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Crea A, Grimod G, Scalia G, Verlotta M, Mazzeo L, Rossi G, Mattavelli D, Rampinelli V, Luzzi S, Spena G. Fronto-orbito-ethmoidal intradiploic meningiomas: A case study with systematic review. Surg Neurol Int 2021; 12:485. [PMID: 34754535 PMCID: PMC8571263 DOI: 10.25259/sni_386_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/08/2021] [Indexed: 10/26/2022] Open
Abstract
Background Primary intradiploic meningiomas, extra-axial tumors arising primarily in the skull, are rare. The authors reported a complex case of intradiploic intraosseous metaplastic meningioma of the left medial wall and orbital roof with the left frontal sinus invasion and left ethmoidal body bone substitution. The authors also conducted a systematic review concerning diagnosis and management of patients affected by purely calvarial intradiploic meningiomas along with a focus on fronto-orbito-ethmoidal ones. Methods A literature search was conducted using PubMed and Scopus databases according to preferred reporting items for systematic reviews and meta-analysis statement and with the following Mesh terms: Intradiploic, intraosseous, calvarial, and meningioma. Eligibility criteria were limited by the nature of existing literature on intradiploic meningiomas, consisting of only case series, and case reports. Results A total of 128 published studies were identified through our search. 41 studies were included in this systematic review, 59 patients with a female/male ratio of 1.2/1. The mean age of the patients is of 47.69 years (range 3-84 years). Only seven out of 59 patients (11.9%) presented a complex intradiploic meningioma located in fronto-orbito-ethmoidal region like our case. In almost all patients, a gross-total resection was performed (96.6%) and only in two patients (3.4%) a subtotal resection was achieved. Conclusion The authors shared this successfully treated case to add to the overall clinical experience in the management of this rare subtype tumor, with the hope that more studies are conducted to further address the mechanism of intradiploic meningiomas development.
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Affiliation(s)
- Antonio Crea
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Gianluca Grimod
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital of National Importance "Garibaldi", Catania, Italy
| | - Mariarosaria Verlotta
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Lucio Mazzeo
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giorgio Rossi
- Department of Oncology, Pathological Anatomy and Histology Unit, Alessandro Manzoni Hospital, Lecco, Italy
| | - Davide Mattavelli
- Department of Surgical Specialties, Radiological Sciences and Public Health, Unit of Otorhinolaryngology - Head and neck Surgery, Piazza del Mercato, Brescia, Italy
| | - Vittorio Rampinelli
- Department of Surgical Specialties, Radiological Sciences and Public Health, Unit of Otorhinolaryngology - Head and neck Surgery, Piazza del Mercato, Brescia, Italy
| | - Sabino Luzzi
- Department of Neurosurgery, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giannantonio Spena
- Department of Neuroscience, Neurosurgery Unit, Alessandro Manzoni Hospital, Lecco, Italy
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Ho UC, Chang K, Lin YH, Huang YC, Tsuang FY. Primary intraosseous meningioma of the vertebra: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21362. [PMID: 35855279 PMCID: PMC9281493 DOI: 10.3171/case21362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, and
| | | | - Yen-Heng Lin
- Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
| | - Yu-Cheng Huang
- Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
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Harary M, Tung JK, Sood S, Corrales CE, Smith T, Iorgulescu JB. Benign purely intraosseous meningioma of the skull: Diagnosis and surgical outcomes. J Clin Neurosci 2020; 82:36-42. [PMID: 33317736 DOI: 10.1016/j.jocn.2020.10.040] [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: 05/31/2020] [Revised: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
Primary intraosseous meningioma (PIM) is a rare subtype of extradural meningiomas that originates within bone. We aimed to characterize the clinical, radiographic, and pathologic features of PIM and the resulting outcomes following resection. Herein we examined a retrospective case series of all patients with a pathologically confirmed WHO grade I PIM that were managed at one of three tertiary care centers. Patients with tumors that demonstrated extraosseous extension or involvement of the dura mater were excluded. The main outcomes included surgical safety and duration of local tumor control. Nine patients were identified with benign PIMs, presenting with headaches or painless enlarging subcutaneous masses if involving the calvarium or with neurologic deficits if involving the skull base, or otherwise incidentally identified. Surgery was pursued for symptomatic relief and/or tissue diagnosis. Lesions were evaluated by radiographic imaging - including sensitive detection by plain X-ray films - and definitive diagnosis ascertained by histopathological examination. Maximal resection of both calvarial and skull base lesions was safely tolerated. PIM represents a rare benign skull lesion, whose identification depends on the integration of radiographic findings with intraoperative findings and histopathological confirmation; it should be considered in the differential for slow-growing expansile intraosseous lesions of the skull.
