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Sugii N, Tsurubuchi T, Sakamoto N, Shibuya M, Ishikawa E. Sclerosing meningioma with a large peritumoral cyst: Case report. Radiol Case Rep 2023; 18:2401-2406. [PMID: 37275742 PMCID: PMC10232944 DOI: 10.1016/j.radcr.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 06/07/2023] Open
Abstract
Meningioma morphology is diverse. Although unlisted in the WHO classification, sclerosing meningioma is a rare variation featuring an extremely low signal intensity on MRI T2-weighted imaging. About 50 cases of sclerosing meningiomas, including spinal tumors, have been reported; however, cases with an accompanying large peritumoral cyst remain unreported. Here, we first report a rare case of sclerosing meningioma with a large peritumoral cyst and review relevant literature.
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Affiliation(s)
- Narushi Sugii
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575 Japan
| | - Noriaki Sakamoto
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Makoto Shibuya
- Central Clinical Laboratory, Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575 Japan
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Shrateh ON, Jobran AWM, Bakri IA, Saa SA. Rare clinical entity of cystic meningioma in an elderly patient: A case report and review of the literature. Int J Surg Case Rep 2023; 107:108384. [PMID: 37301093 DOI: 10.1016/j.ijscr.2023.108384] [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: 05/04/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Meningiomas, the most prevalent extra-axial neoplasm, are frequent tumors of the central nervous system that make up around 15 % of all intracranial malignancies. Although atypical and malignant meningiomas do exist, benign meningiomas make up the majority of cases. On both computed tomography and magnetic resonance imaging, a well-circumscribed, homogeneously enhancing, extra-axial mass is a typical imaging feature. An associated cyst is a rare imaging characteristic that may make it challenging to differentiate the tumor from a primary intra-axial glial neoplasm. Peritumoral edema can also lead to false positive results. CASE PRESENTATION A 64-year-old female patient presented to the emergency department of our hospital due to difficulty of the speech with a 3-week duration associated with unilateral headache, gait unsteadiness, and urinary incomitance. Neuroimaging of the brain by magnetic resonance imaging (MRI) with and without gadolinium contrast revealed an extra-axial cystic lesion located in the left fronto-temporal area, measuring about 4 cm × 4 cm × 4 cm. The patient underwent a craniotomy for removal of the lesion and the resected tissue was sent to pathology. Histopathological assessment revealed a pure cystic meningioma. CLINICAL DISCUSSION Cystic meningioma's preoperative diagnosis is not often easy to make. Compared to CT screening, brain MRI with gadolinium offers a higher diagnostic yield. To confirm the category and subtype of the tumor, a histopathological assessment of the tumor cells should always be performed. CONCLUSION Although its rare, cystic meningioma should be considered in the differential diagnosis of cystic brain lesions.
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Affiliation(s)
- Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | | | - Izzeddin A Bakri
- Department of Pathology, Makassed Islamic Charitable Hospital, Jerusalem, Palestine
| | - Shadi Abu Saa
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine; Department of Neurosurgery, Palestinian Medical Complex (PMC), Ramallah, Palestine
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Huang R, Su S, Yang Z, Wang H, Hong L, Chen L, Wu X, Zheng Y, Zhuang R, Liu Y. Neuroradiologic Findings and Clinical Features of Meningiomas With Spontaneous Hemorrhagic Onset: A Single-center 10-year Experience. World Neurosurg 2022; 162:e605-e615. [PMID: 35338017 DOI: 10.1016/j.wneu.2022.03.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/17/2022] [Accepted: 03/17/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to elucidate the clinicoradiologic features of spontaneous hemorrhagic meningiomas (HMs) and examine risk factors associated with meningioma hemorrhage. METHODS We retrospectively reviewed 651 consecutive meningioma patients who underwent surgical resection in our hospital between January 2011 and January 2021. After exclusions, 169 patients were included for analysis. Patients were grouped according to presence of hemorrhage in the meningioma: the HM group (n = 19) and non-HM group (n = 150). Clinicoradiologic patient data were examined and compared using univariate and multivariate analysis. RESULTS HMs accounted for 2.9% of the entire series of meningiomas. HMs were mainly located at the convexity (63.2%). Mean diameter of HMs was 4.8 cm. On computed tomography, most HMs appeared as mixed isodensity and hyperdensity (84.2%). On magnetic resonance imaging, most appeared as mixed isointensity and hyperintensity on T1-weighted imaging and mixed hypointesity and hyperintensity on T2-weighted imaging (52.6%). Seventeen tumors exhibited heterogeneous enhancement, a dural tail, and peritumoral brain edema. Thirteen showed intratumoral cystic change. The misdiagnosis rate was significantly higher in HMs than non-HMs (31.6% vs. 7.3%; P = 0.005). Intratumoral cystic change was the only independent predictor of meningioma hemorrhage in multivariate analysis (odds ratio 4.116; 95% confidence interval 1.138-14.894; P = 0.031). CONCLUSIONS Mixed isodensity/intensity and hyperdensity/intensity on computed tomography/magnetic resonance imaging in conjunction with heterogenous enhancement, a dural tail, and varying degrees of peritumoral brain edema suggest a high possibility of HM. Presence of intratumoral cystic change was an independent risk factor associated with meningioma hemorrhage.
