Primary extracranial meningiomas: an analysis of 146 cases

Primary Typical Meningioma of the Sphenoid Sinus: A Case Report and Literature Review

Primary cranial meningioma is extremely rare and only rarely described in clinical practice, as is primary sinus ectopic meningioma. We detailed the surgical management of a female patient, aged 83, who had a primary meningioma of the sphenoid sinus. This uncommon clinical entity was the subject of a study of the literature, and its prognosis was summarized.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-024-04722-8.

Association of imaging classification and histopathological grading in primary intraosseous meningioma of the skull

BACKGROUND

Primary intraosseous meningioma of the skull (PIMS) is a rare type of primary extradural meningioma (PEM) involving cranial bone. The existing literature strongly suggest the importance of radiological feacures in pathological diagnosis of PIMS. Thereby, the aim of this study is to investigate the association between imaging classification and histopathological grading in PIMS.

METHODS

In this retrospective study, we retrospectively analyzed the computed tomography scan/magnetic resonance imaging and pathological data pertaining to patients with pathologically proven PIMS. The association between radiological features, imaging classification, and histopathological grading was analyzed using logistic regression analysis.

RESULTS

In this study, data of 25 patients with PIMS were assessed. The univariate logistic regression analysis results showed significant correlation between histopathological grading and imaging classification (OR: 22.5; 95% CI: 2.552-198.378; p = 0.005), intra- and extracalvarial extension (OR: 7.2; 95% CI: 1.066-48.639; p = 0.043), and tumor margin (OR: 7.19; 95% CI: 1.06-47.61; p = 0.043). According to the results of multivariate logistic regression analysis, imaging classification was the strongest independent risk factor for high-grade PIMS, and the risk of aggressiveness of osteoblastic type of PIMS was 16.664 times higher than that of osteolytic type of PIMS (OR: 16.664; 95% CI: 1.15-241.508; p = 0.039).

CONCLUSIONS

Imaging classification is an independent risk factor for high-grade PIMS.

The FGF6 amplification mutation plays an important role in the progression and treatment of malignant meningioma

Meningioma is a benign tumor with slow growth and long course. However, patients with recurrent malignant meningioma still face a lack of effective treatment. Here, we report a rare case of primary mediastinal malignant meningioma with lung and bone metastases, who benefited from the treatment of apatinib (≥33 months) and anlotinib (until the publication date). Retrospective molecular analysis revealed the frequent amplification of FGF6 in primary and metastatic lesions. Then we constructed the FGF6 over-expressed IOMM-LEE and CH157MN malignant meningioma cell lines, and in vitro and vivo experiments showed that overexpression of FGF6 can promote the proliferation, migration and invasion of malignant meningioma cells. Based on the Western analysis, we revealed that FGF6 can promote the phosphorylation of FGFR, AKT, and ERK1/2, which can be inhibited by anlotinib. Together, we were the first to verify that overexpression of FGF6 promotes the progression of malignant meningiomas by activating FGFR/AKT/ERK1/2 pathway and pointed out that anlotinib may effectively inhibit the disease progression of patients with FGF6 amplification.

Primary extradural meningioma with a history of traumatic head injury during infancy: A case report

INTRODUCTION AND IMPORTANCE

Meningiomas are an extra-axial tumour arising from arachnoid cells and are typically benign and slow growing. Primary extradural meningiomas refer to meningiomas that arise outside the subdural compartment and are extremely rare (0.3 % of meningiomas).

CASE PRESENTATION

A 42-year-old female presented to her primary health care provider with a 2-year history of a painful mass on her left forehead with a past medical history of a traumatic brain injury and intracranial hematoma from a motor vehicle accident when she was 11 months old. An ultrasound reported as likely sebaceous cyst. The lesion was resected and sent for pathological examination. The diagnostic summary reported an ectopic subgaleal left frontal meningioma WHO Grade 1.

CLINICAL DISCUSSION

Extracranial meningiomas have been divided into two classifications; primary extracranial meningiomas and secondary extracranial meningiomas. In the female population group 88 % of extracranial meningiomas found on the scalp/skin are grade 1 meningiomas. Most extracranial meningiomas are diagnosed after histology examination, due to the rarity. They can arise via entrapment of arachnoid cells during embryologic development and from traumatic events displacing arachnoid cells.

CONCLUSION

The authors suggest that the patient's aetiology of her PEM is from the entrapment of arachnoid islet cells secondary to her traumatic brain injury during infancy. Interestingly, the patients' symptoms began 40 years post trauma. Other case studies of this rare tumour have correlated a shorter time period between the trauma and the diagnosis. We suggest that all patients should have radiographic and histologic investigations of scalp masses.