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Affiliation(s)
- Maya Harary
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States; Harvard Medical School, Boston, MA, United States; Cushing Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Joe K Tung
- Harvard Medical School, Boston, MA, United States
| | - Shreya Sood
- Harvard Medical School, Boston, MA, United States; Department of Radiology, Boston Children's Hospital, Boston, MA, United States
| | - C Eduardo Corrales
- Harvard Medical School, Boston, MA, United States; Cushing Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, MA, United States
| | - Timothy Smith
- Harvard Medical School, Boston, MA, United States; Cushing Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States
| | - J Bryan Iorgulescu
- Harvard Medical School, Boston, MA, United States; Cushing Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States; Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, United States.
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Omofoye OA, Huynh T, Jhun R, Ashfaque H, Cronk K. Primary intraosseous meningioma of the calvarium: A systematic review. Clin Neurol Neurosurg 2020; 199:106283. [PMID: 33069929 DOI: 10.1016/j.clineuro.2020.106283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/23/2020] [Accepted: 10/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Primary intraosseous meningiomas (PIM) of calvarial origin are a small subset of meningiomas that arise from and occur within the calvarial bone. Its definition is often confused with other forms of non-dural based intracranial meningiomas, which has made previously published retrospective reviews heterogenous, non-specific and sometimes inaccurate. We present a systematic review of calvarial PIM. METHODS Using a systematic search protocol that included databases such as PubMed, Web of Science and Embase, we extracted all human studies on PIM published from inception to December 2017. This systematic review includes case reports and retrospective reviews that specifically described PIM. RESULTS On review of 166 articles identified with the systematic search protocol, 69 articles were analyzed. These comprised of 64 case reports, 1 case series and 4 retrospective reviews. 111 patients with PIM of calvarial origin were analyzed, 58 % of which were females and 42 % males. The mean patient age was 51 years and the frontal bone was the most common tumor location, occurring in 26.1 % of the cases. Surgical resection was the predominant modality of treatment in 97.2 % of the cases, and gross total resection was achieved in 84 % of cases that reported extent of resection. There were no recurrences for grade I meningiomas. However, all grade III meningiomas recurred and 33.3 % of grade II meningiomas showed recurrence with a mean postoperative follow-up interval of 20 months. Statistical analysis using Fisher's exact test showed the recurrence rate to be strongly associated with WHO tumor grade (p-value <0.001). CONCLUSION There is statistically significant increased recurrence rate for calvarial PIM of higher grades, and we recommend close follow-up in those cases. Surgical resection remains the overwhelming treatment of choice for calvarial PIM, and it has a high gross total resection rate and low risk of complications and mortality.
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Affiliation(s)
- Oluwaseun A Omofoye
- Boston Medical Center, Department of Neurosurgery, 725 Albany Street 7c, Boston, MA, 02118, USA.
| | - Trong Huynh
- Boston Medical Center, Department of Neurosurgery, 725 Albany Street 7c, Boston, MA, 02118, USA.
| | - Ray Jhun
- Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
| | - Hasan Ashfaque
- Boston Medical Center, Department of Neurosurgery, 725 Albany Street 7c, Boston, MA, 02118, USA.
| | - Katharine Cronk
- Boston Medical Center, Department of Neurosurgery, 725 Albany Street 7c, Boston, MA, 02118, USA.
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Kim NR, Yie GT. Intraoperative frozen cytology of intraosseous cystic meningioma in the sphenoid bone. J Pathol Transl Med 2020; 54:508-512. [PMID: 32601263 PMCID: PMC7674761 DOI: 10.4132/jptm.2020.05.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/21/2020] [Indexed: 11/26/2022] Open
Abstract
Meningiomas in bone are rarely subjected to fine-needle aspiration diagnosis, and those arising in the skull bone with a cystic presentation are rare. A 24-year-old woman presented with subdural hemorrhage, and subsequent radiology depicted an osteolytic mass-like lesion in the sphenoid bone. Intraoperatively, a solid and cystic hemorrhagic lesion mimicking an aneurysmal bone cyst was observed in the sphenoid bone with dural tearing. Frozen cytology showed singly scattered or epithelioid clusters of round to elongated cells intermixed with many neutrophils. Tumor cells had bland-looking round nuclei with rare prominent nucleoli and nuclear inclusions and eosinophilic granular to globoid cytoplasm in capillary-rich fragments. Histology revealed intraosseous meningothelial and microcystic meningioma (World Health Organization grade 1) in right lesser wing of the sphenoid bone. Considering its unusual location and cytologic findings, differential diagnoses included chordoma, chondroma, chondrosarcoma, and aneurysmal bone cyst. The present case posed a diagnostic challenge due to possible confusion with these entities.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Gie-Taek Yie
