 84.0%, and 73.9%, respectively. Univariate COX analysis demonstrated skull base location and higher Ki-67 index as significant negative prognostic factors for PFS (P < 0.05); multivariate analysis identified tumor location and Ki-67 index as independent factors (P < 0.01), as well. Of note, the PFS of MM was worse than other WHO grade 1 subtypes (P < 0.001), but better than atypical meningiomas (P < 0.001), and the PFS differences were retained even when the analysis was limited to the patients receiving GTR (P < 0.05). CONCLUSION The PFS of MM was worse than other WHO grade 1 subtypes and better than atypical meningiomas. Skull base location and higher Ki-67 index were independent negative prognostic factors in MM.
Collapse
Affiliation(s)
- Leihao Ren
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Institute of Neurosurgery, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Lingyang Hua
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Institute of Neurosurgery, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Zhongyuan Bao
- Department of Neurosurgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Jiaojiao Deng
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Institute of Neurosurgery, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Daijun Wang
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Institute of Neurosurgery, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Jiawei Chen
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Institute of Neurosurgery, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China
| | - Hong Chen
- Department of Pathology, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Tareq A Juratli
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Ye Gong
- Department of Neurosurgery, Shanghai Medical College, Huashan Hospital, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China. .,Institute of Neurosurgery, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China. .,Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China. .,Department of Critical Care Medicine, Shanghai Medical College, Huashan Hospital, Fudan University, 12# Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China.
| |
Collapse
|
4
|
Noureldine MHA, Shimony N, Jallo GI. Benign Spinal Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:583-606. [PMID: 37452955 DOI: 10.1007/978-3-031-23705-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Benign spinal intradural tumors are relatively rare and include intramedullary tumors with a favorable histology such as low-grade astrocytomas and ependymomas, as well as intradural extramedullary tumors such as meningiomas and schwannomas. The effect on the neural tissue is usually a combination of mass effect and neuronal involvement in cases of infiltrative tumors. The new understanding of molecular profiling of different tumors allowed us to better define central nervous system tumors and tailor treatment accordingly. The mainstay of management of many intradural spinal tumors is maximal safe surgical resection. This goal is more achievable with intradural extramedullary tumors; yet, with a meticulous surgical approach, many of the intramedullary tumors are amenable for safe gross-total or near-total resection. The nature of these tumors is benign; hence, a different way to measure outcome success is pursued and usually depends on functional rather than oncological or survival outcomes.
Collapse
Affiliation(s)
- Mohammad Hassan A Noureldine
- Department of Neurosurgery and Brain Repair, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Nir Shimony
- Institute of Neuroscience, Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Danville, PA, USA
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Department of Surgery, St Jude Children's Research Hospital, Memphis, USA
| | - George I Jallo
- Institute for Brain Protections Sciences, Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA.
| |
Collapse
|
5
|
Kuroda K, Tokugawa J, Yamataka M, Nishioka K, Ueda T, Mitsuhashi T, Mitsuhashi T, Hishii M. A case of microcystic meningioma associated with acute subdural hematoma in the posterior cranial fossa. Radiol Case Rep 2022; 17:3646-3650. [PMID: 35936886 PMCID: PMC9352515 DOI: 10.1016/j.radcr.2022.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022] Open
Abstract
A 53-year-old woman was brought to the emergency room with headache and progressive deterioration of consciousness. Radiological examinations revealed acute subdural hematoma extending along the cerebellar tentorium to the falx cerebri, and a mass lesion with hemorrhage in the left cerebellum, with acute hydrocephalus. Emergency tumor and hematoma removal with decompressive craniectomy of the occiput was performed. Histopathological diagnosis was microcystic meningioma. Postoperatively, the patient recovered to clear consciousness with sequelae of left cerebellar ataxia, cerebellar dysarthria, and vertigo. This case of tentorial microcystic meningioma associated with acute subdural hematoma in the posterior cranial fossa is extremely rare, with only reported 4 similar cases.
Collapse
Affiliation(s)
- Kiyotaka Kuroda
- Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Joji Tokugawa
- Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Motoki Yamataka
- Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Kazuki Nishioka
- Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Tetsuya Ueda
- Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Takumi Mitsuhashi
- Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Takashi Mitsuhashi
- Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| | - Makoto Hishii
- Department of Neurosurgery, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo 177-8521, Japan
| |
Collapse
|
6
|
Myriad Presentations of Intracranial Meningiomas: Pictoral Essay. J Belg Soc Radiol 2022; 106:25. [PMID: 35581977 PMCID: PMC9053553 DOI: 10.5334/jbsr.2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022] Open
Abstract
Meningiomas are the most common non-glial tumor of the central nervous system (CNS). Seen in middle age with a female preponderance, most of the tumors are solitary and supratentorial with benign histology (WHO grade I). Atypical and anaplastic (malignant) meningiomas (WHO grade II and III), comprise 15–20% of all intracranial meningiomas [12345]. Magnetic resonance imaging (MRI) is the imaging modality of choice.
Collapse
|
7
|
Utility of multiparametric pre-operative magnetic resonance imaging in differentiation of chordoid meningioma from the other histopathological subtypes of meningioma-a retrospective study. Neuroradiology 2021; 64:253-264. [PMID: 33837805 DOI: 10.1007/s00234-021-02690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the magnetic resonance imaging (MRI) features which could pre-operatively differentiate chordoid meningioma (CM) from other histopathological subtypes of meningioma. METHODS Retrospective analysis of pre-operative MRI of cases with histopathologically confirmed diagnosis of meningioma during the last 5 years at our institute was done. T1W, T2W, FLAIR sequences, and post-contrast enhancement were evaluated on a qualitative scale. Normalized ADC ratios (nADCR) and normalized fractional anisotropy ratios (nFAR) were derived. The intratumoral susceptibility score (ITSS), presence of sunburst pattern of vasculature, bone changes, tumour-parenchyma interface, and oedema-to-tumour ratio were also determined. RESULTS A total of 81 lesions were analyzed out of which 15 were CM. CM showed a higher relative contrast enhancement as compared to all other subtypes except for angiomatous and microcystic meningioma. Relative signal intensity on FLAIR could differentiate CM from transitional meningioma. nFAR was found to be significantly higher in fibroblastic meningioma and significantly lower in microcystic meningiomas as compared to CM. Anaplastic meningiomas were remarkable for bone changes and an ill-defined tumour-brain interface in significantly higher proportion of cases as compared to CM. nADCR > 1.5 was found to be an independent predictor of CM with a sensitivity of 84.6%, specificity of 89.8%, positive predictive value of 64.7%, and negative predictive value of 96.4%. CONCLUSION Routine pre-operative MRI may be able to differentiate CM from other meningioma subtypes and a cut-off value of greater than 1.5 for nADCR could be predictive of > 50% chordoid histology of meningioma with a high sensitivity, specificity, and negative predictive value.