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Affiliation(s)
- Ruibin Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Shuyan Su
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Zhiqi Yang
- Department of Radiology, Meizhou People's Hospital, Meizhou, Guangdong, P.R.China
| | - Huanpeng Wang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Liangli Hong
- Department of Pathology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Liujiang Chen
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Xiaojia Wu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Yungui Zheng
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Ruyao Zhuang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
| | - Yuan Liu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China
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Huang RB, Chen LJ, Su SY, Wu XJ, Zheng YG, Wang HP, Zhuang RY, Liu Y. Misdiagnosis and Delay of Diagnosis in Hemorrhagic Meningioma: A Case Series and Review of the Literature. World Neurosurg 2021; 155:e836-e846. [PMID: 34520866 DOI: 10.1016/j.wneu.2021.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the clinicoradiologic characteristics of hemorrhagic meningiomas (HMs) that are missed or misdiagnosed on radiologic imaging studies. METHODS Clinical and radiologic data from 6 patients with HM who were initially misdiagnosed were collected and recorded respectively. In addition, we performed a literature review for misdiagnosed HM and summarized the results. RESULTS Five of the 6 patients with misdiagnosed HM were female, and 1 was male. Both computed tomography (CT) and magnetic resonance imaging were performed in 4 patients, and CT alone was performed in 2. On CT, the HM was heterogeneously hyperdense in 5 patients and isodense in 1 patient. In all 4 patients who underwent magnetic resonance imaging, the HM was mixed iso- and hypointense on T1-weighted imaging and heterogeneously hyperintense on T2-weighted imaging. Marked heterogeneous contrast enhancement was observed in 2 patients, strong rim enhancement in 1, and peripheral enhancement in 1. The dural tail sign was seen in only 1 patient. The initial radiologic misdiagnoses were subdural hematoma (n = 1), malignant glioma (n = 1), ruptured arterial aneurysm (n = 1), metastasis (n = 2), and uncertain (n = 1). In the literature review, 22 cases of HM diagnostic error were collected. The main misdiagnoses were subdural hematoma (27.3%), traumatic hematoma (13.6%), vascular anomaly (13.6%), malignant glioma (4.5%), and metastasis (4.5%). CONCLUSIONS Our study showed that in patients with HM with inadequate imaging evaluation, a small tumor associated with massive hematoma and atypical imaging features was more likely to be misdiagnosed.
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Affiliation(s)
- Rui-Bin Huang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Liu-Jiang Chen
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Shu-Yan Su
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Xiao-Jia Wu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Yun-Gui Zheng
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Huan-Peng Wang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
| | - Ru-Yao Zhuang
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China.
| | - Yuan Liu
- Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P. R. China
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Wang M, Wang Z, Ren P, Zhang X, Liu S. Meningioma with ring enhancement on MRI: a rare case report. BMC Med Imaging 2021; 21:22. [PMID: 33568080 PMCID: PMC7877038 DOI: 10.1186/s12880-021-00555-x] [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: 09/01/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
Background Meningiomas typically manifest on magnetic resonance imaging (MRI) as iso- to hypointense on T1-weighted imaging and iso- to hyperintense on T2-weighted imaging. After contrast administration, they usually homogeneously enhance and exhibit a visible dural tail. Meningiomas with atypical findings may be misdiagnosed. Case presentation We report a 50-year-old female patient with a pathologically diagnosed fibrous meningioma (World Health Organization grade I) that exhibited ring enhancement on MRI. Conclusions Meningiomas may rarely present with ring enhancement on MRI. The natural history and mechanisms of cystic degeneration and enhancement in the various types of meningioma require further study.