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Lee JH, Kim HS, Yoon YC, Cha MJ, Lee SH, Kim ES. Differentiating between spinal schwannomas and meningiomas using MRI: A focus on cystic change. PLoS One 2020; 15:e0233623. [PMID: 32469953 PMCID: PMC7259580 DOI: 10.1371/journal.pone.0233623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/08/2020] [Indexed: 12/04/2022] Open
Abstract
Objectives To retrospectively determine the diagnostic ability of MRI in differentiating between intradural extramedullary spinal schwannomas and meningiomas. Methods A total of 199 patients with spinal intradural extramedullary tumors who underwent preoperative contrast-enhanced MRI between January 2012 and December 2018 were included in this study. Two radiologists independently analyzed the presence of cystic change, dural tail sign, and neural foraminal extension. Clinical and MRI features between the two groups were compared by univariable and multivariable analyses using logistic regression. Interobserver agreements were calculated using kappa statistics. Results Patients with schwannoma showed significantly higher frequency of cystic change (96% vs 24%, P < 0.001), neural foraminal extension (29% vs 3%, P = 0.001), and lumbar location (41% vs 5%, P = 0.008). Patients with meningioma showed significantly higher frequency of dural tail sign (64% vs 1%, P < 0.001), thoracic location (75% vs 31%, P = 0.007), older age (59.7 years vs 47.6 years, P < 0.001), higher female predominance (83% vs 50%, P < 0.001), and smaller size (19.8 cm vs 28.8 cm, P < 0.001). Multivariable analysis showed that cystic change (P < 0.001; odds ratio [OR], 0.02), dural tail sign (P < 0.001; OR, 36.23), age (P = 0.032; OR, 1.06), and lumbar location (P = 0.006; OR, 0.02) were independent factors. Interobserver agreements were almost perfect for all analyses. Conclusions MRI features were useful in differentiating between intradural extramedullary schwannomas from meningiomas. The presence of cystic change and dural tail sign were independently significant discriminators.
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Affiliation(s)
- Ji Hyun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Su Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Young Cheol Yoon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kee TP, Liauw L, Sathiyamoorthy S, Lee HY, Tan GSL, Yu WY. Large solitary lytic skull vault lesions in adults: radiological review with pathological correlation. Clin Imaging 2019; 59:129-143. [PMID: 31816540 DOI: 10.1016/j.clinimag.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/29/2019] [Accepted: 10/17/2019] [Indexed: 12/13/2022]
Abstract
The diagnosis of a large solitary lytic skull vault lesion in adults is a challenge due to variable aggressiveness and overlapping features. The purpose of this article is to demonstrate the use of an imaging approach to narrow the differential diagnosis when a large solitary lytic skull vault lesion is encountered. The initial imaging assessment using computed tomography (CT) is invaluable in determining lesion aggressiveness based on bony margins and skull tables involvement. Further assessment with magnetic resonance (MR) imaging including diffusion weighted imaging (DWI) aids in soft tissue characterization. We present cases of large solitary lytic skull vault lesions in adults, emphasizing on salient and atypical imaging features, with pathological correlation for better understanding of the disease processes that underlie the imaging features.
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Affiliation(s)
- Tze Phei Kee
- Department of Diagnostic Radiology, Singapore General Hospital, 169608, Singapore.
| | - Lishya Liauw
- Department of Diagnostic Radiology, Singapore General Hospital, 169608, Singapore.
| | | | - Hwei Yee Lee
- Department of Pathology, Tan Tock Seng Hospital, 308433, Singapore.
| | - Grace Siew Lim Tan
- Department of Diagnostic Radiology, Singapore General Hospital, 169608, Singapore.
| | - Wai Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, 308433, Singapore.
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Yaprak Bayrak B, Vural Ç, Çam İ, Yildiz DK, Duman Öztürk S, Akansel G, Sarper EB. Multiple primary intraosseous meningioma mimicking fibrous dysplasia: a case report. Br J Neurosurg 2019:1-3. [PMID: 31380701 DOI: 10.1080/02688697.2019.1650251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Primary intraosseous meningioma (PIM) is a rare subtype of primary extradural meningiomas. These rare ectopic meningiomas have been usually reported in the frontotemporal regions of the calvarium, orbits, and anterior cranial fossa. We report a case with bilateral tumors located in frontoparietal regions of calvarium. Our initial diagnosis was fibrous dysplasia but the lesions were seen to expand under follow-up. One was resected and the histopathological diagnosis was PIM. This is the second reported case of multiple PIM.
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Affiliation(s)
| | - Çiğdem Vural
- a Department of Pathology, Kocaeli University , Kocaeli , Turkey
| | - İsa Çam
- b Department of Radiology, Kocaeli University , Kocaeli , Turkey
| | | | | | - Gür Akansel
- b Department of Radiology, Kocaeli University , Kocaeli , Turkey
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