Collapse
|
8
|
Adepoju A, Narayan A, Aldyab M, Foyt D, Peris-Celda M. Absence of contrast enhancement in a petroclival meningioma: Case report and systematic literature review. Surg Neurol Int 2020; 11:418. [PMID: 33365181 PMCID: PMC7749960 DOI: 10.25259/sni_489_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/18/2020] [Indexed: 11/07/2022] Open
Abstract
Background: Meningioma is one of the most common intracranial tumors with well-established radiologic features such as contrast enhancement, dural tail, and hyperostosis on computed tomography and magnetic resonance imaging. Contrast enhancement is usually homogeneous or heterogeneous based on tumor vascularity and underlying histopathology. Even in this context, faint or nonenhancing meningioma is exceedingly rare. Case Description: A 57-year-old male presented with progressive right hearing loss, disequilibrium, occasional difficulty swallowing, and facial numbness. Imaging demonstrated an extensive hypodense, nonenhancing right cerebellopontine angle mass extending from the interpeduncular, and ambient cisterns to the foramen magnum. The pathological analysis demonstrated a microcystic meningioma WHO Grade I. There are few reported case reports or series of minimal or nonenhancing meningiomas, and a systematic review was performed for these cases. Seven peer-reviewed articles with 14 verifiable cases were identified and reviewed for radiologic features, tumor location, and tumor classification. The majority of minimal or nonenhancing meningiomas were microcystic, and most of them located at the convexity. This is the second case reported of a nonenhancing meningioma at the cerebellopontine angle and petroclival region Conclusion: Meningioma should be considered a differential diagnosis for nonenhancing lesion at the cerebellopontine and petroclival regions.
Collapse
Affiliation(s)
- Adedamola Adepoju
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Ananth Narayan
- Department of Radiology, Albany Medical Center, Albany, New York, United States
| | - Mahmoud Aldyab
- Department of Pathology, Albany Medical Center, Albany, New York, United States
| | - David Foyt
- Department of Otolaryngology and Head and Neck Surgery, Albany Medical Center, Albany, New York, United States
| | - Maria Peris-Celda
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| |
Collapse
|
9
|
Tabibkhooei A, Azar M, Alagha A, Jahandideh J, Ebrahimnia F. Investigating Effective Factors on Estimated Hemorrhage Intraoperative in Brain Meningioma Surgery. Basic Clin Neurosci 2020; 11:631-638. [PMID: 33643556 PMCID: PMC7878064 DOI: 10.32598/bcn.9.10.370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 06/25/2019] [Accepted: 11/26/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction The primary and definitive diagnosis of meningioma is based on histological assessment; however, employing imaging methods, like Magnetic Resonance Imaging (MRI) is very helpful to describe lesion's characteristics. Accordingly, we decided to study the effect of imaging factors, like MRI data on the volume of hemorrhage (estimated blood loss) during meningioma surgery. Methods This was a cross-sectional, retrospective, and analytical study. The eligible patients were those with meningioma who were candidates for surgery. A total of 40 patients with meningioma were selected and assessed. The preoperative imaging findings were recorded, then estimated blood loss during the surgery was determined. Results A reverse association was revealed between the degree of proximity to the nearest sinus and the rate of bleeding. Furthermore, the size of the mass was positively associated with the rate of bleeding; however, there was no significant correlation between the volume of bleeding and other parameters, including the degree of edema, the volume of mass, the site of the tumor in the brain, and the histological subtype of the tumor. The mean time of operation was strongly correlated with blood loss. The rate of bleeding was more expected in hypertensive versus normotensive patients. Conclusion Bleeding in various volumes could be a frequent finding in intracranial meningioma surgery. Overall, tumor size, the duration of surgery, a history of hypertension, and distance to the nearest sinuses were the main determinants for the severity of hemorrhage in patients undergoing meningioma surgery.
Collapse
Affiliation(s)
- Alireza Tabibkhooei
- Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Azar
- Skull Base Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Alagha
- Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Javad Jahandideh
- Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Feyzollah Ebrahimnia
- Department of Neurosurgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Kim T, Kim JW, Ji SY, Kang H, Kim KM, Kim YH, Park CK, Choi SH, Park SH. Intracranial Metaplastic Meningioma : Clinical and Radiological Characteristics of 11 Cases. J Korean Neurosurg Soc 2020; 63:657-663. [PMID: 32883060 PMCID: PMC7477148 DOI: 10.3340/jkns.2020.0151] [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] [Received: 05/27/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Metaplastic meningioma is an extremely rare subtype of World Health Organization (WHO) grade I meningioma. It has distinctive histological subtypes according to its own mesenchymal components. Owing to its scarcity, clinical or radiological features of a metaplastic meningioma are poorly described. METHODS Between 2004 and 2018, we analyzed total 1814 cases surgically proven meningioma for 15 years. Among them, metaplastic meningioma was diagnosed in 11 cases. Magnetic resonance images were taken for all patients, and computed tomography scan was taken for 10 patients. RESULTS WHO grade I meningiomas were 1376 cases (75.9%), 354 cases (19.5%) in WHO grade II, and 84 cases (4.6%) in WHO grade III meningiomas. Metaplastic meningioma was 11 cases as 0.8% of WHO grade I meningioma and 0.6% of entire meningiomas for 15 years. Among the entire 11 metaplastic meningiomas, five tumors (45%) were diagnosed as a lipomatous subtype with rich fat components, four (36%) as an osseous subtype with extensive bone formation and two (18%) as a xanthomatous subtype. There was no cartilaginous subtype metaplastic meningioma in our study. Lipomatous and osseous metaplastic meningioma have peculiar radiological characteristics according to mesenchymal components. CONCLUSION We investigated a rare metaplastic meningioma subtype based on our 15-year surgical experience with meningiomas. Further investigation will be necessary for the clear clarification of tumor nature of this rare tumor.