FNA of Meningioma with Rhabdoid Features Presenting as a Lateral Neck Mass

Primary meningioma at extracranial head and neck sites is uncommon. Since fine needle aspiration (FNA) is often the first line diagnostic modality for the evaluation of masses in the head and neck, extracranial meningiomas can create a significant diagnostic pitfall for FNA. We report a case of meningioma with rhabdoid features and BAP1 loss in a 26-year-old woman, presenting as a large neck mass along the carotid sheath. FNA biopsy of the mass demonstrated a highly cellular specimen with clusters of uniform, epithelioid cells with round to ovoid nuclei and moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel performed on cell block sections showed that the tumor cells were weakly EMA positive, progesterone receptor was focally positive, and SSTR2A was diffuse and strongly positive. BAP1 immunohistochemistry showed a diffuse loss of expression in the tumor cells. After the cytologic diagnosis of meningioma, a tissue biopsy was performed, and the diagnosis of meningioma with rhabdoid features and BAP1 loss was confirmed. We also perform a literature review of meningioma cases presenting as a neck mass and evaluated by FNA. Our case highlights the significant diagnostic challenges that can be caused by extracranial meningiomas on FNA and the importance of ancillary studies to avoid diagnostic pitfalls.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial, we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case. Pulmonary meningothelial proliferative lesions, including primary pulmonary meningiomas, minute pulmonary meningothelial-like nodules, and metastatic pulmonary meningiomas are rare pulmonary lesions. These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations. Herein, we briefly introduce the clinical, imaging, and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Extracranial Meningioma-Pelvic Bone on FDG PET/CT: A Rare of the Rarest Site

ABSTRACT

Meningiomas are benign extra-axial tumors of the central nervous system. Extracranial meningiomas are extremely rare (2%) and can develop as a direct extension from a primary intracranial meningioma or as a true primary extracranial meningioma originating from ectopic arachnoid cells. We report an extremely unusual case of a 61-year-old woman who was diagnosed with pelvic meningioma with the help of PET/CT and PET/CT-guided biopsy. The clinicopathological features of the patient and immunoprofile of the tumor are presented.

External auditory canal ectopic atypical meningioma: A case report and brief literature review

Meningiomas are tumours typically derived from the meningothelial cells of the arachnoid mater. They most often arise in intracranial, intraspinal, or orbital locations. Ectopic meningiomas, described as primary meningiomas with no intracranial involvement, are definitely unconventional. In fact, most of the extracranial meningiomas described in the literature, particularly in the outer ear, are effectively spreads of disease with primary intracranial localization. We describe a case of a primary external auditory canal meningioma with demonstrated absence of intracranial involvement, and we provide a full radiological, histological, immunohistochemical and molecular characterization of the lesion.

Extracranial Meningioma En Plaque With Skull Invasion

The study reflects on a 69-year-old female patient with a history of cardio-respiratory disorders who was diagnosed with meningioma en plaque. Her clinical management entailed surgical resection of the tumor, which was followed by a complex postoperative course, including cardiorespiratory arrest and respiratory failure. Histologically, extracranial meningiomas are categorized into five subtypes based on predominant cellular morphology, with the meningothelial type being prevalent in this case. The report also examines the significance of complete tumor resection, noting a lower recurrence rate with gross total resection. Additionally, it discusses the increased susceptibility of extracranial meningiomas with advancing age and a higher incidence in females. Data from various studies underscore the importance of a surgical approach and extent of resection in predicting recurrence risk. The case report concludes by highlighting the critical aspects of the pathology of meningiomas and the surgical strategy that ensured the patient's recovery. The findings from this case contribute to the broader understanding of extracranial meningiomas, their diagnosis, and management.

Complete loss of E-cadherin expression in a rare case of metastatic malignant meningioma: a case report

BACKGROUND

Hematogenous tumor spread of malignant meningiomas occurs very rarely but is associated with very poor prognosis.

CASE PRESENTATION

We report an unusual case of a patient with a malignant meningioma who developed multiple metastases in bones, lungs and liver after initial complete resection of the primary tumor. After partial hepatic resection, specimens were histologically analyzed, and a complete loss of E-cadherin adhesion molecules was found. No oncogenic target mutations were found. The patient received a combination of conventional radiotherapy and peptide receptor radionuclide therapy (PRRT). Due to aggressive tumor behavior and rapid spread of metastases, the patient deceased after initiation of treatment.

CONCLUSIONS

E-cadherin downregulation is associated with a higher probability of tumor invasion and distant metastasis formation in malignant meningioma. Up to now, the efficacy of systemic therapy, including PRRT, is very limited in malignant meningioma patients.

Humps and bumps of head: review of meningiomas of the scalp

Meningiomas are a type of tumor that arises from meningothelial cells and primarily develops in intracranial space, being some of the most common benign tumors of the central nervous system. However, meningiomas can rarely occur on the scalp and are called primary cutaneous meningiomas. Since the pathogenesis of these lesions is still uncertain, these tumors still pose challenges in terms of histopathological diagnosis. In this review, we will discuss the main cases of scalp meningiomas in the literature, their classification, pathological and immunohistochemical diagnosis, differential diagnosis with other scalp lesions and the most effective treatment. This study highlights the importance of immunohistochemistry in the differential diagnosis of skin lesions located on the scalp.

Primary extracranial meningioma of the pelvis discovered on screening pelvic examination

Many conditions that affect a woman's health can be evaluated through the pelvic examination. Early detection and treatment of a range of gynaecologic and non-gynaecological conditions, including unusual pelvic masses, may decrease a woman's morbidity and mortality. Here, we have a female patient in her early 20s who was found to have a mass on her first screening pelvic examination. Subsequent imaging followed by surgical resection were performed with the final diagnosis of a pelvic meningioma. Routine pelvic examinations in asymptomatic women may be more useful than merely screening for cervical cancer and sexually transmitted infections. Once detected, the differential diagnosis of a pelvic mass may include aetiologies outside of the gynaecological organ system.

