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Liang Q, Ge P, Liu Y, Zhu X, Lu S, Pan C, Ji Z, Wang Q, Wang Y. Central nervous system clear cell meningioma: a systematic literature review. Neurosurg Rev 2024; 47:35. [PMID: 38183517 DOI: 10.1007/s10143-023-02251-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
Clear cell meningiomas are a rare histological subtype of World Health Organization (WHO) grade II meningioma. Despite its relatively low frequency, clear cell meningioma has attracted considerable attention because of its unique pathological characteristics, clinical behavior, and challenging management considerations. The purpose of our systematic review is to provide clinicians with a better understanding of this rare disease. PubMed was searched for articles in the English language published from 1988 to 2023 June. The keywords were as follows: "clear cell meningioma," "clear cell" and "meningioma." We analyzed clinical manifestations, radiological manifestations, pathological features, comprehensive treatment strategies, and prognosis to determine the factors influencing recurrence-free survival (RFS). Recurrence-free survival curves of related factors were calculated by the Kaplan‒Meier method. The log-rank test and Cox univariate analysis were adopted to assess the intergroup differences and seek significant factors influencing prognosis and recurrence. Fifty-seven papers met the eligibility criteria, including 207 cases of clear cell meningioma (CCM), which were confirmed by postoperative pathology. The fifty-seven articles involved 84 (40.6%) males and 123 (59.4%) females. The average age at diagnosis was 27.9 years (range, 14 months to 84 years). Among the symptoms observed, headache, neurologic deficit, and hearing loss were the most commonly reported clinical manifestations. Most tumors (47.8%) were located in the skull base region. Most tumors showed significant enhancement, and homogeneous enhancement was more common. A total of 152 (74.1%) patients underwent gross total resection (GTR), and 53 (25.9%) patients underwent subtotal resection (STR). During the follow-up, the tumor recurred in 80 (39.4%) patients. The log-rank test and the Cox univariate analysis revealed that tumor resection range (GTR vs. STR) and adjuvant treatment (YES vs. NO) were significant predictors of recurrence-free survival (RFS). Clear cell meningioma is a rare type of meningioma with challenging diagnosis and therapy. The prognosis of this disease is different from that of regular meningiomas. Recurrence remains a possibility even after total tumor resection. We found that the surgical resection range and adjuvant treatment affected the recurrence period. This finding provides significant guidance for the treatment of clear cell meningioma.
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Affiliation(s)
- Qi Liang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Pengfei Ge
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yanhua Liu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Xiaoxi Zhu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Shan Lu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Chengliang Pan
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Zhilin Ji
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Qingxuan Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China.
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Libert DM, Prayson RA. Pediatric clear cell meningioma involving the middle cranial fossa in the context of NF2 and SMARCE1 mutations. Ann Diagn Pathol 2020; 46:151516. [PMID: 32311644 DOI: 10.1016/j.anndiagpath.2020.151516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
Meningiomas are an uncommon entity in children and adolescents. <30 cases of pediatric clear cell meningioma (CCM), a World Health Organization (WHO) Grade II tumor, have been reported in the literature. These tumors are more likely to recur than the more common WHO Grade I meningiomas, especially with incomplete surgical resection. CCMs are most commonly found in the spine and posterior cranial fossa. Recently, SMARCE1 mutations have been linked to the development of CCM. To evaluate the progression of pediatric CCM in the context of emerging genetic knowledge, we reviewed all 45 cases of CCM at our institution for a 23 year period (1997-2019) to identify pediatric cases. Forty-four of the tumors arose in adults from age 34-81 years. The one pediatric case originally presented at age 4 years; the patient was found to have a CCM in the left cavernous sinus projecting into the posterior fossa, associated with a novel germline SMARCE1 mutation and somatic NF1 and DMD mutations. After two years, the patient had a recurrence of the tumor and underwent a second resection. This is the 5th reported case of CCM in the middle cranial fossa, and the only recurrent case, as well as the only reported case of recurrent pediatric CCM associated with a germline SMARCE1 mutation. Further study of the natural history of tumors associated with germline SMARCE1 loss could potentially inform prognosis.
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Affiliation(s)
- Diane M Libert
- Cleveland Clinic Lerner College of Medicine and Cleveland Clinic Department of Anatomic Pathology, Cleveland, OH, United States of America
| | - Richard A Prayson
- Cleveland Clinic Lerner College of Medicine and Cleveland Clinic Department of Anatomic Pathology, Cleveland, OH, United States of America.