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Affiliation(s)
- Miao Wang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University, 400037, Chongqing, China
| | - Zhongke Wang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University, 400037, Chongqing, China
| | - Peng Ren
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University, 400037, Chongqing, China
| | - Xiaoqing Zhang
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University, 400037, Chongqing, China
| | - Shiyong Liu
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University, 400037, Chongqing, China.
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Ansari A, Riyaz S. Two-Staged Approach for Giant Hypervascular Meningioma Resection. Asian J Neurosurg 2020; 15:349-353. [PMID: 32656131 PMCID: PMC7335117 DOI: 10.4103/ajns.ajns_364_19] [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: 12/23/2019] [Revised: 01/03/2020] [Accepted: 02/25/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: Giant meningiomas represent very uncommon and challenging tumors. Surgical morbidity is high due to the difficult and complex approaches to devascularize these hypervascular lesions. In the present series, we demonstrate a two-staged approach for surgical resection of giant hypervascular meningiomas. Patients and Methods: Four such patients having giant hypervascular meningiomas between July 2017 and June 2019 were taken in the present study. There were two falco-tentorial, one anterior and middle parasagittal and falcine meningioma, and one sphenoid wing with convexity meningioma. Results: In the first stage, only the hypervascular bone was removed, and the dura was coagulated and excised. In the definitive stage, usually undertaken 5–8 days following the first surgery, the meningioma was excised, leading to Simpson's Grade 2 excision in two and Grade 3 excision in the remaining two patients. There was one mortality of a previously operated malignant meningioma (histopathologically proven), owing to a cardiac event in the patient, while the other three were discharged without any new neurologic deficit. Conclusion: Two-staged approach for giant meningiomas represents a safe and effective surgical management, tolerable for the patient and more comfortable for the neurosurgeon.
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Affiliation(s)
- Ahmed Ansari
- Department of Neurosurgery, UPUMS, Etawah, Uttar Pradesh, India
| | - Sadaf Riyaz
- Department of Microbiology, UPUMS, Etawah, Uttar Pradesh, India
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Jacobo JA, Mamani R, Jimenez SM, Avendaño J, Nuñez S. Microcystic meningioma associated with other meningioma subtypes: A diagnostic challenge, report of two cases. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Meningiomas quísticos: correlación radiológica y patológica con implicaciones quirúrgicas. Neurocirugia (Astur) 2019; 30:1-10. [DOI: 10.1016/j.neucir.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/17/2018] [Accepted: 08/18/2018] [Indexed: 11/30/2022]
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Li J, Meng J, Wang Q, Wang Y, Liu W, Hui X. A case report on cystic meningioma in cerebellopontine angle and recommendations for management. Medicine (Baltimore) 2018; 97:e13179. [PMID: 30431593 PMCID: PMC6257460 DOI: 10.1097/md.0000000000013179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Cystic meningioma located at the cerebellopontine angle (CPA) is an extremely rare occurrence. It is frequently misdiagnosed preoperatively. Little is known about the clinical features and outcome of this rare disease. PATIENT CONCERNS A 70-year-old male presenting with progressive headache and gait disturbance. DIAGNOSIS According to the symptoms, signs, and Gd-enhanced magnetic resonance images (MRI), a preoperative diagnosis of hemangioblastoma located in left CPA was made. Finally, the histological examination revealed a meningioma. INTERVENTIONS A complete resection, including the part of the solid mass together with cyst, was performed. OUTCOMES The postoperative course of the patient was uneventful, and no residual or recurrent tumor was found during the 24-month follow-up period. LESSONS Cystic meningioma should be included in the differential diagnosis of a CPA mass with atypical radiologic features, such as a large cyst and enhanced mural nodule. By summarizing the related literature, we found that the most common pathological subtype of CPA cystic meningioma is the clear cell subtype, which belongs to WHO grade II. Gross total resection including the enhanced cyst wall is extremely important. A close follow-up is necessary because of the high recurrence rate in this subset of meningioma.
