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Tauziède-Espariat A, Kleinmann P, Benali A, Bitton L, Antin G, Hasty L, Georges O. [A pulmonary tumor that racks our brains!]. Ann Pathol 2021; 41:486-489. [PMID: 33926758 DOI: 10.1016/j.annpat.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
We report the case of a 74-year-old woman who, as part of the follow-up for two breast cancers, presented a 2cm long lung nodule. A microscopic examination of the biopsy under a scanner showed a proliferation of epithelial appearance but whose immunophenotypic profile did not permit a precise diagnosis (negativity of CK7, GATA3, TTF1, negative estrogen receptors but positive progesterone receptors). Wedge resection surgery was performed. Extemporaneous and definitive microscopic examination showed a well-defined lesion made up of lobules of cohesive-looking cells, frequently forming coils. The tumor cells showed some intranuclear inclusions and a few psammomas while the immunohistochemical study showed diffuse expression of EMA, SSTR2A and progesterone receptor markers and a low proliferation index. A diagnosis of a pulmonary localization of a meningioma was proposed. The radiological assessment of the entire neuraxis did not show any other lesion leading to the final diagnosis of primary intra-pulmonary meningioma. This is an exceptional tumor with a difficult histopathological diagnosis of biopsy material, which must familiar to the pathologists. It is associated with an excellent prognosis. Our observation aims to illustrate the macroscopic and microscopic aspects and to present the data from the recent literature review.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Cabinet de pathologie Medipath site de Paris, 17, rue Gazan, 75014 Paris, France; Service de neuropathologie, GHU Paris-neurosciences et psychiatrie, site hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| | - Philippe Kleinmann
- Service de chirurgie thoracique, clinique du Val d'Or, 14-16, rue Pasteur, Saint-Jacques, 92210 Saint-Cloud, France
| | - Ali Benali
- Cabinet de pathologie Medipath site de Paris, 17, rue Gazan, 75014 Paris, France
| | - Laura Bitton
- Cabinet de pathologie Medipath site de Paris, 17, rue Gazan, 75014 Paris, France
| | - Gérard Antin
- Cabinet de pathologie Medipath site de Paris, 17, rue Gazan, 75014 Paris, France
| | - Lauren Hasty
- Service de neuropathologie, GHU Paris-neurosciences et psychiatrie, site hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - Odette Georges
- Cabinet de pathologie Medipath site de Paris, 17, rue Gazan, 75014 Paris, France
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Lin D, Yu Y, Wang H, Fang Y, Yin J, Shen Y, Tan L. Radiological manifestations, histological features and surgical outcomes of pulmonary meningothelial proliferation: a case series and rethinking. Transl Lung Cancer Res 2020; 9:1159-1168. [PMID: 32953494 PMCID: PMC7481605 DOI: 10.21037/tlcr-19-699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Lung cancer screening with computed tomography (CT) has been adopted worldwide. Consequently, there is an increase of some previously rarely reported lesions, like pleuropulmonary meningothelial proliferation (PMP), which included metastatic pulmonary meningiomas (MPMs), primary pulmonary meningiomas (PPMs) and minute pulmonary meningothelial-like nodules (MPMNs). To date, the understanding of the clinical management of PMP is limited. Methods We retrospectively searched PMP (MPMs, PPMs, and MPMNs) on the medical database (May 2005 to April 2019) of our department, and extracted the demographic and perioperative information. The last follow-up was in May 2019. Results A total of 78 patients, including 16 (20.5%) males and 62 (79.5%) females, were enrolled, with the median age as 61 (range, 27–78) years. There was 1 case with multiple MPMs, 4 cases with PPMs and 73 cases with MPMNs. On CT, MPMs manifested as round nodules with solid or part-solid components. PPM mainly presented as an isolated, round, solid, and well-circumscribed nodule, with or without lobulation. While MPMNs often showed as multiple, round, randomly-distributed, solid or partly-solid nodules, most of which were in tiny size. Histologically, MPM, PPM, and MPMN had similar morphological and immunohistochemical (IHC) features. As to the surgical outcomes, the case with multiple MPMs had undergone a progression after wedge resection and was in an active monitoring. And the four cases with PPMs and the five cases with MPMNs were all in regular surveillance. Conclusions PPM has variable radiological manifestations. But it can be histologically identified by the characteristic features. Although surgery is able to achieve satisfying prognosis, active observation is an alternative in selected cases due to the surgical invasiveness and the indolent nature of the disease.