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Li J, Deng X, Zhang S, Wang Q, Cheng J, Li X, Ke D, Hui X. Intracranial clear cell meningioma: Clinical study with long-term follow-up in 24 patients. Clin Neurol Neurosurg 2018; 175:74-83. [DOI: 10.1016/j.clineuro.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
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Domingo-Arrué B, Gil-Benso R, Megías J, Navarro L, San-Miguel T, Muñoz-Hidalgo L, López-Ginés C, Cerdá-Nicolás M. Molecular progression in unusual recurrent non-pediatric intracranial clear cell meningioma. Curr Oncol 2017; 24:e244-e250. [PMID: 28680293 PMCID: PMC5486398 DOI: 10.3747/co.24.3509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report a case of a recurrent clear cell meningioma (ccm) in the frontal lobe of the brain of a 67-year-old man. The patient developed three recurrences: at 3, 10, and 12 years after his initial surgery. Histopathology observations revealed a grade 2 ccm with positivity for vimentin and epithelial membrane antigen. Expression of E-cadherin was positive only in the primary tumour and in the first available recurrence. Fluorescence in situ hybridization analyses demonstrated 1p and 14q deletions within the last recurrence. Multiplex ligation-dependent probe amplification studies revealed a heterozygous partial NF2 gene deletion, which progressed to total loss in the last recurrence. The last recurrence showed homozygous deletions in CDKN2A and CDKN2B. The RASSF1 gene was hypermethylated during tumour evolution. In this report, we show the genetic alterations of a primary ccm and its recurrences to elucidate their relationships with the changes involved in the progression of this rare neoplasm.
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Affiliation(s)
| | - R. Gil-Benso
- Department of Pathology, Universitat de València, and
| | - J. Megías
- Department of Pathology, Universitat de València, and
| | - L. Navarro
- Department of Pathology, Universitat de València, and
| | - T. San-Miguel
- Department of Pathology, Universitat de València, and
| | | | | | - M. Cerdá-Nicolás
- Department of Pathology, Universitat de València, and
- incliva, Clinic Hospital of Valencia, Valencia, Spain
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Intracranial Clear Cell Meningiomas: Study on Clinical Features and Predictors of Recurrence. World Neurosurg 2017; 97:693-700.e11. [DOI: 10.1016/j.wneu.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 11/20/2022]
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Abstract
We present a case of clear-cell meningioma occurring in a 72-year-old female presenting with an infiltrative external auditory canal mass (with both intracranial and extracranial extension and extensive leptomeningeal involvement) and facial nerve paralysis.
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Mellouli M, Bahri I, Abid N, Boudawara A, Gouiaa N, Boudawara T. [A rare tumor of the cerebellopontine angle]. Ann Pathol 2014; 34:482-4. [PMID: 25499865 DOI: 10.1016/j.annpat.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 08/28/2014] [Accepted: 09/24/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Manel Mellouli
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie.
| | - Ibticem Bahri
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
| | - Najla Abid
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
| | - Adib Boudawara
- Service de neurochirurgie, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
| | - Naourez Gouiaa
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
| | - Tahya Boudawara
- Laboratoire d'anatomie et de cytologie pathologiques, hôpital Habib-Bourguiba, 3029 Sfax, Tunisie
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Li Z, Zhang Y, Wang E, Wang Z, Li W, Huang S, Li J. Intracranial clear cell meningioma in two children with blood relations: two case reports and literature review. Childs Nerv Syst 2012; 28:2143-51. [PMID: 22814951 DOI: 10.1007/s00381-012-1840-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 06/13/2012] [Indexed: 12/23/2022]
Abstract
Intracranial clear cell meningioma (CCM) is very rare and often has an aggressive clinical course. The predilection site of intracranial CCM in children was cerebellopontine angle where represents challenging tumor resection because of the vicinity of brainstem, vertebral artery, and lower cranial nerve. Therefore, special consideration is required for this tumor.We report two cases with intracranial CCM in a family and reviewed the literature concerning pediatric intracranial CCM. Case 1 is a 4-year-old boy with a tumor at the right posterior fossa. Case 2 is an 8-year-old boy with a left basilar region tumor. Gross total resection and subtotal resection was achieved in case 1 and case 2, respectively. Case 1 had no tumor recurrence at 12 months after the operation. Case 2 received cyber-knife radiosurgery (CKS) after subtotal resection at 4 months, and the residual tumor had gradually shrunk. Comprehensive chromosomal number aberrations in both patients were revealed by array-comparative genomic hybridization, and loss of neurofibromatosis 2 (NF2) gene was the common genetic abnormality in the two patients.To the best of our knowledge, this is the first report concerned two patients with CCM in a family, and the findings in this article suggest that CKS is a safe and effective adjuvant therapy for residual CCM after operation and NF2 gene mutation plays a role in tumorigenesis of pediatric intracranial CCM.