Collapse
Affiliation(s)
- Taehoon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
11
|
Kulanthaivelu K, Lanka V, Chandran C, Nandeesh BN, Tiwari S, Mahadevan A, Prasad C, Saini J, Bhat MD, Chakrabarti D, Pruthi N, Vazhayil V, Sadashiva N, Srinivas D. Microcystic Meningiomas: MRI-Pathologic Correlation. J Neuroimaging 2020; 30:704-718. [PMID: 32521093 DOI: 10.1111/jon.12743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND AND PURPOSE Microcystic meningiomas (MM) are a distinctive, rare subtype of Grade I meningiomas with limited radiological descriptions. We intend to identify unique imaging phenotypes and seek radiopathological correlations. METHODS Retrospective analysis of histopathologically proven MM was undertaken. Clinicodemographic profiles, imaging, and histopathological characteristics were recorded. Spearman rank correlations among radiological and pathological attributes were performed. RESULTS Twenty-eight cases were analyzed (mean age = 45.5 years; M:F = 1:1.54; mean volume = 50.1 mL; supratentorial n = 27). Most lesions were markedly T2 hyperintense (higher than peritumoral brain edema-a unique finding) (89.3%) and showed invariable diffusion restriction, severe peritumoral brain edema (edema index >2 in 64.3%), a "storiform" pattern on T2-weighted images (T2WI) (75%), reticular pattern on postcontrast T1 (78.6%)/diffusion-weighted images (DWI) (65.4%), hyperperfusion, T1 hypointensity (84.6%), and absence of blooming on susceptibility-weighted image (80.9%). Storiform/reticular morphology correlated with large cysts on histopathology (ρ = .56; P = .005753). Lesion dimension positively correlated with reticular morphology on imaging (ρ = .59; P = .001173), higher flow voids (ρ = .65; P = .00027), and greater microcystic changes on histopathology (ρ = .51; P = .006778). Peritumoral brain edema was higher for lesions demonstrating greater angiomatous component (ρ = .46; P = .014451). CONCLUSIONS We have elucidated varied neuroimaging features and highlighted pathological substrates of crucial imaging findings of MM. MM ought to be considered as an imaging possibility in an extra-axial lesion with a marked hypodensity on noncontrast computed tomography, markedly T2-hyperintense/T1-hypointense signal, and a storiform/reticular pattern on T2W/GdT1w//DWI.
Collapse
Affiliation(s)
- Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vivek Lanka
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Chitra Chandran
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bevinhalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Maya D Bhat
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| |
Collapse
|
12
|
Jacobo JA, Mamani R, Jimenez SM, Avendaño J, Nuñez S. Microcystic meningioma associated with other meningioma subtypes: A diagnostic challenge, report of two cases. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
13
|
Xiaoai K, Qing Z, Lei H, Junlin Z. Differentiating microcystic meningioma from atypical meningioma using diffusion-weighted imaging. Neuroradiology 2020; 62:601-607. [PMID: 31996968 DOI: 10.1007/s00234-020-02374-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/20/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Microcystic meningioma (MCM) appears similar to atypical meningioma(AM) as per conventional diagnostic imaging. However, considering their different recurrence rate and prognosis, accurate differential diagnosis is essential for determine the appropriate treatment strategy. The aim of the study was to differentiate MCM from AM by diffusion-weighted imaging (DWI), in order to provide the basis for accurate preoperative diagnosis. METHODS The preoperative clinical data, conventional MRI and DWI data of 15 MCM and 30 AM cases were retrospectively analyzed. The average apparent diffusion coefficient (ADCmean), minimum ADC (ADCmin) and normalized ADC (nADC) between MCM and AM were compared using two sample t-tests. The value of ADCmean, ADCmin and nADC in the differential diagnosis of MCM and AM were calculated by the receiver operating curve (ROC) analysis. RESULTS The ADCmean (1.06 ± 0.10 vs 0.80 ± 0.11 × 10-3 mm2/s; P < 0.001), ADCmin (0.99 ± 0.10 vs 0.74 ± 0.12 × 10-3 mm2/s; P < 0.001) and nADC (1.45 ± 0.17 vs 1.07 ± 0.17; P < .0001) were significantly higher in MCM compared to AM. ADCmean of 0.91 × 10-3 mm2/s showed an optimum area under the ROC curve of 0.967 ± 0.022, and distinguished between MCM and AM with 86.67% sensitivity, 100% specificity and 88.89% accuracy. In addition, its positive and negative predictive values were 96.29% and 77.78% respectively. CONCLUSIONS DWI can differentially diagnose MCM and AM, and ADCmean is a potential quantitative tool that can improve preoperative diagnosis of both tumors.
Collapse
Affiliation(s)
- Ke Xiaoai
- Department of Radiology, Lanzhou University Second Hospital, Second Clinical School, Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
| | - Zhou Qing
- Department of Radiology, Lanzhou University Second Hospital, Second Clinical School, Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
| | - Han Lei
- Department of Radiology, Lanzhou University Second Hospital, Second Clinical School, Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China
| | - Zhou Junlin
- Department of Radiology, Lanzhou University Second Hospital, Second Clinical School, Lanzhou University, Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China.
| |
Collapse
|
14
|
Kuroi Y, Akagawa H, Shibuya M, Onda H, Maegawa T, Kasuya H. Identification of shared genomic aberrations between angiomatous and microcystic meningiomas. Neurooncol Adv 2019; 1:vdz028. [PMID: 32642661 PMCID: PMC7212863 DOI: 10.1093/noajnl/vdz028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Angiomatous and microcytic meningiomas are classified as rare subtypes of grade I meningiomas by World Health Organization (WHO). They typically exhibit distinct histopathological features as indicated by their WHO titles; however, these angiomatous and microcystic features are often intermixed. Recently, angiomatous meningiomas were reported to show characteristic chromosomal polysomies unlike the other WHO grade I meningiomas. In the present study, we hypothesize that microcystic meningiomas share similar cytogenetic abnormalities with angiomatous meningioma. Methods We performed copy number analysis using single nucleotide polymorphism (SNP) arrays for three angiomatous and eight microcystic meningiomas. Of these, three angiomatous and three microcystic meningiomas were also analyzed by whole exome sequencing and RNA sequencing. Results We first analyzed three angiomatous and three microcystic meningiomas for which both frozen tissues and peripheral blood were accessible. Copy number analysis confirmed previously reported multiple polysomies in angiomatous meningiomas, which were entirely replicated in microcystic meningiomas when analyzed on different analytical platforms with five additional samples prepared from formalin-fixed paraffin-embedded tumors. Polysomy of chromosome 5 was found in all cases, along with chromosome 6, 12, 17, 18, and 20 in more than half of the cases including both angiomatous and microcystic meningiomas. Furthermore, next generation sequencing did not reveal any distinctive somatic point mutations or differences in gene expression characterizing either angiomatous or microcystic meningiomas, indicating a common genetic mechanism underlying tumorigenesis. Conclusions Angiomatous and microcystic meningiomas have substantially similar genetic profiles represented by the characteristic patterns of multiple polysomies originating from chromosome 5 amplification.