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Affiliation(s)
- Jiuhong Li
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Jinli Meng
- Department of Radiology, Hospital of Chengdu office of People's Government of Tibetan Autonomous Region (Hospital C.T), Chengdu, China
| | - Qiguang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Yanchao Wang
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Wenke Liu
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University
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Go KO, Lee K, Heo W, Lee YS, Park YS, Kim SK, Lee JH, Jung JM. Cystic Meningiomas: Correlation between Radiologic and Histopathologic Features. Brain Tumor Res Treat 2018; 6:13-21. [PMID: 29644810 PMCID: PMC5932295 DOI: 10.14791/btrt.2018.6.e3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/28/2022] Open
Abstract
Background Tumors with cysts often correlate with gliomas, metastatic tumors, or hemangioblastomas, which require differentiation. Methods Thirty-eight cases of cyst associated-meningioma based on preoperative radiologic studies and histologic confirmations were reviewed from November 1998 to July 2017. Results A total of 395 cases of meningioma were observed in the 20 years, and surgical treatment of intracranial meningioma was performed in 120 cases. Thirty-eight (9.6%) cases of cyst associated meningiomas were analyzed. Nauta type I was the most common type of cyst (39.5%) and the most frequent histopathological subtype was meningothelial type (36.8%). Conclusion Statistically there were no significant associations between meningioma histopathological type and associated cysts; however, the rate of World Health Organization grade II was higher in cyst associated meningiomas than in unrelated meningiomas. This correlation was weak, in accordance with the meningioma grade.
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Affiliation(s)
- Kyeong O Go
- Department of Neurosurgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Kwangho Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Won Heo
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Young Seok Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Young Seop Park
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sung Kwon Kim
- Department of Neurosurgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Hee Lee
- Department of Pathology, Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jin Myung Jung
- Department of Neurosurgery, Gyeongsang National University Hospital, Jinju, Korea.,Department of Neurosurgery, Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea.
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Zakhari N, Torres C, Castillo M, Nguyen TB. Uncommon Cranial Meningioma: Key Imaging Features on Conventional and Advanced Imaging. Clin Neuroradiol 2017; 27:135-144. [PMID: 28466126 DOI: 10.1007/s00062-017-0583-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
Given the high incidence of intracranial meningiomas encountered in clinical practice, it is not uncommon to find rare subtypes of meningioma, with unusual imaging findings. These commonly represent a diagnostic challenge. In this article, we review the imaging appearance of typical meningioma on conventional and advanced imaging as well as the key imaging features of multiple uncommon subtypes: cystic, microcystic, lipomatous, chordoid, angiomatous, intraosseous, extracranial, atypical/malignant, and tumor-to-tumor metastasis (also known as collision tumors). Some of these uncommon subtypes, however, demonstrate imaging features that may allow for a more specific diagnosis, or features, which can influence patient's management.
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Affiliation(s)
- Nader Zakhari
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada
| | - Carlos Torres
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326 Old Infirmary Building, Manning Drive, 27599-7510, Chapel Hill, NC, USA
| | - Thanh B Nguyen
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada
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Boukobza M, Cebula H, Pop R, Kouakou F, Sadoun A, Coca HA, Polivka M, Diemidio P, Ganau M, George B, Froelich S, Proust F, Chibbaro S. Cystic meningioma: radiological, histological, and surgical particularities in 43 patients. Acta Neurochir (Wien) 2016; 158:1955-64. [PMID: 27510826 DOI: 10.1007/s00701-016-2898-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/13/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of cysts is a rare occurrence for intracranial meningiomas in adults. We report our experience in a large consecutive series of cystic meningiomas. METHOD We prospectively collected data for a dedicated database of cystic meningioma cases between January 2004 and December 2011 in two tertiary neurosurgical centers. Studied data included preoperative imaging, surgical records, and pathology reports. RESULTS Among 1214 surgeries for intracranial meningioma, we identified 43 cases of cystic meningioma, corresponding to an incidence of 3.5 %. The most common localization was the hemispheric convexity (17/43 cases). Twenty-eight patients had intratumoral cysts, nine peritumoral, and five mixed intra and extratumoral. In 29 patients with available diffusion imaging, ADC coefficients were significantly lower in grade II-III tumors compared to grade I (p = 0.01). Complete resection of the cystic components was possible in 27/43 patients (63 %); partial resection in 4/43 (9 %); in 6/43 (14 %) cyst resection was not possible but multiple biopsies were performed from the cystic walls; in another 6/43 (14 %) the cystic wall was not identified during surgery. Cells with neoplastic features were identified within the cyst walls at pathology in 26/43 cases (60 %). All patients were followed-up for 24 months; long-term follow-up was available only in 32 patients for an average period of 49 months (range, 36-96 months). No recurrence requiring surgery was observed. CONCLUSIONS Cystic meningiomas are rare. Cells with neoplastic features are often identified within the cyst walls. Complete cyst resection is recommendable when considered technically feasible and safe.