Parapharyngeal meningioma extending through foramen ovale: a case report

BACKGROUND

Meningioma is a common non-glial tumor of the brain. Extracranial meningiomas in the parapharyngeal space are especially rare. Herein we report a case of extracranial meningioma in the parapharyngeal space and give a comprehensive description of its complete clinical course and radiological findings, which may provide helpful information in the diagnosis and treatment of extracranial meningiomas in the parapharyngeal space.

CASE PRESENTATION

A 61-year-old man presented a slowly increased mass under the left ear without pain and numbness over one year. Ultrasound examination detected a hypoechoic uneven mass behind the left parotid gland with a clear boundary, and color Doppler flow imaging revealed blood flow signals within the mass. Unenhanced computed tomography (CT) of the craniofacial region revealed a homogenous soft tissue mass in the parapharyngeal space without calcification. Magnetic resonance imaging (MRI) showed that a homogenous soft tissue mass was hyperintense on T2-weighted image, hypointense on T1-weighted image, and obviously enhanced after contrast enhancement in the parapharyngeal space. Coronal MRI showed that the lesion originated from basicranial dura extending into parapharyngeal space through the left foramen ovale at the skull base. Finally, histopathological and immunohistochemical analyses confirmed the final diagnosis of extracranial meningiomas in the parapharyngeal space.

CONCLUSION

Extracranial meningiomas of the parapharyngeal space are rare and often pose a diagnostic challenge. Preoperative imaging examinations, especially CT and MRI, can aid in the accurate preoperative diagnosis, especially when intracranial extensions and dural tail signs are observed.

Malignant and Nonmalignant Sinonasal Tumors

Sinonasal tumors are rare, diverse, complex lesions with overlapping demographic and clinical features. Malignant tumors are more common, with a grave prognosis, and require biopsy for accurate diagnosis. This article briefly reviews the classification of sinonasal tumors and provides imaging examples and imaging characteristics of each clinically important nasal and paranasal mass lesions. Although there are no true pathognomonic imaging features, it is important for the radiologist to have a broad knowledge of the various CT and MR imaging findings that can help narrow the differential diagnosis and aid in early diagnosis and mapping of tumor for treatment planning.

Primary nasosinus meningioma, an etiology masks another: Case report

INTRODUCTION AND IMPORTANCE

Extracranial meningiomas of the sinonasal tract are rare tumors. The diagnosis is not generally evident. We report, through an observation, the clinical particularities, the diagnostic difficulties and the therapeutic approach of primary sinonasal meningiomas.

CASE PRESENTATION

We report the case of a 54-year-old woman who presented with complaints of right nasal obstruction with the notion of recurrent epistaxis evolving for one year. At the examination, nasal endoscopy found a voluminous purplish-gray mass filling both the middle meatus and the olfactory cleft. The CT examination showed an ethmoïdonasal tumoral process extending to orbital cavity and infratemporal fossa without endocranial extension. A transnasal approach was performed, histopathological examination demonstrates a méningothélial meningioma rank1. The clinical, endoscopic and CT controls did not show tumor residue or a local recurrence.

CLINICAL DISCUSSION

Meningioma is a common non-glial intracranial neoplasm. Primary or secondary extracranial meningioma (depending on whether they are isolated or associated with an intracranial tumor) location is uncommon, clinical presentation is nonspecific. Diagnostic confirmation is anatomopathological with immunohistochemically study. Imaging confirms the primary nature of these tumors. The prognosis is favorable after complete surgical excision without further adjuvant treatment.

CONCLUSION

Primary nasosinus meningiomas are rare, with non-specific symtomatology and common with other local pathologies. Imaging confirms the primary character of these tumors, anatomopathological examination completed by immunohistochemical study confirms the diagnosis. Surgery with complete exeresis remains the best option with a good prognosis.

Extracranial Nasosinusal Meningioma: A Case Report of a Rare Entity

Meningiomas are the most common neoformations of the central nervous system, and represent the 33% of all intracranial neoplasms. The nasosinusal tract is involved in 24% of cases of extracranial localization. The aim of our paper is to present the case of a patient with an ethmoidal sinus meningioma.

Top 10 Nested Pattern Head and Neck Lesions to Notice

BACKGROUND

Nested is defined as "cellular clusters arranged in small groupings with intervening vascular or stromal networks, lacking lumens or glandular formation." Using this definition, multiple neoplastic and non-neoplastic lesions of the head and neck come into the differential. We have broadly organized the differential diagnosis of "nested" tumors into entities with neuroendocrine differentiation, squamous differentiation, thyroid follicular cell differentiation, and other lesions.

METHODS

Review.

RESULTS

Many different entities have a nested appearance and the morphologic, immunohistochemical, clinical, and radiographic features contribute to the differential diagnosis. The different tumors covered in this review include neuroendocrine neoplasms, paraganglioma, middle ear neuroendocrine tumor (formerly known as middle ear adenoma), medullary thyroid carcinoma, poorly differentiated thyroid carcinoma, olfactory neuroblastoma, ectopic pituitary neuroendocrine tumor, hyalinizing trabecular tumor, solid subtype of papillary thyroid carcinoma, solid cell nests/C-cell hyperplasia, necrotizing sialometaplasia, and meningioma.