Collapse
Affiliation(s)
- Yasuhiro Kuroi
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Tokyo Women's Medical University, Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan
| | - Hiroyuki Akagawa
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Tokyo Women's Medical University, Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan
| | - Makoto Shibuya
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Central Laboratory, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Hideaki Onda
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Division of Neurosurgery, Kofu Neurosurgical Hospital, Kofu, Yamanashi, Japan
| | - Tatsuya Maegawa
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Tokyo Women's Medical University, Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan
| | - Hidetoshi Kasuya
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.,Tokyo Women's Medical University, Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan
| |
Collapse
|
15
|
Tamada T, Enatsu R, Kikuchi N, Mikuni N. Meningioma mimicking an intraparenchymal cystic tumor. NAGOYA JOURNAL OF MEDICAL SCIENCE 2018; 80:431-434. [PMID: 30214093 PMCID: PMC6125649 DOI: 10.18999/nagjms.80.3.431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Meningiomas rarely exhibit cystic lesions with mural nodules, and may be misdiagnosed as intraparenchymal cystic tumors. We herein present a 64-year-old woman with a cystic lesion and enhancing mural nodule in the left temporal lobe accompanied by peritumoral brain edema. Differential diagnoses included low-grade gliomas, hemangioblastoma, and cystic meningioma. Gross total resection of the tumor was achieved through a temporal surgical approach. Intraoperative findings showed that the tumor was an extraparenchymal tumor. The cyst was covered by an extraparenchymal thin membrane and the cystic fluid was yellowish in color. The final result of the pathological examination was microcystic meningioma, WHO grade I. Although intraparenchymal tumors, such as hemangioblastoma, ganglioglioma, pilocytic astrocytoma, and pleomorphic xanthoastrocytoma, commonly display this MRI pattern, meningioma needs to be included in the differential diagnosis.
Collapse
Affiliation(s)
- Tomoaki Tamada
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Noriaki Kikuchi
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
16
|
Characteristic features and proposed classification in 69 cases of intracranial microcystic meningiomas. Neurosurg Rev 2018; 42:443-453. [PMID: 29721630 DOI: 10.1007/s10143-018-0982-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/16/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
Microcystic meningioma (MM) is a rare subtype of intracranial meningiomas, with clinical and radiologic features not well characterized in the literature. Based on our experience, we propose a classification system of intracranial MMs. We reviewed the medical records, radiographic studies, and operative notes of a group of consecutive patients with intracranial MM. The mean age of the 69 patients was 46.8 ± 10.6 years (range, 21-75 years). Three types of intracranial MMs could be identified. Type 1 MMs presented as a solid lesion, hypointense or isointense on T1WI, hyperintense on T2WI, and homogeneous or heterogeneous enhancement, and were found in 43 patients (67.2%). Type 2 MMs represented signals similar to CSF both on T1WI and T2WI, and faint reticular enhancement with marginal enhancement, and these were found in 7 patients (10.9%). Type 3 MMs consisted of cystic-solid or cystic lesion and were found in 14 patients (21.9%). Significant differences were observed among the different types of MMs for the following variables: sex, presence of severe peritumoral brain edema (PTBE), and extent of tumor resection. Females were found in all of patients with type 2 MMs, but were only 35.7% of those with type 3 MMs (P = 0.018). Severe PTBEs were more common among patients with type 1 MMs (55.8%) than among those with type 2 (14.3%) and type 3 MMs (14.3%) (P = 0.007). Type 1 MMs (97.7%) were associated with a significantly higher rate of gross total resection compared with the other two types (71.4 and 78.6%) (P = 0.019). Total length of hospital stay after craniotomy ranged from 4 to 30 days (median, 8 days). There were no significant differences in progression-free survival among the three types of MMs (P = 0.788). The current classification identifies three distinct types of intracranial MM based on their radiological findings and growth patterns. The type 1 MMs are more commonly associated with severe PTBE. Type 2 and Type 3 MMs have a higher predilection towards parasaggital location with venous involvement and therefore have a lower rate of gross total resection.
Collapse
|
17
|
Imaging features of intracranial psammomatous meningioma. J Neuroradiol 2017; 44:395-399. [DOI: 10.1016/j.neurad.2017.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 05/22/2017] [Accepted: 06/14/2017] [Indexed: 11/17/2022]
|
18
|
Danisman MC, Kelesoglu KS, Sivri M, Koplay M, Paksoy Y. Microcystic meningioma: difficulties in diagnosis and magnetic resonance imaging findings. Acta Neurol Belg 2017; 117:745-747. [PMID: 28197976 DOI: 10.1007/s13760-017-0760-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/04/2017] [Indexed: 10/20/2022]
|
19
|
Zakhari N, Torres C, Castillo M, Nguyen TB. Uncommon Cranial Meningioma: Key Imaging Features on Conventional and Advanced Imaging. Clin Neuroradiol 2017; 27:135-144. [PMID: 28466126 DOI: 10.1007/s00062-017-0583-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
Given the high incidence of intracranial meningiomas encountered in clinical practice, it is not uncommon to find rare subtypes of meningioma, with unusual imaging findings. These commonly represent a diagnostic challenge. In this article, we review the imaging appearance of typical meningioma on conventional and advanced imaging as well as the key imaging features of multiple uncommon subtypes: cystic, microcystic, lipomatous, chordoid, angiomatous, intraosseous, extracranial, atypical/malignant, and tumor-to-tumor metastasis (also known as collision tumors). Some of these uncommon subtypes, however, demonstrate imaging features that may allow for a more specific diagnosis, or features, which can influence patient's management.