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Affiliation(s)
- Monique Boukobza
- Department of Neuroradiology, Lariboisière University Hospital, Paris, France
| | - Helene Cebula
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Raoul Pop
- Department of Interventional Neuroradiology UF6954, Hautepierre University Hospital, 1 Avenue Moliere, 67098, Strasbourg, France.
| | - Fulbert Kouakou
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Amirouche Sadoun
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Hugo Andres Coca
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Marc Polivka
- Department of Histopathology, Lariboisière University Hospital, Paris, France
| | - Paolo Diemidio
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Mario Ganau
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Bernard George
- Department of Neurosurgery, Lariboisière University Hospital, Paris, France
| | - Sebastien Froelich
- Department of Neurosurgery, Lariboisière University Hospital, Paris, France
| | - Francois Proust
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
| | - Salvatore Chibbaro
- Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France
- Department of Neurosurgery, Lariboisière University Hospital, Paris, France
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13
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Wang P, Han S, Liu N, Yu C, Qi X, Zhu M, Zhang X, Wang LI, Yan C. Peritumoral cystic meningioma: A report of two cases and review of the literature. Exp Ther Med 2016; 11:904-908. [PMID: 26998010 DOI: 10.3892/etm.2016.2999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 10/27/2015] [Indexed: 11/06/2022] Open
Abstract
The present study reported two cases of cystic meningioma. The clinical manifestations, magnetic resonance imaging (MRI) scan and histological aspects of the lesion and the associated cyst were examined. The classification of cystic meningioma was also discussed. The present study focused on the formation, diagnosis and management of the peritumoral cystic meningioma, and aimed to clarify certain contradictions in the literature concerning the formation of the peritumoral cyst meningioma: MRI alone is inadequate to determine the type of cystic meningioma, or to identify neoplastic cells on the cystic wall. In conclusion, surgical removal of the entire cyst is recommended in peritumoral cyst meningioma.
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Affiliation(s)
- Pengfei Wang
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Song Han
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Ning Liu
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Chunjiang Yu
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Xueling Qi
- Department of Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Mingwang Zhu
- Department of Radiation, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Xiangqian Zhang
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - L I Wang
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
| | - Changxiang Yan
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093, P.R. China
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Sotiriadis C, Vo QD, Ciarpaglini R, Hoogewoud HM. Cystic meningioma: diagnostic difficulties and utility of MRI in diagnosis and management. BMJ Case Rep 2015; 2015:bcr-2014-208274. [PMID: 25814028 DOI: 10.1136/bcr-2014-208274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a patient presenting with convulsions in the emergency department. A CT examination revealed a mixed solid and cystic frontal peripheral mass. The intra-axial or extra-axial location and the differentiation between primary or secondary origin were not evident so MRI was performed. The most probable diagnosis was cystic meningioma with intratumoural cysts. Based on MRI findings, the neurosurgeon resected the mass together with its cystic components. The histological report verified the diagnosis and the patient had an excellent outcome.
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Affiliation(s)
| | - Quoc Duy Vo
- HFR-Fribourg-Hôpital Cantonal, Fribourg, Switzerland
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Abstract
INTRODUCTION Intracranial cystic meningiomas are rare and preoperative diagnosis is difficult. The present study was performed to assess the clinical and radiological outcome of intracranial cystic meningiomas. METHODS We performed a retrospective analysis of 13 patients (mean age: 49.9 years) who underwent surgical resection of intracranial cystic meningiomas from January 2006 to February 2014. There were 5 male and 8 female patients. The Glasgow Outcome Scale was used to assess the clinical outcome at 6 months. RESULTS Headache was the main presenting clinical feature. Most of the tumours were located on the right side. The frontal convexity was the most common site. Gross total resection was performed in 10 patients. The most common histopathological type was meningothelial variety. CONCLUSION Intracranial cystic meningiomas are usually benign that occur in relatively young patients. Resection of cysts that show contrast enhancement is essential to reduce recurrence.