CONCLUSION

In this review, we discuss the morphologic and immunohistochemical features of the covered entities as a guide to differential diagnosis when nested-patterned head and neck lesions are encountered.

Rare case of extracranial chordoid meningioma adjacent to the carotid sheath: illustrative case

BACKGROUND

Chordoid meningioma is a rare World Health Organization (WHO) grade 2 variant of meningioma with histological features resembling those of a chordoma. This tumor type is known for having an aggressive clinical course with a propensity for local recurrence. Most cases occur within the cranium, more specifically around the cerebral convexities. Although extracranial meningiomas of various subtypes have been documented, extracranial meningioma with a chordoid subtype is an extremely rare entity.

OBSERVATIONS

The authors herein report the case of a 51-year-old female who presented with a chief complaint of dysphagia and was found to have a neck mass abutting the carotid sheath. The patient underwent resection and final pathology results revealed a WHO grade 2 chordoid meningioma.

LESSONS

This case report demonstrates an atypical case of an extracranial chordoid meningioma adjacent to the carotid sheath. To the authors' knowledge, this is the first reported case of a chordoid meningioma occurring within the soft tissue of the neck.

Asymptomatic Intraosseous Meningioma of the Humerus: A Case Report and Review of the Literature

Meningiomas are the most common central nervous system tumor. They are typically benign neoplasms but may produce neurological symptoms due to mass effect. Meningiomas may also extend to extradural locations; however, these account for only a small percentage of all meningiomas. Most extradural meningiomas arise in intraosseous locations, usually within the cranial bones or vertebrae. However, this is a rare case of extradural extension of an asymptomatic intracranial meningioma to the proximal humerus in the absence of any musculoskeletal symptoms. To the best of our knowledge, this presentation of an extradural intraosseous meningioma has not previously been reported in the literature. We present a case of an incidental intraosseous meningioma in a 66-year-old man. This patient was initially being screened for metastasis of stage IA1 adenocarcinoma of the lung, and a positron emission tomography (PET) scan revealed a focus of activity in the proximal diaphysis of the right humerus suspicious for malignancy. The upper extremity magnetic resonance imaging (MRI) demonstrated an indeterminate lesion. Curettage of the humeral lesion revealed an intraosseous psammomatous meningioma without evidence of metastatic lung carcinoma. Our case report aims to illustrate the importance of considering alternative metastatic sources, such as intracranial meningioma, during the investigation of an indeterminate bony lesion. This is the first case to illustrate asymptomatic intraosseous meningioma in an appendicular skeletal location, highlighting the need for thorough source investigation.

A rare case of primary sinonasal meningioma: A case report

Introduction and importance

Extra cranial primary meningioma of sinonasal tract is a rare entity. It is often misdiagnosed as nasal polyp.

Case presentation

Here we report a case of a primary ethmoid sinus meningioma with extension into the nasal cavity in a 41-year-old man. The tumor was completely excised via endoscopic endonasalapproach and the histologic diagnosis of meningioma was established. The patient was regularly follow up for 12 months without recurrence of the tumor.

Clinical discussion

The final diagnosis of primary sinonasal meningioma is based on histopathology and immunohistochemistry analyses results. The importance of complete surgical resection is undoubted and also is a goodindicator prognosis.

Conclusion

The otolaryngologists should be aware of the diagnosis of primary meningioma; despite of its rarity it is considered as a possible cause of nasal obstruction.

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Primary extra cranial meningioma is rare and its Histogenesis is still unknown.

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Clinical presentation of sinonasal ectopic meningiomas is not specific.

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Diagnosis is based on histopathological examination and immunohistochemistry.

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Complete resection is not always possible due to complex anatomy of nasal cavity and paranasal sinuses.

Primary Ectopic Meningioma of Nasal Cavity: A Rare Presentation

Primary ectopic meningiomas of the nasal cavity are rare tumours and thus, often not diagnosed and treated properly. In this case report we are going to discuss about our experience with a primary nasal meningioma involving bilateral nasal cavity with its diagnosis, management and histopathological features. A 28 year old female presented with nasal obstruction and nasal discharge for the past 1 year and swelling over right side of face for the past 8 months. Patient underwent surgical resection by a combined endoscopic and external approach under general anaesthesia. Histopathological evaluation confirmed the diagnosis of Transitional meningioma WHO grade 1. A repeat nasal endoscopy done one week after surgery, showed no evidence of any residual tumour. Due to ectopic meningiomas being relatively less common one must always exclude the presence of a central meningioma, which makes radiological investigations a must in such cases. As primary extra-cranial meningiomas have an unpredictable behaviour, this study should further aid in diagnosis and management of these tumours.