Collapse
Affiliation(s)
- Nader Zakhari
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada
| | - Carlos Torres
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326 Old Infirmary Building, Manning Drive, 27599-7510, Chapel Hill, NC, USA
| | - Thanh B Nguyen
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada
| |
Collapse
|
20
|
Kang H, Kim JW, Se YB, Dho YS, Choi SH, Park SH. Sclerosing Meningioma : Radiological and Clinical Characteristics of 21 Cases. J Korean Neurosurg Soc 2016; 59:584-589. [PMID: 27847571 PMCID: PMC5106357 DOI: 10.3340/jkns.2016.59.6.584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/12/2016] [Accepted: 08/30/2016] [Indexed: 11/27/2022] Open
Abstract
Objective A rare subtype of meningioma, sclerosing meningioma is not included in the current World Health Organization classification of meningiomas and is classified into the category of other morphological variation subtypes. Sclerosing meningioma is often misdiagnosed to other non-benign meningioma or malignant neoplasm, so it is important to diagnose sclerosing type correctly. We analyzed the radiological and clinical characteristics of a series of sclerosing meningiomas. Methods Twenty-one patients who underwent surgery in one institute with a histopathologically proven sclerosing meningioma were included from 2006 to 2014. Eighteen tumors were diagnosed as a pure sclerosing-type meningioma, and 3 as mixed type. Magnetic resonance image was taken for all patients including contrast enhancement image. Computed tomography (CT) scan was taken for 16 patients. One neuroradiologist and 1 neurosurgeon reviewed all images retrospectively. Results In the all 16 patients with preoperative CT images, higher attenuation was observed in the meningioma than in the brain parenchyma, and calcification was observed in 11 (69%). In 15 of the 21 patients (71%), a distinctive very low signal intensity appeared as a dark color in T2-weighted images. Nine of these 15 tumors (60%) exhibited heterogeneous enhancement, and 6 (40%) exhibited homogeneous enhancement that was unlike the homogeneous enhancing pattern shown by conventional meningiomas. Ten patients had a clear tumor margin without peritumoral edema. Conclusion Although these peculiar radiological characteristics are not unique to sclerosing meningioma, we believe that they are distinctive features that may be helpful for distinguishing sclerosing meningioma from other subtypes.
Collapse
Affiliation(s)
- Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Young-Bem Se
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Yun-Sik Dho
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
21
|
Boukobza M, Cebula H, Pop R, Kouakou F, Sadoun A, Coca HA, Polivka M, Diemidio P, Ganau M, George B, Froelich S, Proust F, Chibbaro S. Cystic meningioma: radiological, histological, and surgical particularities in 43 patients. Acta Neurochir (Wien) 2016; 158:1955-64. [PMID: 27510826 DOI: 10.1007/s00701-016-2898-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/13/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of cysts is a rare occurrence for intracranial meningiomas in adults. We report our experience in a large consecutive series of cystic meningiomas. METHOD We prospectively collected data for a dedicated database of cystic meningioma cases between January 2004 and December 2011 in two tertiary neurosurgical centers. Studied data included preoperative imaging, surgical records, and pathology reports. RESULTS Among 1214 surgeries for intracranial meningioma, we identified 43 cases of cystic meningioma, corresponding to an incidence of 3.5 %. The most common localization was the hemispheric convexity (17/43 cases). Twenty-eight patients had intratumoral cysts, nine peritumoral, and five mixed intra and extratumoral. In 29 patients with available diffusion imaging, ADC coefficients were significantly lower in grade II-III tumors compared to grade I (p = 0.01). Complete resection of the cystic components was possible in 27/43 patients (63 %); partial resection in 4/43 (9 %); in 6/43 (14 %) cyst resection was not possible but multiple biopsies were performed from the cystic walls; in another 6/43 (14 %) the cystic wall was not identified during surgery. Cells with neoplastic features were identified within the cyst walls at pathology in 26/43 cases (60 %). All patients were followed-up for 24 months; long-term follow-up was available only in 32 patients for an average period of 49 months (range, 36-96 months). No recurrence requiring surgery was observed. CONCLUSIONS Cystic meningiomas are rare. Cells with neoplastic features are often identified within the cyst walls. Complete cyst resection is recommendable when considered technically feasible and safe.
Collapse
Affiliation(s)
- Monique Boukobza
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France
| | - Helene Cebula
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Raoul Pop
- Department of Interventional Neuroradiology UF6954, Hautepierre University Hospital, 1 Avenue Moliere, 67098, Strasbourg, France.
| | - Fulbert Kouakou
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Amirouche Sadoun
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Hugo Andres Coca
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Marc Polivka
- Department of Histopathology, Lariboisière University Hospital, Paris, France
| | - Paolo Diemidio
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Mario Ganau
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Bernard George
- Department of Neurosurgery, Lariboisière University Hospital, Paris, France
| | - Sebastien Froelich
- Department of Neurosurgery, Lariboisière University Hospital, Paris, France
| | - Francois Proust
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Salvatore Chibbaro
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
- Department of Neurosurgery, Lariboisière University Hospital, Paris, France
| |
Collapse
|
22
|
Terada Y, Toda H, Okumura R, Ikeda N, Yuba Y, Katayama T, Iwasaki K. Reticular Appearance on Gadolinium-enhanced T1- and Diffusion-weighted MRI, and Low Apparent Diffusion Coefficient Values in Microcystic Meningioma Cysts. Clin Neuroradiol 2016; 28:109-115. [DOI: 10.1007/s00062-016-0527-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
|
23
|
Kunimatsu A, Kunimatsu N, Kamiya K, Katsura M, Mori H, Ohtomo K. Variants of meningiomas: a review of imaging findings and clinical features. Jpn J Radiol 2016; 34:459-69. [PMID: 27138052 DOI: 10.1007/s11604-016-0550-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 04/14/2016] [Indexed: 01/28/2023]
Abstract
Meningiomas are common neoplasms that frequently occur in the brain and spine. Among the 15 histological subtypes of meningiomas in the WHO classification, the incidence of meningothelial meningiomas is the highest, followed by fibrous and transitional meningiomas. These three subtypes account for approximately 80 % of all meningiomas, and thus could be regarded as typical meningiomas. For this reason, other uncommon histological subtypes may be considered as imaging variants, and diagnosis is often challenging for radiologists solely based on imaging features of typical meningiomas. In addition to the histological subtypes, meningiomas arising in atypical locations could be easily mistaken for other lesions more commonly observed in those locations. The purpose of this article is to review characteristic clinical and imaging findings of uncommon meningiomas, including histological variants and meningiomas occurring in relatively rare locations.