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Affiliation(s)
- Dong Lin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yangli Yu
- Department of Radiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yong Fang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jun Yin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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Zhao Z, Sun K, Yan T, Wei R, Guo W. Multiple primary tumors: a case report and review of the literature. BMC Musculoskelet Disord 2020; 21:394. [PMID: 32571290 PMCID: PMC7310446 DOI: 10.1186/s12891-020-03426-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Multiple primary tumors, especially quadruple primary neoplasms is extremely rare. Fibrous dysplasia (FD), osteosarcoma (OS), and giant cell tumor of bone (GCTB) are three bone tumors with low incidence while primary pulmonary meningioma is a rare disease. In this case report, we present a unique synchronous occurrence of these four separate pathological conditions. CASE PRESENTATION A 53-year-old male previously underwent resection of OS of fifth rib and FD of eighth rib 1 year ago. Recently, a discontinuous pain at right knee developed. Serial X-ray films showed a progressively pure osteolytic lesion of proximal tibia which extended gradually. The incisional biopsy revealed that this tumor was confirmed as GCTB, and the tumor was successfully managed by extensive curettage and bone cement filling. The diagnosis of GCTB was re-confirmed by the postoperative histopathologic examinations. High-throughput sequencing from the GCTB exhibited a somatic mutation of H3.3A (G35W exon2). Germline testing revealed a germ-cell variant in gene of BRCA2 (exon 8 V220Ifs*4). CONCLUSIONS This is a unique case with quadruple primary tumors. Germline mutation in gene of BRCA2 may be associated with the occurrence of multiple primary tumors in this patient.
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Affiliation(s)
- Zhiqing Zhao
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Kunkun Sun
- Department of Pathology, Peking University People's Hospital, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China.
| | - Ran Wei
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing, 100044, China
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Wang X, Li P, Zhou P, Fu Y, Lai Y, Che G. Intrapulmonary metastasis from primary pulmonary meningioma presenting as multiple cystic lesions: a case report. BMC Pulm Med 2019; 19:8. [PMID: 30621651 PMCID: PMC6325864 DOI: 10.1186/s12890-018-0773-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/27/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cystic lung lesions involving both lungs include a variety of diseases, such as pulmonary Langerhans cell histiocytosis, lymphangioleiomyomatosis and pulmonary metastasis. Primary pulmonary meningioma accompanied with intrapulmonary metastasis was extremely rare and we were not aware of previous studies reporting with cystic radiological manifestation. CASE PRESENTATION A 64-year-old female patient was admitted to our department for a mass located in right posterior mediastinum with multiple cystic pulmonary lesions. A thoracoscopic lung biopsy was performed and the diagnosis was confirmed as bilateral pulmonary metastasis from primary pulmonary meningioma. CONCLUSIONS Intrapulmonary metastasis from a primary pulmonary meningioma may manifest as multiple thin-walled cystic lesions on computed tomography. Differential diagnosis of cystic pulmonary disease should include this situation. Our case shows the new CT manifestation of metastatic primary pulmonary meningioma and the importance of immunomolecular analysis.
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Affiliation(s)
- Xin Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Pengfei Li
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Ping Zhou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yiyun Fu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yutian Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
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Abstract
RATIONALE Primary extracranial meningiomas are rare outside the head and neck region. PATIENT CONCERNS A 44-year-old female patient had chest pain for more than 1 year. DIAGNOSES Preoperative chest computed tomography (CT) scan revealed a nodule in the right lower lobe, 1.8 cm in diameter. Tumor tissues were examined by immunohistochemistry for vimentin and S-100. INTERVENTIONS Histopathologically, the tumor was characterized by whorled nests of spindle-shaped cells accompanied by psammoma bodies. Immunohistochemistry demonstrated tumor cell positivity for vimentin and S-100. This case was diagnosed as a primary pulmonary meningioma. The tumor was removed by a thoracoscopic pulmonary wedge resection. OUTCOMES Postoperative cranial and spinal CT scan did not show any intracranial or spinal mass. No recurrence of the tumor was reported at the time of writing up this case report. LESSONS A primary pulmonary meningioma should be considered in the differential diagnosis workup of pulmonary nodules.