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Affiliation(s)
- Ehtesham Ghani
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City , Riyadh , Saudi Arabia
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Surgical Outcome of Treating Grades II and III Meningiomas: A Report of 32 Cases. NEUROSCIENCE JOURNAL 2012; 2013:706481. [PMID: 26317097 PMCID: PMC4475582 DOI: 10.1155/2013/706481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/18/2012] [Indexed: 11/17/2022]
Abstract
Aim. To evaluate the frequency of atypical and malignant meningiomas and analyze recurrence rate; to study the morbidity and mortality of these tumors compared to benign meningiomas. Methods. During 1992–2007, 16 patients with malignant and 16 patients with atypical meningioma were operated in Neurosurgery Department of Thessaloniki's Papanikolaou Hospital. We analyzed tumor histology, location, and extent of surgical resection with respect to tumor reappearance and patients' outcome and compared the behavior of benign versus nonbenign meningiomas. Results. Malignant meningiomas accounted for 4.4% (16 patients) and atypical meningiomas for another 4.4% of the series of patients (353) who were operated for intracranial meningioma at our department that period.
Malignant meningiomas recurred at a rate of 75% and atypical meningiomas recurred at a rate of 41.6%. There was a significant association of the histological classification (benign, atypical, and malignant) with recurrence (P < 0.01). The recurrence rate after complete resection was 13.8%. The recurrence rate for incomplete resection was 46.7%. Extent of tumor removal was significant to recurrence (P < 0.001) for benign as well for atypical and malignant meningiomas.
Tumor location (P > 0.05) was not significant to recurrence. Conclusions. Atypical and malignant meningiomas appeared at a rate of 8.8% of our series of intracranial meningiomas. They showed a significant predisposition to recur. These rare subtypes have higher morbidity and mortality rates than benign meningiomas. Recurrence depends primarily on the extent of surgical removal and on the histological characterization of the tumor as atypical or malignant.
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Microcystic meningioma presenting as a cystic lesion with an enhancing mural nodule in elderly women: report of three cases. Brain Tumor Pathol 2011; 28:335-9. [DOI: 10.1007/s10014-011-0052-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/20/2011] [Indexed: 10/17/2022]
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18
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A cystic meningioma misdiagnosed as malignant glioma by radiologic and intraoperative histological examinations. Brain Tumor Pathol 2010; 27:111-5. [DOI: 10.1007/s10014-010-0273-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 06/15/2010] [Indexed: 09/29/2022]
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Hu SL, Li F, Hu R, Cui G, Meng H, Feng H. Atypical histopathologic type of cystic meningioma. Acta Neurochir (Wien) 2010; 152:105-9. [PMID: 19693432 DOI: 10.1007/s00701-009-0426-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 05/22/2009] [Indexed: 11/27/2022]
Abstract
The authors report a 21-year-old male with an atypical cystic meningioma in the right parietal area. On T1-weighted imaging (T1WI), the solid component was hypointense, while on T2-weighted imaging (T2WI), it was hyperintense. On T1WI, the cystic component was hypointense, and on T2WI, it was hyperintense. The authors review the literature about incidence, locations, MRI features, cyst type, and intraoperative managements of atypical cystic meningiomas.