Collapse
Affiliation(s)
- Akira Kunimatsu
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Natsuko Kunimatsu
- Department of Radiology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Kouhei Kamiya
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaki Katsura
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Harushi Mori
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kuni Ohtomo
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,International University of Health and Welfare, Otawara, Japan
| |
Collapse
|
24
|
Fogh SE, Johnson DR, Barker FG, Brastianos PK, Clarke JL, Kaufmann TJ, Oberndorfer S, Preusser M, Raghunathan A, Santagata S, Theodosopoulos PV. Case-Based Review: meningioma. Neurooncol Pract 2016; 3:120-134. [PMID: 31386096 DOI: 10.1093/nop/npv063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Indexed: 12/30/2022] Open
Abstract
Meningioma is by far the most common primary intracranial tumor in adults. Treatment of meningioma is complex due to a tremendous amount of variability in tumor behavior. Many patients are incidentally found to have tumors that will remain asymptomatic throughout their lives. It is important to identify these patients so that they can be spared from potentially morbid interventions. On the other end of the spectrum, high-grade meningiomas can behave very aggressively. When treatment is necessary, surgical resection is the cornerstone of meningioma therapy. Studies spanning decades have demonstrated that extent of resection correlates with prognosis. Radiation therapy, either in the form of external beam radiation therapy or stereotactic radiosurgery, represents another important therapeutic tool that can be used in place of or as a supplement to surgery. There are no chemotherapeutic agents of proven efficacy against meningioma, and chemotherapy treatment is generally reserved for patients who have exhausted surgical and radiotherapy options. Ongoing and future studies will help to answer unresolved questions such as the optimum use of radiation in resected WHO grade II meningiomas and the efficacy of additional chemotherapy agents.
Collapse
Affiliation(s)
- Shannon E Fogh
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Derek R Johnson
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Fred G Barker
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Priscilla K Brastianos
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Jennifer L Clarke
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Timothy J Kaufmann
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Stephan Oberndorfer
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Matthias Preusser
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Aditya Raghunathan
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Sandro Santagata
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| | - Philip V Theodosopoulos
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA (S.E.F.); Department of Radiology, Mayo Clinic, Rochester, MN, USA (D.R.J., T.J.K.); Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (F.G.B.); Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (P.K.B.); Department of Neurology and Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (J.L.C.); Department of Neurology, Karl Landsteiner University Clinic, St Pölten, Austria (S.O.); Department of Internal Medicine, Medical University, Vienna, CCC, Austria (M.P.); Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA (A.R.); Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (S.S.); Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA (P.V.T.)
| |
Collapse
|
25
|
Abstract
Extra-axial brain tumors are the most common adult intracranial neoplasms and encompass a broad spectrum of pathologic subtypes. Meningiomas are the most common extra-axial brain tumor (approximately one-third of all intracranial neoplasms) and typically present as slowly growing dural-based masses. Benign meningiomas are very common, and may occasionally be difficult to differentiate from more aggressive subtypes (i.e., atypical or malignant varieties) or other dural-based masses with more aggressive biologic behavior (e.g., hemangiopericytoma or dural-based metastases). Many neoplasms that typically affect the brain parenchyma (intra-axial), such as gliomas, may also present with primary or secondary extra-axial involvement. This chapter provides a general and concise overview of the common types of extra-axial tumors and their typical imaging features.
Collapse
Affiliation(s)
- Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| | - James G Smirniotopoulos
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
26
|
Differentiation of benign angiomatous and microcystic meningiomas with extensive peritumoral edema from high grade meningiomas with aid of diffusion weighted MRI. BIOMED RESEARCH INTERNATIONAL 2014; 2014:650939. [PMID: 25478572 PMCID: PMC4248374 DOI: 10.1155/2014/650939] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/29/2014] [Accepted: 06/16/2014] [Indexed: 11/29/2022]
Abstract
Objective. To determine whether angiomatous and microcystic meningiomas which mimic high grade meningiomas based on extent of peritumoral edema can be reliably differentiated as low grade tumors using normalized apparent diffusion coefficient (ADC) values. Methods. Preoperative magnetic resonance imaging (MRI) of seventy patients with meningiomas was reviewed. Morphologically, the tumors were divided into 3 groups. Group 1 contained 12 pure microcystic, 3 pure angiomatoid and 7 mixed angiomatoid and microcystic tumors. Group 2 included World Health Organization (WHO) grade II and WHO grade III tumors, of which 28 were atypical and 9 were anaplastic meningiomas. Group 3 included WHO grade I tumors of morphology different than angiomatoid and microcystic. Peritumoral edema, normalized ADC, and cerebral blood volume (CBV) were obtained for all meningiomas. Results. Edema index of tumors in group 1 and group 2 was significantly higher than in group 3. Normalized ADC value in group 1 was higher than in group 2, but not statistically significant between groups 1 and 3. CBV values showed no significant group differences. Conclusion. A combination of peritumoral edema index and normalized ADC value is a novel approach to preoperative differentiation between true aggressive meningiomas and mimickers such as angiomatous and microcystic meningiomas.
Collapse
|
27
|
Matano F, Adachi K, Murai Y, Kitamura T, Ohashi R, Teramoto A, Morita A. Microcystic meningioma with late-phase accumulation on thallium-201 single-photon emission computed tomography: case report. Neurol Med Chir (Tokyo) 2014; 54:686-9. [PMID: 24418788 PMCID: PMC4533491 DOI: 10.2176/nmc.cr.2013-0220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Microcystic meningiomas are rare but benign brain tumors. Previous reports have shown that Thallium-201 single-photon emission computed tomography ((201)Tl SPECT) demonstrated a higher late-phase accumulation of (201)Tl in malignant or recurrent meningiomas than in nonaggressive meningiomas. No study has reported (201)Tl SPECT findings in microcystic meningiomas. We here describe a case of a microcystic meningioma with a high (201)Tl SPECT retention rate in a 62-year-old woman who complained of headache. Computed tomography revealed an intracranial tumor in the right frontal lobe. Moreover, (201)Tl SPECT revealed a high uptake of (201)Tl in the tumor, which was particularly prominent in the delayed phase. The uptake index on an early image was 1.46 and that on a delayed image was 1.35. Therefore, the retention index was 0.92. After 2 years of tumor growth, we performed successful radical resection, and histological examination revealed the presence of a microcystic meningioma. Therefore, we concluded that (201)Tl SPECT may be useful for the preoperative diagnosis of microcystic meningiomas and that late-phase accumulation of (201)Tl is not a specific finding of malignant brain tumors. Therefore, we need to be careful in the evaluation and judgment of high retention in a delayed image of (201)Tl SPECT.