Surgical Challenges of Meningiomas with Extracranial Invasion: A Clinical Study

Objective: Meningiomas are mostly benign tumors located intracranially and intradurally, but they can rarely show extradural and extracranial growth. Surgical treatment of extracranial meningiomas is specifically challenging. In this study, we present an illustrated surgical series to convey our experience in treating meningiomas with extracranial extension. Methods: We retrospectively reviewed 11 patients with meningioma who underwent surgery between 2008 and 2020. In these patients, both intracranial and extracranial components were confirmed both radiologically and intraoperatively. Results: The patients were 7 males and 4 females with a mean age of 55.4 years. Most presented with facial disfigurement or asymmetrical growth of their skull. The most common symptom at presentation was headache. The most common location of meningiomas was the frontal region and that of extracranial growth was the paranasal sinuses and parietal bone invasion. We recognized two distinct modalities of bone destruction: hyperostosis (n=3) and osteolysis (n=8). Pathological study revealed atypical features in 6 patients. Preop embolization was attempted in 4 patients and proved difficult. Proper embolization was achieved only in one patient. The most commonly encountered surgical challenges were large calvarial and cranial base defects due to bone erosion, dural defects, and managing the superior sagittal sinus with parietal tumors. Excessive blood was of a particular concern and was managed by simple scalp clips, intraoperative transfusion, and conservative approach for tumor extensions into paranasal sinuses. No perioperative mortality occurred. Postoperative CSF fistulas beneath the scalp were common complications but conservatively managed with pressure wrapping. No cranial base CSF fistula developed. Calvarial reconstruction was performed with PMMA cement where needed. Conclusions: Meningiomas with extracranial extension are surgically challenging but treatable tumors. It contains fine neurosurgical trics in its treatment and follow-up.

Bone Invasive Meningioma: Recent Advances and Therapeutic Perspectives

Meningioma is the most common primary neoplasm of the central nervous system (CNS). Generally, these tumors are benign and have a good prognosis. However, treatment can be challenging in cases with aggressive variants and poor prognoses. Among various prognostic factors that have been clinically investigated, bone invasion remains controversial owing to a limited number of assessments. Recent study reported that bone invasion was not associated with WHO grades, progression, or recurrence. Whereas, patients with longer-recurrence tended to have a higher incidence of bone invasion. Furthermore, bone invasion may be a primary preoperative predictor of the extent of surgical resection. Increasing such evidence highlights the potential of translational studies to understand bone invasion as a prognostic factor of meningiomas. Therefore, this mini-review summarizes recent advances in pathophysiology and diagnostic modalities and discusses future research directions and therapeutic strategies for meningiomas with bone invasion.

Update from the 5th Edition of the World Health Organization Classification of Head and Neck Tumors: Nasal Cavity, Paranasal Sinuses and Skull Base

The World Health Organization Classification of Head and Neck Tumours recently published the 5th edition. There are new entities, emerging entities, and significant updates to the taxonomy and characterization of tumor and tumor-like lesions, specifically in this article as it relates to nasal cavity, paranasal sinuses and skull base. Importantly, the number of diagnostic entries has been reduced by creating category-specific chapters for soft tissue, hematolymphoid, melanocytic, neuroectodermal, and metastatic tumors. Bone and salivary gland tumors are also not separately reported in the sinonasal tract, but included in the jaw and salivary gland sections, respectively. Repetition of characteristic entities in each anatomic site was also reduced, instead highlighting only the unique features in each anatomic site. Two new entities (SWI/SNF complex-deficient sinonasal carcinomas and HPV-related multiphenotypic sinonasal carcinoma) will be highlighted in this review, with a discussion of several emerging entities. There is a short description of updated information for all 24 diagnostic entities included in this edition to allow the reader a snapshot of current state of knowledge, but to encourage more investigation and further broaden understanding of these diverse and rare entities.

Primary external auditory canal meningioma: Case report and review of the literature

Meningiomas are tumors that arise from arachnoid cells attached to both the pia mater and the inner portion of the arachnoid. They are common intracranial tumors, representing 12-25% of intracranial neoplasms. Intracranial meningiomas can spread extracranially to involve surrounding structures, including the ear and temporal bone. Ectopic meningiomas, described as primary meningiomas with no intracranial involvement, are rare. We describe a case of a primary external auditory canal meningioma with no evidence of intracranial involvement. We present pre-operative imaging findings proving no intracranial involvement prior to surgical intervention. A literature review of this uncommon clinical entity is presented and a discussion regarding its prognosis and treatment is reviewed.

Primary pulmonary meningioma presenting as multiple lung nodules: A case report

Primary pulmonary meningioma (PPM) is a very rare and mostly benign disease. Although PPM is incidentally detected as a solitary pulmonary nodule on X-ray or chest computed tomography, it does not have unique radiological characteristics; thus, it is difficult to differentiate it from other lung tumors. A healthy 54-year-old man visited our hospital because of multiple variable-sized lung nodules. He had no contributive medical history and no abnormality that was suggestive of extrapulmonary malignancy. Video-assisted thoracoscopic wedge resection was undertaken for diagnosis, and the tumor cells were histopathologically confirmed as PPM. Brain magnetic resonance imaging revealed no intracranial tumor. The patient has been well and without any progression of the remaining lesions over 24 months. Here, we present the clinicopathological features of this case in which the patient's nodules were mistaken for multiple metastatic lung nodules.

Primary intraosseous meningioma of the vertebra: illustrative case

BACKGROUND

Primary intraosseous meningiomas (PIMs) are rare, and PIMs of the vertebrae have not yet been reported. The authors report a case of primary meningioma arising from the vertebrae.

OBSERVATIONS

A 49-year-old man presented with lower back pain and numbness in both lower extremities. Lumbar spine magnetic resonance imaging revealed an L2 pathological fracture with epidural and paraspinal invasion. The patient had undergone a first palliative decompression and fixation surgery, and the diagnosis turned out to be a World Health Organization grade III anaplastic meningioma based on histopathology. The tumor had progressed after first operation and radiation therapy, and the patient was referred to the authors’ institute for excision. The patient had an uneventful postoperative course after a revisional total en bloc spondylectomy of L2.