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Affiliation(s)
- Zhiqi Li
- Department of neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, 12#, Wulumuqi Zhong Road, Shanghai 200040, People's Republic of China
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Hori S, Hayashi N, Ishizawa S, Hayashi S, Sato H, Nagao S, Akioka N, Nagai S, Nishikata M, Endo S. Clear cell meningioma with histologically aggressive appearance and clinically aggressive behavior: A case report. Neuropathology 2011; 32:415-9. [DOI: 10.1111/j.1440-1789.2011.01272.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen H, Li XM, Chen YC, Wu JS, Dou YF, Wang Y, Xu J, Zhong P, Jiang CC, Wang XQ. Intracranial clear cell meningioma: a clinicopathologic study of 15 cases. Acta Neurochir (Wien) 2011; 153:1769-80. [PMID: 21643672 DOI: 10.1007/s00701-011-1052-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 05/16/2011] [Indexed: 11/27/2022]
Abstract
OBJECT Clear cell meningioma (CCM) is a rare histological variant of meningioma. CCM has a high recurrence rate and aggressiveness. In this study, we reviewed our experience in the treatment of the lesion. METHODS Here we present a series of 15 patients with intracranial CCM. The clinical data were retrieved from the records of our Neurosurgery Department and the patients' prognoses were attained by clinic service and telephone. Immunohistochemistry for epithelial membrane antigen (EMA), vimentin, glial fibrillary acidic protein (GFAP), CD10, and S-100 was done, and the MIB-1 labeling index was calculated in all cases. RESULTS The 15 patients included eight males and seven females; the mean age was 34.8 years. The most frequent initial symptoms were headache and hearing loss. The most common location was the cerebellopontine angle (CPA) zone. Eleven patients had total removal and four patients underwent subtotal removal. Histological features of atypia were present in different proportions, from 6.7% to 100%, and six cases accorded with atypia. Three tumors showed brain invasion. EMA and vimentin were 100% positive, and CD10 was 100% negative. GFAP was 87% negative and S-100 was 93% negative. The mean follow-up period was 36.7 months. Three patients with brain invasion all recurred and five cases with atypia recurred. In 11 patients with total removal, six patients recurred. In four patients with subtotal removal, three patients recurred. Kaplan-Maier analysis showed that incomplete surgical resection was significantly associated with recurrence (p = 0.001). The MIB-1 labeling index for recurrence was 5.7 ± 2.7% versus 2.8 ± 1.5% for no recurrence (p = 0.036). CONCLUSIONS CCM is a rare subtype of meningioma, with a tendency to present in younger patients and a propensity to recur. Immunohistochemistry plays a vital role in differentiating CCM from other tumors. Brain invasion, atypia and MIB-1 labeling index are likely to predict the recurrence. The extent of resection might be connected with the prognosis.
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Affiliation(s)
- Hong Chen
- Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, China
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Clear Cell Meningioma: A Clinicopathologic Study of 18 Tumors and Examination of the Use of CD10, CA9, and RCC Antibodies to Distinguish Between Clear Cell Meningioma and Metastatic Clear Cell Renal Cell Carcinoma. Appl Immunohistochem Mol Morphol 2010; 18:422-8. [DOI: 10.1097/pai.0b013e3181dd35d2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chen HK, Wu YT, Lin YJ, Lin JW. Clear cell meningioma with frequent chordoid features and aggressive behavior: a clinicopathologic study of ten cases at a single institution. J Neurooncol 2010; 103:551-9. [DOI: 10.1007/s11060-010-0418-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/13/2010] [Indexed: 01/06/2023]
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Abstract
Abstract
BACKGROUND AND IMPORTANCE
Intracranial clear cell meningioma is very rare. We present 3 cases of intracranial clear cell meningiomas genetically characterized by comparative genomic hybridization with a review of the literature.
CLINICAL PRESENTATION
Patient 1 is a 38-year-old woman with a petroclival tumor. Patient 2 is a 60-year-old man with a tumor at the foramen magnum. Patient 3 is a 60-year-old man with a tumor at the posterior clinoid process. Gross total resection was performed in patients 1 and 2. Patient 1 has been free from recurrence for 10 years. Patient 2 had a tumor recurrence at 14 months after the operation. After partial resection, conventional radiotherapy was given, and there was no tumor regrowth at 2 years after radiotherapy. Subtotal resection was performed in patient 3, and no regrowth was detected for 3 months. Histologically, all tumors were composed of cells with clear cytoplasm reactive for periodic acid–Schiff and diagnosed as clear cell meningioma. The MIB-1 and p53 staining indexes were 1.8, 1.7, and 5.6 and 1.1, 1.0, and 5.5, respectively. Comparative genomic hybridization revealed no chromosomal number aberrations in patient 1, numerous losses and gains including loss of chromosome 1 in patient 2, and loss of only 22q in patient 3. Because staining indexes of MIB-1 and p53 were equivalent in 2 patient (patients 1 and 2) with a long follow-up period, the contrary clinical courses are likely associated with genetic characteristics.