Collapse
|
28
|
Magnetic resonance imaging of meningiomas: a pictorial review. Insights Imaging 2014; 5:113-22. [PMID: 24399610 PMCID: PMC3948902 DOI: 10.1007/s13244-013-0302-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/14/2013] [Accepted: 11/20/2013] [Indexed: 01/17/2023] Open
Abstract
UNLABELLED Meningiomas are the most common non-glial tumour of the central nervous system (CNS). There are a number of characteristic imaging features of meningiomas on magnetic resonance imaging (MRI) that allow an accurate diagnosis, however there are a number of atypical features that may be diagnostically challenging. Furthermore, a number of other neoplastic and non-neoplastic conditions may mimic meningiomas. This pictorial review discusses the typical and atypical MRI features of meningiomas and their mimics. TEACHING POINTS There are several characteristic features of meningiomas on MRI that allow an accurate diagnosis Some meningiomas may display atypical imaging characteristics that may be diagnostically challenging Routine MRI sequences do not reliably distinguish between benign and malignant meningiomas Spectroscopy and diffusion tensor imaging may be useful in the diagnosis of malignant meningiomas A number of conditions may mimic meningiomas; however, they may have additional differentiating features.
Collapse
|
29
|
Ichimura S, Hara K, Shimokawa R, Kagami H, Inaba M. A case of intraosseous microcystic meningioma without a mass lesion. Neurol Med Chir (Tokyo) 2013; 53:699-702. [PMID: 24064568 PMCID: PMC4508748 DOI: 10.2176/nmc.cr2012-0124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Both intraosseous and microcystic meningiomas are rare tumor types. We report the case of a 66-year-old woman with intraosseous microcystic meningioma without a mass lesion. She presented with a rare intraosseous microcystic meningioma manifesting as pain. Radiological examination revealed an osteolytic lesion in the right parietal bone. Magnetic resonance (MR) images showed iso- to hypointensity on T1-weighted images and hyperintensity on T2-weighted images corresponding to the lesion. T1-weighted MR imaging with gadolinium enhancement better defined the marginal area. The inner table of the skull was disrupted prominently, and both sides of the outer table were eroded. There was fluid leakage during surgery but no obvious tumor mass. Histological examination revealed microcystic meningioma in the inner part of the defective bone. A macroscopic lesion was not found, because most of the tumor comprised microcysts, and their contents leaked out during the surgical procedure. Intraosseous microcystic meningioma may be considered as one of the differential diagnoses when the intraosseous tumor in the skull has fluid leakage and does not have a mass lesion during the surgery.
Collapse
Affiliation(s)
- Shinya Ichimura
- Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital
| | | | | | | | | |
Collapse
|
30
|
Tamura R, Tomita H, Shimizu K, Sugiyama K. Low-grade meningioma showing nearly equal density with spinal fluid on radiographic images. BMJ Case Rep 2013; 2013:bcr-2013-009554. [PMID: 23813510 DOI: 10.1136/bcr-2013-009554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 61-year-old woman had an intracranial tumour that was located on the falx. Meningioma was suspected and the tumour rapidly grew over 1 year. It showed nearly equal density with spinal fluid showing almost no enhancement on radiographic images, like microcystic meningioma. Successful removal of the tumour was achieved. Histopathologically, the tumour was diagnosed as low-grade meningioma. The meningioma had variable sized microcysts and the appearance of solid area was meningothelial meningioma. This is a rare radiographic image for meningothelial meningioma.
Collapse
Affiliation(s)
- Ryota Tamura
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga City, Japan
| | | | | | | |
Collapse
|
31
|
Manwaring J, Ahmadian A, Stapleton S, Gonzalez-Gomez I, Rodriguez L, Carey C, Tuite GF. Pediatric microcystic meningioma: a clinical, histological, and radiographic case-based review. Childs Nerv Syst 2013; 29:361-5. [PMID: 23250249 DOI: 10.1007/s00381-012-1991-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Microcystic meningioma (MM) is a World Health Organization grade I tumor that is rare in the pediatric population. Meningiomas account for approximately 2-4 % of all childhood central nervous system (CNS) tumors compared to approximately 20 % of all adult CNS tumors. The authors present one of the few confirmed cases of microcystic meningioma in a child and discuss the characteristic radiographic appearance and histological findings. HISTORY We report the case of an 11-year-old boy who presented with first-time seizure and imaging consistent with brain tumor. There was significant vasogenic edema within the entire right hemisphere, disproportionate to the size of the falcine-based tumor. Histopathological analysis revealed the microcystic subtype of meningioma. DISCUSSION We review the radiographic characteristics, histopathological findings, and reported pediatric cases of MM in conjunction with our case. CONCLUSION MM has distinct radiographic characteristics (variable enhancement, lack of a dural tail, and disproportionate vasogenic edema) that can be misinterpreted in the pediatric population, suggesting a more aggressive tumor.
Collapse
Affiliation(s)
- Jotham Manwaring
- Department of Neurosurgery and Brain Repair, Morsani School of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | | | | | | | | |
Collapse
|
32
|
Osawa T, Tosaka M, Nagaishi M, Yoshimoto Y. Factors affecting peritumoral brain edema in meningioma: special histological subtypes with prominently extensive edema. J Neurooncol 2012; 111:49-57. [PMID: 23104516 DOI: 10.1007/s11060-012-0989-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 10/10/2012] [Indexed: 11/30/2022]
Abstract
Various degrees of peritumoral brain edema (PTBE) are observed in patients with intracranial meningiomas. Factors affecting the occurrence of PTBE in intracranial meningioma were investigated. PTBE was investigated retrospectively for 110 patients with primary intracranial meningiomas. Predictive factors related to PTBE were analyzed, for example patient age, sex, magnetic resonance imaging features (contrast enhancement, tumor shape, tumor location, tumor volume), angiographical features (tumor stain, pial-cortical arterial supply, venous obstruction), and histopathological features (histological subtypes, mindbomb homolog 1 labeling index (MIB1-LI)). Histological subtypes were classified into World Health Organization (WHO) grade I common type (meningothelial, transitional, fibrous), grade I uncommon type, and grade II and III types. The extent of PTBE was assessed by calculation of the edema index (EI). PTBE was present in 53 cases (48 %). Male sex, heterogeneous enhancement, superficial location, tumor volume (≥10 cm(3)), remarkable tumor stain, pial supply, venous obstruction, malignant pathology, and MIB1-LI ≥4 % were correlated with PTBE in univariate analysis. Pial supply and remarkable tumor stain were correlated with PTBE in multivariate analysis. WHO grade I uncommon type had obviously higher EI than WHO grade I common type, and WHO grade II and III types (P < 0.001). Seven cases with prominently high EI (EI ≥10) were all WHO grade I uncommon type, including angiomatous, microcystic, secretory, and lymphoplasmacyte-rich meningioma. Prominently extensive PTBE might indicate the presence of WHO grade I uncommon type meningioma.
