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Melocchi L, Rossi G, Valli M, Mengoli MC, Mondoni M, Lazzari-Agli L, Santandrea G, Davoli F, Baldovini C, Cavazza A, Colby TV. Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)? Diagnostics (Basel) 2023; 13:diagnostics13040802. [PMID: 36832290 PMCID: PMC9955492 DOI: 10.3390/diagnostics13040802] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Pulmonary minute meningothelial-like nodules (MMNs) are common incidental findings in surgical specimens, consisting of tiny proliferation (usually no larger than 5-6 mm) of bland-looking meningothelial cells showing a perivenular and interstitial distribution, sharing morphologic, ultrastructural, and immunohistochemical profiles with meningiomas. The identification of multiple bilateral MMNs leading to an interstitial lung disease characterized by diffuse and micronodular/miliariform patterns radiologically allows the diagnosis of diffuse pulmonary meningotheliomatosis (DPM). Nevertheless, the lung is the most common site of metastatic primary intracranial meningioma, and differential diagnosis with DPM may be impossible without clinic-radiologic integration. Herein, we report four cases (three females; mean age, 57.5 years) fitting the criteria of DPM, all incidentally discovered and histologically evidenced on transbronchial biopsy (2) and surgical resection (2). All cases showed immunohistochemical expression of epithelial membrane antigen (EMA), progesterone receptor, and CD56. Notably, three of these patients had a proven or radiologically suspected intracranial meningioma; in two cases, it was discovered before, and in one case, after the diagnosis of DPM. An extensive literature review (44 patients with DPM) revealed similar cases with imaging studies excluding intracranial meningioma in only 9% (4 of 44 cases studied). The diagnosis of DPM requires close correlation with the clinic-radiologic data since a subset of cases coexist with or follow a previously diagnosed intracranial meningioma and, thus, may represent incidental and indolent metastatic deposits of meningioma.
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Affiliation(s)
- Laura Melocchi
- Pathology Unit, Department of Oncology, Fondazione Poliambulanza Hospital Institute, 25124 Brescia, Italy
- Correspondence: ; Tel.: +39-0303518661
| | - Giulio Rossi
- Pathology Unit, Department of Oncology, Fondazione Poliambulanza Hospital Institute, 25124 Brescia, Italy
| | - Mirca Valli
- Operative Unit of Pathologic Anatomy, Ospedale Infermi, Azienda USL Romagna, 47900 Rimini, Italy
| | | | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy
| | - Luigi Lazzari-Agli
- Pulmonology Unit, Ospedale Infermi, Azienda USL Romagna, 47900 Rimini, Italy
| | - Giacomo Santandrea
- Operative Unit of Pathology, Azienda USL/IRCCS, 42123 Reggio Emilia, Italy
| | - Fabio Davoli
- Department of Thoracic Surgery, Azienda USL Romagna, S. Maria delle Croci Teaching Hospital, 48121 Ravenna, Italy
| | - Chiara Baldovini
- Cardiovascular Pathology Unit, Department of Pathology, IRCCS, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Alberto Cavazza
- Operative Unit of Pathology, Azienda USL/IRCCS, 42123 Reggio Emilia, Italy
| | - Thomas V. Colby
- Department of Laboratory Medicine and Pathology (Emeritus), Mayo Clinic Arizona, Scottsdale, AZ 13400, USA
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Murata D, Zaizen Y, Tokisawa S, Matama G, Chikasue T, Nishii Y, Ohno S, Tsumura K, Tominaga M, Fukuoka J, Fujimoto K, Hoshino T. A Rare Case of Diffuse Bilateral Minute Pulmonary Meningothelial-like Nodules Increasing Over the Short Term and Resembling Metastatic Lung Cancer. Intern Med 2022; 62:1207-1211. [PMID: 36047121 PMCID: PMC10183270 DOI: 10.2169/internalmedicine.0343-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 54-year-old woman was referred to our hospital because computed tomography (CT) revealed multiple lung nodules during a health checkup. The nodules were up to 5 mm in diameter and randomly distributed in both lungs, appearing ring-shaped. No clinical symptoms were present. However, the nodes proliferated, and multiple lung metastases could not be ruled out, so a biopsy was performed to establish a diagnosis. She was diagnosed with minute pulmonary meningothelial-like nodules (MPMNs), and her condition had not deteriorated at the latest follow-up. Although rare, MPMNs can proliferate for a short time, but a biopsy to exclude malignant causes is essential.
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Affiliation(s)
- Daiki Murata
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Saeko Tokisawa
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Goushi Matama
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Tomonori Chikasue
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Yuuya Nishii
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Shuuhei Ohno
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Kenji Tsumura
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
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