CONCLUSION
To the best of our knowledge, this is the first report that suggests association between tumor behavior and genetic characteristics in clear cell meningiomas.
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Affiliation(s)
- Shigeo Ohba
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Tokuhiro Kimura
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Ikeda
- Department of Pathology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Takeshi Kawase
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
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Tong-tong W, Li-juan B, Zhi L, Yang L, Bo-ning L, Quan H. Clear cell meningioma with anaplastic features: Case report and review of literature. Pathol Res Pract 2010; 206:349-54. [DOI: 10.1016/j.prp.2009.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 06/22/2009] [Accepted: 06/23/2009] [Indexed: 11/30/2022]
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Rousselot C, Francois P, Jan M, Bergemer AM. Étude de sept cas de méningiomes à cellules claires et revue de la littérature. Ann Pathol 2010; 30:73-82. [DOI: 10.1016/j.annpat.2010.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 12/30/2009] [Accepted: 01/05/2010] [Indexed: 11/16/2022]
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Tena-Suck ML, Collado-Ortìz MA, Salinas-Lara C, García-López R, Gelista N, Rembao-Bojorquez D. Chordoid meningioma: a report of ten cases. J Neurooncol 2010; 99:41-8. [PMID: 20094774 DOI: 10.1007/s11060-009-0097-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 12/07/2009] [Indexed: 11/30/2022]
Abstract
Chordoid meningioma is a rare variant of meningioma with histological features resembling those of chordoma. This tumor has a great risk of recurrence and aggressive growth (WHO grade II). This study was done to document the clinical and pathological features of ten patients with chordoid meningioma who submitted to surgery at the National Institute of Neurology and Neurosurgery in Mexico City. Clinical, histological and immunohistochemical features were examined. The age range was from 30 to 67 years old (mean, 34.2 years). Seven patients were female and three male. The duration of symptoms varied from 3.5 months to 5 years (mean, 14.1 months). No systemic symptoms were noted. The tumor was localized in eight cases in the supratentorial compartments. Histologically, the tumors were characterized by strands and cords of meningothelial cells arranged in a mucinous stroma. Two of the ten tumors showed metaplasic changes, and seven showed brain invasion. Tumor cells demonstrated CK7, EMA and focal S-100 protein and Ep-CAM. Cytokeratin AE1/AE3, GFAP and synaptophysin were negative. The MIB-1 proliferative index was from 6 to 9% (mean 7.8). PCNA Li was 6 to 20% (mean, 14), and microvascular density was 6-16 (mean, 14.5). The mean rate of the MIB-1 labeling index in recurrences was 7.1% versus 6.33% for no tumor recurrence. Chordoid meningioma, World Health Organization grade II, is an uncommon variant of meningioma with a propensity for aggressive behavior and increased likelihood of recurrence. Chordoid meningiomas are predominantly tumors of young adults with a predilection for the supratentorial location. Intraventricular location and absence of systemic manifestations, despite the presence of abundant B-lymphocytes, mast cells and low MIB-1 LI, are some of the interesting findings in the present series that need further study. Hence, a larger number of cases with adequate follow-up data need to be studied further to establish the clinical relevance of this variant.
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Affiliation(s)
- Martha Lilia Tena-Suck
- Department of Neuropathology, National Institute of Neurology and Neurosurgery, Mexico City, DF, Mexico.
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Ma L, Liu WK, Wang K, Shrestha B, Zhang YK. Intracranial clear-cell meningioma. Acta Neurochir (Wien) 2009; 151:373-8; discussion 378. [PMID: 19277460 DOI: 10.1007/s00701-009-0236-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 01/19/2009] [Indexed: 11/28/2022]
Abstract
Intracranial clear-cell meningioma (CCM) is rarely reported in the literature since it has to be distinguished from other subtypes of meningioma. Most of the CCMs are intraspinal, according to the related literature. We report a case of occipital parietal CCM in a 6-year-old child, review all the 35 intracranial CCMs that have been reported since 1995 to present and discuss their clinical, radiological and histopathologic characteristics.
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Affiliation(s)
- Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, PR China
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