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Affiliation(s)
| | - Li Chen
- Department of Cardiothoracic Surgery
| | - Yuping Mao
- Department of Pathology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, China
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Satoh Y, Ishikawa Y. Multiple primary pulmonary meningiomas: 20-year follow-up findings for a first reported case confirming a benign biological nature. Int J Surg Case Rep 2017; 31:58-60. [PMID: 28107759 PMCID: PMC5247277 DOI: 10.1016/j.ijscr.2017.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Primary pulmonary meningiomas (PPMs) are very rare neoplasms, and we reported the first multiple case of PPMs in 1998. Usually, PPMs are slow-growing tumors with a good prognosis. Herein, we reported a rare multiple case of PPMs with an extremely long clinical course. PRESENTATION OF THE CASE An 84-year-old Japanese woman with a history of multiple PPMs histologically confirmed as having a right-sided slowly growing lung nodule for 20 years. In 2010, we also reported the additional clinical course in the initial case 10 years after surgery implying a benign biological nature. Subsequent to that report, new lesions appeared in the bilateral lung fields with quite a slow growth rate. She was asymptomatic, and no tumor was observed in the cranial cavity during the course of her disease. DISCUSSION AND CONCLUSION This case illustrates rare multiple PPMs and highlights their biological behavior with very slow progression from a most likely benign tumor over a 20-year period.
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Affiliation(s)
- Yukitoshi Satoh
- Department of Thoracic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
| | - Yuichi Ishikawa
- Department of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
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Primary Pulmonary Meningioma Simulating a Pulmonary Metastasis. Case Rep Pulmonol 2016; 2016:8248749. [PMID: 27974986 PMCID: PMC5128704 DOI: 10.1155/2016/8248749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022] Open
Abstract
Primary pulmonary meningiomas represent a rare tumor entity. Few cases have been reported in the English medical literature, and they have almost all been solitary and benign in nature, with the exception of several extremely rare cases. We report herein a case of PPM that raised suspicion of a pulmonary metastatic tumor initially, as it was depicted as a single, round, small, ground-glass opacity pulmonary nodule on a chest computed tomography scan, in a 55-year-old man with a history of buccal cancer. Increased awareness of the clinical and radiologic characteristics of this rare category can assist a multidisciplinary team to perform adequate management.
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Masago K, Hosada W, Sasaki E, Murakami Y, Sugano M, Nagasaka T, Yamada M, Yatabe Y. Is primary pulmonary meningioma a giant form of a meningothelial-like nodule? A case report and review of the literature. Case Rep Oncol 2012; 5:471-8. [PMID: 23109924 PMCID: PMC3457042 DOI: 10.1159/000342391] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Minute pulmonary meningothelial-like nodules (PMNs) are asymptomatic, small nodules that are occasionally detected in surgical or autopsy specimens. Recent improvements in tumor imaging and the increased use of computed tomography (CT) scans of the chest have led to the early detection of these pulmonary nodules in various clinical settings, often before surgery or health examinations. However, large PMNs have rarely been observed. In this study, we report a patient with a large PMN, which was almost identical to so-called ‘primary pulmonary meningioma’. A CT scan of his chest revealed a small, well-circumscribed nodule. Immunohistochemical analysis of the tumor revealed that the tumor cells were positive for CD56, epithelial membrane antigen, and progesterone receptor. Given the similarity of these results to the staining pattern of minute PMNs in previous reports, we suggest that the primary pulmonary meningiomas reported to date are, in fact, a giant form of PMN.
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Affiliation(s)
- Katsuhiro Masago
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan
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Saha MK, Hamieh T. An elusive cause of pleural effusion. BMJ Case Rep 2012; 2012:bcr-01-2012-5616. [PMID: 22907848 DOI: 10.1136/bcr-01-2012-5616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 32-year-old man was admitted with cerebrospinal fluid leakage from a right scalp surgical wound after a resection of recurrent meningioma and reconstruction of skull with muscle flap 3 weeks earlier. On day 4 of admission, he was found to be tachycardic and decreased breath sounds on the right side. Chest x-ray revealed a large right pleural effusion which was found to be exudative after thoracocentesis. Infectious work-up and cytology was negative. CT showed both parietal and visceral pleural masses, which was consistent with meningioma on ultrasound-guided biopsy. He underwent right-side decortication and pleurodesis for recurrent pleural effusion. He declined further treatment and opted for hospice care and expired a month later.
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Affiliation(s)
- Manish K Saha
- Department of Internal Medicine, Health Partners, Saint Paul, Minnesota, USA.
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Pandya CM, Gadgeel S, Dogra S. A 67-Year-Old Woman With Right Lung Mass: A Rare Diagnosis. Chest 2010. [DOI: 10.1378/chest.10441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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