LESSONS

The authors present a rare case of PIM of the vertebrae with epidural and paraspinal invasion. Careful preoperative assessment and surgical planning is crucial for successful patient management.

Skull Base Primary Extracranial Meningioma with Hyperostosis in a Small Mixed-Breed Dog

A 7 yr old female spayed Chihuahua-terrier mix was presented for a progressive dry, hacking cough over 9 mo, with dyspnea aggravated by eating and drinking. Computed tomography of the skull revealed a large mineral attenuating mass associated with the left skull base, without intracranial involvement. A modified ventral paramedian hypophysectomy approach along the medial aspect of the left ramus was used to approach the base of the skull. Ninety percent of the mass was debulked via high-speed pneumatic burr. Histopathology was consistent with hyperostosis originating from a primary extracranial meningioma (ECM), with the tissue staining positive for vimentin and negative for cytokeratin. The patient was symptom free for 9 mo before clinical signs returned because of tumor recurrence and was euthanized 11 mo postoperation because of diminished quality of life. ECM is uncommonly reported in the dog, and to the authors' knowledge has not previously been reported with hyperostosis or located along the skull base at the level of the tympanic bulla. Additionally, although hyperostosis predominantly occurs as diffuse bone thickening adjacent to a meningioma, proliferative focal hyperostosis is uncommon. Given the findings in this patient, ECM should be considered as a differential diagnosis for osseous skull base masses.

Primary Extracranial Meningiomas of the Head and Neck

Meningiomas represent the most common benign histological tumor of the central nervous system. Usually, meningiomas are intracranial, showing a typical dural tail sign on brain MRI with Gadolinium, but occasionally they can infiltrate the skull or be sited extracranially. We present a systematic review of the literature on extracranial meningiomas of the head and neck, along with an emblematic case of primary extracranial meningioma (PEM), which provides further insights into PEM management. A literature search according to the PRISMA statement was conducted from 1979 to June 2021 using PubMed, Web of Science, Google Scholar, and Scopus databases, searching for relevant Mesh terms (primary extracranial meningioma) AND (head OR neck). Data for all patients were recorded when available, including age, sex, localization, histological grading, treatment, possible recurrence, and outcome. A total of 83 published studies were identified through PubMed, Google Scholar, and Scopus databases, together with additional references list searches from 1979 to date. A total of 49 papers were excluded, and 34 manuscripts were considered for this systematic review, including 213 patients. We also reported a case of a 45-year-old male with an extracranial neck psammomatous meningioma with sizes of 4 cm × 3 cm × 2 cm. Furthermore, whole-body ⁶⁸Ga-DOTATOC PET/CT was performed, excluding tumor spread to other areas. Surgical resection of the tumor was accomplished, as well as skin flap reconstruction, obtaining radical removal and satisfying wound healing. PEMs could suggest an infiltrative and aggressive behavior, which has never found a histopathological correlation with a malignancy (low Ki-67, <5%). Whole-body ⁶⁸Ga-DOTATOC PET/CT should be considered in the patient’s global assessment. Surgical removal is a resolutive treatment, and the examination of frozen sections can confirm the benignity of the lesion, reducing the extension of the removal of healthy tissue surrounding the tumor.

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

INTRODUCTION

Extraneural/-cranial metastases (ENM) of primary central nervous system (CNS) tumors are rare and may be diagnostically challenging. We describe the cytomorphological and pertinent clinical features of ENM in a case series assessed by fine-needle aspiration (FNA). A search of the laboratory information systems of 2 tertiary care centers in Toronto (2000-2015) was performed. Cases with direct extracranial/-spinal extension of CNS neoplasms were excluded. Microscopic slides of FNA and surgical specimens were reviewed. Demographic and clinicopathological data were retrieved.

CASE PRESENTATION

Six cases were identified with the original diagnoses of glioblastoma, glioblastoma with primitive neuroectodermal tumor-like components, anaplastic ependymoma, myxopapillary ependymoma, atypical meningioma, and hemangiopericytoma. Median patient age at first diagnosis was 44 years (range 22-56). The time interval between initial diagnosis and first metastatic disease manifestation was 3 months to 19 years. All FNA diagnoses were rendered correctly. In 4 cases, immunohistochemistry was used to support the diagnosis. All cases had prior surgical intervention at the primary tumor site. In 4 cases, the ENM location was the ipsilateral parotid or buccal area. Two primary tumors in midline location developed ENM in the scapular area.

DISCUSSION/CONCLUSION

ENM are a rare manifestation of a range of different primary CNS tumors and may involve the ipsilateral head and neck mimicking clinically a salivary gland neoplasm. FNA can rapidly discriminate ENM from other, potentially more indolent conditions. Awareness of the clinical history is paramount to avoid diagnostic confusion.

Ectopic thoracic meningioma: a diagnostically challenging case

Whilst meningiomas are common neoplasms of the central nervous system; ectopic meningiomas are very rare. When they do occur, they are typically in the head and neck. Due to their rarity, they propose a diagnostic challenge with interesting pathological findings. To date, only seven ectopic meningiomas arising in the mediastinum have been reported in the literature. We aim to shift the focus on the diagnostic journey of this rare entity which involved various imaging and histopathological techniques. Our patient was successfully treated with no complications after four years through input from specialists and the multidisciplinary team.

Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base

Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.

Extracranial meningioma in the scalp skin 25 years after epidural hematoma surgery: A case report

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Extracranial meningiomas are sporadic, with only published case reports in the literature.

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Extracranial meningiomas are classified into the primary and secondary types, often misdiagnosed before operation due to lack of prevalence and unusual symptoms.

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It is impossible to distinguish between intracranial and extracranial meningiomas regardless of histologic features.

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Surgical resection is the first-choice treatment for extracranial meningiomas.

Introduction and importance

Extracranial meningiomas are rare, accounting for 1–2% of all meningiomas with just published in the form of a case report or series. They are categorized as primary or secondary tumors. In this paper, we present a case of extracranial meningioma in the scalp skin, which is believed in Vietnam's first case.

Case presentation

A 38 years old male with a history of brain epidural hematoma surgery in 1995 presented a subcutaneous protruding mass, which revealed approximately 3-centimeters from an incision scar in the left frontoparietal scalp. The tumor was firm, mobilized with contrast enhancement on magnetic resonance image. The complete surgical excision of the whole mass was performed, and histological examination revealed a WHO grade I meningioma.

Clinical discussion

Epidemiology, classification, diagnosis, treatment as well as prognosis of extracranial meningioma were discussed. We also hypothesized the emergence of extracranial meningioma after an epidural hematoma surgery.

Conclusion

Extracranial meningioma is quite rare, but it could be presented after a traumatic brain injury. Neurosurgery was the first choice, safe and effective treatment.

Extracranial Meningioma in the Scalp with Concurrent Steatocystoma

This report documents a rare case of an extracranial meningioma on the posterior scalp without apparent dural connection. Additionally, a sebaceous steatocystoma of the anterior scalp presented alongside the meningioma. A steatocystoma localized to the scalp is also remarkably rare. To our knowledge, this is the first report documenting both an extracranial meningioma and a steatocystoma presenting concurrently on the scalp. A male patient in his thirties presented with a mass lesion on the scalp. A CT scan revealed one posterior scalp mass with no intracranial abnormalities. Post excision histologic examination confirmed an extracranial meningioma (meningothelial variant, WHO Grade I). A second anterior scalp mass, not revealed by CT scan, was discovered during surgery. It was excised and diagnosed as a steatocystoma. Meningiomas predominantly occur intracranially but, in some instances, may present as a standalone extracranial tumor without intracranial abnormalities. Because extracranial meningioma is uncommon, it may be overlooked during clinical diagnosis of scalp masses. We recommend that this neoplasm be routinely considered in the differential diagnosis of extracranial tumors. The discovery of another rare tumor—a steatocystoma located in immediate proximity on the scalp—is further remarkable. We briefly review relevant case reports and etiologies and consider a potential relationship between the two neoplasms. However, it remains more likely that the concurrence of these tumors in our patient was simply coincidental.

Case Report: Rare site for intraoral meningioma

Extracranial meningioma is very rare with few cases reported, especially in the oral cavity. Its diagnosis is considered a challenge owing to the unusual site of occurrence.  We report, to the best of our knowledge, the first case of extra-cranial meningioma as a primary tumor in the hard palate with no detected intracranial extension. A 59-year-old Egyptian female patient presented with a 22-year history of a large painless swelling at the right side of the hard palate, which could not be seen on radiographs.  An incisional biopsy was taken and, after assessment with a panel of immunohistochemical markers, the lesion was diagnosed as extracranical grade I mengiothelial meningioma. The patient did not show up for surgical excision and follow-up was not performed because of the lose of contact with the patient. Intraoral meningioma is a rare tumor. Immuohistochemical markers are important for confirming this diagnosis.

Clinicoradiologic Characteristics of Temporal Bone Meningioma: Multicenter Retrospective Analysis

OBJECTIVES/HYPOTHESIS

Meningioma is a neoplasm arising from cells related to the arachnoid villi. The aim of the present study was to explore the clinical and radiological characteristics of temporal bone meningioma (TBM) in a multicenter cohort.

STUDY DESIGN

Retrospective cohort study.

METHODS

Thirteen patients diagnosed with TBM at eight medical institutes between 1998 and 2018 were retrospectively enrolled. The clinical procedures, symptoms, signs, and images that led to the diagnosis of TBM were investigated for all patients.

RESULTS

The most common symptom at the initial visit was hearing loss (n = 12/13, 92.3%). All patients exhibited unilateral TBMs with varied symptom durations (1-60 months). Four patients presented masses occupying the external auditory canal; the tympanic membrane (TM) could not be evaluated. The other nine patients did not show TM perforation despite the presence of inflammatory signs. The majority of patients exhibited unilateral conductive or mixed hearing loss. A retrospective review of temporal bone computed tomography (TBCT) images revealed findings suggestive of a tumor in all patients. However, three patients had been misdiagnosed with chronic otitis media and were subjected to tympanomastoidectomy (n = 3/7, 42.9%). TBCT findings that suggested TBM included diffuse trabecular hyperostosis in the middle and posterior cranial fossae and widening and destruction of the temporal bone in the jugular bulb area.

CONCLUSIONS

TBM should be suspected if patients exhibit persistent inflammatory symptoms or signs involving intact TM or unilateral conductive or mixed hearing loss with trabecular hyperostosis or destruction of the temporal bone on computed tomography images.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:173-178, 2021.