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Affiliation(s)
- Sheng Li Hu
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Gaotanyan 29, Chongqing, 400038, The People's Republic of China
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Intracerebral cystic rhabdoid meningioma. J Clin Neurosci 2009; 16:1073-4. [DOI: 10.1016/j.jocn.2008.07.085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 06/14/2008] [Accepted: 07/24/2008] [Indexed: 11/23/2022]
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Zhang D, Hu LB, Zhen JW, Zou LG, Feng XY, Wang WX, Wen L. MRI findings of intracranial cystic meningiomas. Clin Radiol 2009; 64:792-800. [PMID: 19589418 DOI: 10.1016/j.crad.2009.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 04/15/2009] [Accepted: 04/28/2009] [Indexed: 11/29/2022]
Abstract
AIM To report the magnetic resonance imaging (MRI) features of intracranial cystic meningiomas and compare these features in intra- and peritumoural cyst groups. MATERIALS AND METHODS Fourteen cases of peritumoural cystic meningiomas were compared with 18 cases of intratumoural cystic meningiomas. All patients were examined using non-enhanced and contrast-enhanced MRI. Tumour location, tumour size, signal intensity, enhancement characteristics, and cystic changes were assessed. The MRI features were compared between the intra- and peritumoural cyst groups. RESULTS Most cystic meningiomas comprised two or more cysts. The solid parts of the tumours showed moderate or marked enhancement after the injection of contrast material. An enhanced cyst wall was found in six out of 14 cases in the peritumoural cyst group, but not in the intratumoural cyst group. Peritumoural cystic meningiomas were predominately located in the cerebral falx, whereas the intratumoural cystic meningiomas were predominantly found in frontal convexity (X(2)=7.434, p=0.024). The cysts were larger in the peritumoural cyst group than in the intratumoural cyst group (t=5.274, p=0.0258). Peritumoural oedema was more commonly found in the intratumoural cyst group (X(2)=6.863, p=0.008). Cystic meningiomas with solid parts located inside the cyst are reported for the first time. CONCLUSION Cystic meningiomas, although uncommon, should be differentiated from other cystic intracranial lesions. Peri- and intratumoural cystic meningiomas have distinct MRI features. The present study provides the first report of two lesions with solid parts located inside the cyst, as well as one lesion with a calcified solid nodule and haemorrhage within the cyst.
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Affiliation(s)
- D Zhang
- Department of Radiology, XinQiao Hosptial, Third Military Medical University, ChongQing 400037, P. R. China
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Kim EY, Weon YC, Kim ST, Kim HJ, Byun HS, Lee JI, Kim JH. Rhabdoid meningioma: clinical features and MR imaging findings in 15 patients. AJNR Am J Neuroradiol 2007; 28:1462-5. [PMID: 17846191 PMCID: PMC8134374 DOI: 10.3174/ajnr.a0601] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Rhabdoid meningioma (RM) is a recently described variant of malignant meningioma, with radiologic features currently not well characterized in the medical literature. The purpose of this study was to describe and characterize clinical features and imaging findings associated with RM. MATERIALS AND METHODS CT (n = 8) and MR (n = 15) images of 15 patients (4 men and 11 women; mean age, 52 years; range, 22-75 years) with 16 pathologically proved RMs along with associated clinical records were retrospectively reviewed. All of the patients underwent surgical resection and had additional radiation therapy except for 1 patient. After surgery, the patients had follow-up brain MR imaging to evaluate for tumor recurrence. RESULTS Nine lesions (56%) were located in the cerebral convexity, and 4 lesions (25%) were located in the parasagittal areas. The tumors were isointense (n = 15) to gray matter on T1-weighted images, whereas they were hyperintense (n = 14) on T2-weighted images. On gadolinium-enhanced T1-weighted images, homogeneous enhancement was seen in 10 lesions, and heterogeneous enhancement was seen in 6 lesions that had cysts. Cystic components were noted in 6 lesions (38%). Severe peritumoral edema was seen in 12 lesions (75%). Nine lesions (56%) had hyperostosis, and 5 of them also had bone destruction. Among the 8 cases with initial CT scans, only 1 had amorphous calcifications (13%). There was only 1 recurrence of RM found during the follow-up period after surgical resection. CONCLUSION RMs tend to have prominent peritumoral edema, cystic components, and bone involvement.
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Affiliation(s)
- E Y Kim
- Department of Radiology and Centers for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rosca TI, Carstocea BD, Vlãdescu TG, St Tihoan C, Gherghescu GGG. Cystic optic nerve sheath meningioma. J Neuroophthalmol 2006; 26:121-2. [PMID: 16845313 DOI: 10.1097/01.wno.0000223269.94189.bd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 58-year-old woman with a 35-year history of left proptosis underwent neuroimaging that revealed a large cystic lesion. Surgery revealed an optic nerve sheath meningioma associated with cyst formation. The cyst was part of the tumor, a phenomenon that is well described in intracranial meningiomas but not in optic nerve sheath meningiomas.
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Affiliation(s)
- Tatiana I Rosca
- Clinical Emergency Sf. Pantelimon Hospital, Bucharest, Romania.
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