Collapse
Affiliation(s)
- Tadashi Osawa
- Department of Neurosurgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | | | | | | |
Collapse
|
33
|
Sphenoid ridge meningioma with increased intracranial pressure caused by venous congestion. Acta Neurochir (Wien) 2012; 154:1945-6. [PMID: 22914909 DOI: 10.1007/s00701-012-1477-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 08/05/2012] [Indexed: 10/28/2022]
|
34
|
Perfusion MR imaging and 1H spectroscopy: Their role in the diagnosis of microcystic and lipomatous meningiomas. J Neuroradiol 2010; 37:185-8. [DOI: 10.1016/j.neurad.2009.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 08/17/2009] [Accepted: 08/19/2009] [Indexed: 11/21/2022]
|
35
|
Park KJ, Kang SH, Chae YS, Yu MO, Cho TH, Suh JK, Lee HK, Chung YG. Influence of interleukin-6 on the development of peritumoral brain edema in meningiomas. J Neurosurg 2010; 112:73-80. [DOI: 10.3171/2009.4.jns09158] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Object
Peritumoral brain edema (PTBE) is associated with perioperative neurological deficits in patients with meningiomas. However, the pathogenesis of meningioma-associated edema remains unclear. In the present study, the authors investigated the expression of interleukin-6 (IL-6) and its relationship with PTBE in resected meningiomas.
Methods
Thirty-six benign meningiomas obtained in 36 patients were studied retrospectively. Edema volume was assessed on MR images, and an edema index (EI) was calculated. Interleukin-6 mRNA and protein expression were examined by real-time reverse transcriptase polymerase chain reaction and immunohistochemical staining.
Results
Peritumoral brain edema was found in 16 patients (44%). Neither age, sex, histological subtype, nor tumor location were related to PTBE. The level of IL-6 mRNA was 7.72 times greater in the edema group (EI > 0.2) than in the nonedema group (EI < 0.2; p = 0.011). On immunohistochemical analysis, IL-6 protein was found localized in the cytoplasm of the tumor cells, and was detected in 12 (75%) of 16 cases of edematous meningiomas, but in only 6 (30%) of 20 nonedematous cases. There was a significant correlation between the severity of PTBE and IL-6 expression (p = 0.004).
Conclusions
The authors' results in this study indicate that IL-6 expression may contribute to the development of brain edema associated with meningiomas.
Collapse
Affiliation(s)
| | | | - Yang-Seok Chae
- 2Pathology, Korea University Anam Hospital, College of Medicine; and
| | - Mi-Ok Yu
- 1Departments of Neurosurgery and
- 3School of Life Sciences and Biotechnology, Korea University, Seoul, Korea
| | | | | | | | | |
Collapse
|
36
|
Zhang D, Hu LB, Zhen JW, Zou LG, Feng XY, Wang WX, Wen L. MRI findings of intracranial cystic meningiomas. Clin Radiol 2009; 64:792-800. [PMID: 19589418 DOI: 10.1016/j.crad.2009.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/15/2009] [Accepted: 04/28/2009] [Indexed: 11/29/2022]
Abstract
AIM To report the magnetic resonance imaging (MRI) features of intracranial cystic meningiomas and compare these features in intra- and peritumoural cyst groups. MATERIALS AND METHODS Fourteen cases of peritumoural cystic meningiomas were compared with 18 cases of intratumoural cystic meningiomas. All patients were examined using non-enhanced and contrast-enhanced MRI. Tumour location, tumour size, signal intensity, enhancement characteristics, and cystic changes were assessed. The MRI features were compared between the intra- and peritumoural cyst groups. RESULTS Most cystic meningiomas comprised two or more cysts. The solid parts of the tumours showed moderate or marked enhancement after the injection of contrast material. An enhanced cyst wall was found in six out of 14 cases in the peritumoural cyst group, but not in the intratumoural cyst group. Peritumoural cystic meningiomas were predominately located in the cerebral falx, whereas the intratumoural cystic meningiomas were predominantly found in frontal convexity (X(2)=7.434, p=0.024). The cysts were larger in the peritumoural cyst group than in the intratumoural cyst group (t=5.274, p=0.0258). Peritumoural oedema was more commonly found in the intratumoural cyst group (X(2)=6.863, p=0.008). Cystic meningiomas with solid parts located inside the cyst are reported for the first time. CONCLUSION Cystic meningiomas, although uncommon, should be differentiated from other cystic intracranial lesions. Peri- and intratumoural cystic meningiomas have distinct MRI features. The present study provides the first report of two lesions with solid parts located inside the cyst, as well as one lesion with a calcified solid nodule and haemorrhage within the cyst.
Collapse
Affiliation(s)
- D Zhang
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing 400037, P. R. China
| | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
|
39
|
Miclard J, Mokhtari K, Jouvion G, Wyrzykowski B, Van Canneyt O, Wyers M, Colle MA. Microcystic meningioma in a dolphin (Delphinus delphis): immunohistochemical and ultrastructural study. J Comp Pathol 2007; 135:254-8. [PMID: 17101337 DOI: 10.1016/j.jcpa.2006.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 08/17/2006] [Indexed: 11/24/2022]
Abstract
A wild common dolphin was found stranded on the French Atlantic coast. At necropsy, an intracranial grey- to tan-coloured mass (7 x 5 x 4 cm) was found at the right cerebellopontine angle, compressing the right cerebellar hemisphere, the brainstem and the occipital lobe of the right cerebral hemisphere. Microscopically, the tumour was composed of small lobules of polygonal to elongated neoplastic cells with multifocal areas of stellate and vacuolated cells. Neoplastic cells strongly expressed vimentin, S-100 protein and neuron-specific enolase. They were rarely positive for cytokeratin. Ultrastructurally, the neoplastic cells displayed all the diagnostic features of meningiomas and in some areas showed long cytoplasmic processes delimiting extracellular spaces. The immunohistochemical and ultrastructural features were consistent with the histopathological diagnosis of a microcystic meningioma. This is the first report of a meningioma in dolphins or in any other cetacean species.
Collapse
Affiliation(s)
- J Miclard
- Unité d'Anatomie Pathologique, UMR 703 INRA/ENVN, Ecole Nationale Vétérinaire de Nantes, BP 40706 Nantes Cedex 03, France
| | | | | | | | | | | | | |
Collapse
|
40
|
Matsushima N, Maeda M, Takamura M, Matsubara T, Taki W, Takeda K. MRI findings of atypical meningioma with microcystic changes. J Neurooncol 2006; 82:319-21. [PMID: 17177106 DOI: 10.1007/s11060-006-9285-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Accepted: 10/19/2006] [Indexed: 10/23/2022]
|