Pathology of meningiomas

Meningiomas are a diverse group of neoplasms that exhibit a wide range of morphologies and clinical behavior. They are generally accepted to originate from arachnoid cap cells within the leptomeninges. Classic histologic features include whorl formations, psammoma bodies, nuclear holes, and nuclear pseudoinclusions. Meningiomas are classified as benign, atypical, or anaplastic (grades I, II, or III) based on histologic features including mitotic activity, brain invasion, and presence of other minor criteria. There are numerous histologic variants of meningiomas, and some are associated with worse clinical outcomes and therefore are assigned a higher grade. The majority of meningiomas show diffuse positivity for vimentin and epithelial membrane antigen, supporting the dual mesenchymal and epithelial nature of meningothelial cells. The presence of an elevated proliferation index (as measured by Ki-67 immunohistochemical stain) and loss of progesterone receptor expression are associated with the higher grade. Pathologic features including histologic variants, grading criteria, and ancillary tests such as special and immunohistochemical stains are discussed.

[Neuroendocrine neoplasms of the auditory, olfactory, and visual sensory organs]

Neuroendocrine neoplasms (NENs) are infrequent in sensory organs. There are well-differentiated neuroendocrine neoplasms that should be classified as neuroendocrine tumors, in analogy to their gastrointestinal counterparts, however the nomenclature is inconsistent. The best defined entities are neuroendocrine tumors in the middle ear and ectopic pituitary adenoma in the sphenoid region. Poorly differentiated NENs most often arise in the olfactory organ and nasal cavity that are represented by olfactory neuroblastomas and poorly differentiated neuroendocrine carcinomas. They have several mimickers such as the sinonasal undifferentiated carcinoma, poorly differentiated squamous cell carcinoma, mucosal malignant melanoma, rhabdomyosarcoma, Ewing sarcoma/primitive neuroectodermal tumor and non-Hodgkin lymphoma.

Meningioma Originating from the Hypoglossal Canal: Case Report and Review of Literature

BACKGROUND

Primary extracranial meningiomas are uncommon neoplasms. In particular, meningioma involving the hypoglossal canal is extremely rare, with only 4 cases reported in the literature so far. Given that each of these meningiomas originated in the juxtacondyle region with involvement of the hypoglossal canal, to the best of our knowledge, a meningioma that exists only within the hypoglossal canal has yet to be reported.

CASE DESCRIPTION

We present a case of primary extracranial meningioma arising solely from the hypoglossal canal. A 62-year-old woman presented with long-term difficulty in tongue movement. Her tongue was deviated to the right, and neurologic examination revealed fasciculation and muscle wasting on the right side of the tongue. Computed tomography revealed a calcification in the right hypoglossal canal. Magnetic resonance imaging further demonstrated a hypointense tumor on both T1-weighted and T2-weighted images, with contrast enhancement in the right condyle. Total tumor removal was performed via a transcondylar approach, and histopathologic examination confirmed the presence of a transitional meningioma. No recurrence was observed at 14 months of follow-up. The patient's tongue atrophy was slightly improved, and the deviation completely disappeared.

CONCLUSIONS

In this extremely rare case of hypoglossal canal meningioma, total tumor removal via a transcondylar approach resulted in the recovery of hypoglossal nerve function.

Primary Pulmonary Meningioma With Rhabdoid Features

Only 1% to 2% of meningiomas have primary extrameningeal location, which is mostly head and neck region. Primary pulmonary meningiomas (PPMs) are even more uncommon with up to 50 cases reported in the literature. Only 5 cases of PPM with confirmed or possible malignancy have been previously described. Three-grade classification of meningiomas with the accordingly growing risk of aggressive behavior of the tumor has been proposed by the World Health Organization. As it is based on correlations between morphological and clinical features of intracranial meningiomas, the analogous prediction of ectopic tumors prognosis remains questionable due to scarce number of cases. In this article, we present a rare case of PPM with rhabdoid features (World Health Organization grade III), which lacked other signs of malignancy. The patient is doing well for 2 years after the thoracoscopic wedge resection without evidence of the disease recurrence.

Extracranial meningiomas concurrently found in the lung and vertebral bone: a case report

Background

Primary pulmonary meningiomas are very rare, and primary intraosseous meningiomas outside the head and neck region have not yet been reported. We report an extremely unusual case of concurrent meningiomas arising in the pulmonary parenchyma and vertebral bone.

Case presentation

A 40-year-old Asian woman presented with a destructive lesion of the lumbar vertebral bone and a small nodule in the right lung. Five years later, both lesions slightly increased in size. To evaluate both the pulmonary and vertebral lesions, video-assisted thoracic surgery and curettage of the lytic lesion were performed. Both lesions showed similar histopathological findings corresponding to an intracranial meningioma of World Health Organization grade 1. The patient made good postoperative progress and remained free from disease at 41 months after the operation.

Conclusions

Our patient presented with almost synchronous pulmonary and lumbar vertebral intraosseous meningiomas. Regarding the relationship between the two lesions, there are two possibilities: Independent tumors occurred coincidentally or the primary pulmonary meningioma metastasized to the vertebral bone despite its bland morphology. It is important to keep in mind the exceptionally rare condition of extracranial meningioma.