Rhabdoid and papillary meningioma with leptomeningeal dissemination

Large rhabdoid meningioma presenting prominent hyperintensity in the optic nerve: An indicator of visual disturbance on constructive interference steady-state sequence?

BACKGROUND

Rhabdoid meningiomas (RMs) are a rare type of malignant meningioma. Here, we report a case of intracranial RM presenting with visual disturbance and prominent hyperintensity in the optic nerve (ON).

CASE DESCRIPTION

A 20-year-old female presented with a 1-year history of headache. At presentation, her visual acuity (VA) was 20/50 on the right side and 20/40 on the left, with an intraocular pressure of 17 mmHg on both sides. Cerebral magnetic resonance imaging revealed a broad-based tumor in the right frontal convexity. It measured 82 mm × 65 mm × 70 mm in diameter, accompanied by cystic components, and was inhomogeneously enhanced. The intraorbital ONs demonstrated prominent intramedullary hyperintensity on the constructive interference steady-state sequence. Gross total tumor resection was performed and the pathology was consistent with RM. Immediately after surgery, her VA and IOP were 20/17 and 10 mmHg, respectively, with a remarkable resolution of the intramedullary hyperintensity.

CONCLUSION

Prominent hyperintensity in the ON identified in patients with chronic intracranial hypertension may be an indicator of visual disturbance. It can rapidly resolve after resolution of intracranial hypertension with functional recovery.

Clinical, Histopathologic and Genetic Features of Rhabdoid Meningiomas

Rhabdoid meningiomas (RM) shows heterogeneous histological findings, and a wide variety of chromosomal copy number alterations (CNA) are associated with an unpredictable course of the disease. In this study, we analyzed a series of 305 RM samples from patients previously reported in the literature and 33 samples from 23 patients studied in our laboratory. Monosomy 22-involving the minimal but most common recurrent region loss of the 22q11.23 chromosomal region was the most observed chromosomal alteration, followed by losses of chromosomes 14, 1, 6, and 19, polysomies of chromosomes 17, 1q, and 20, and gains of 13q14.2, 10p13, and 21q21.2 chromosomal regions. Based on their CNA profile, RM could be classified into two genetic subgroups with distinct clinicopathologic features characterized by the presence of (1) chromosomal losses only and (2) combined losses and gains of several chromosomes. The latter displays a higher frequency of WHO grade 3 tumors and poorer clinical outcomes.

Multiple High Grade Rhabdoid Papillary Meningiomas Mimicking Choroid Plexus Carcinoma: A Case Report

Rhabdoid papillary meningioma is an uncommon aggressive variant of meningioma which has the potential to metastasize and spread throughout the brain and even out of the cranium. Herein, we present recurrence of the brain tumor in a 26-year-old woman. The patient had history of the surgery for two lesions in the right temporal lobe and the left cerebellopontine angle. Imaging showed three lesions in the right temporal lobe, the right occipital horn wall, and the left cerebellopontine angle. These radiologic findings were mostly suggestive of atypical meningioma. In the surgical view, the mass was solid-cystic reddish Cauliflower-shaped in the right temporal lobe attaching to the temporal horn. The microscopic examination showed a cellular neoplasm with the sheet-like and papillary growth pattern. Individual cells had vesicular nuclei some with prominent nucleoli and eosinophilic cytoplasm. The areas of the tumor cells showed round eccentric nuclei and prominent nucleoli with eosinophilic cytoplasm. Immunohistochemistry studies showed diffuse positivity of tumor cells with Vimentin, EMA, and S100. The overall clinical, radiological and histopathological examinations were compatible with high grade rhabdoid-papillary meningiomas. In the present case study, we discuss imaging and histomorphological features of this rare entity of meningiomas.

Meningioma with rhabdoid, papillary and clear cell features: case report and review of association of rare meningioma variants

Meningiomas are common central nervous system tumors with a wide range of morphological variants, assigned World Health Organization (WHO) Grades I – III. We report an extremely rare rhabdoid, papillary and clear cell meningioma (WHO Grade III) in a 29-year-old female, who presented with diplopia and headache over a few days, 2 years ago. Magnetic resonance imaging showed a well-circumscribed, lobulated, predominantly solid and contrast-enhancing lesion in the right temporal, parietal and occipital lobes. On routine staining, the tumor did not display classical meningioma features. A wide immunohistochemical panel ruled out metastasis and endorsed the meningothelial nature of the lesion (positivity for epithelial membrane antigen and vimentin). Electron microscopy did not show usual hallmarks of meningioma but was helpful in excluding other tumors. Even though the three variants are associated with aggressive behavior, the patient is currently asymptomatic. The concurrent use of different techniques was essential for diagnosis.

Meningiomas With Rhabdoid Features Lacking Other Histologic Features of Malignancy: A Study of 44 Cases and Review of the Literature

The behavior of rhabdoid meningiomas otherwise lacking malignant features remains unknown as most of the originally reported aggressive cases showed anaplastic histologic features independently of rhabdoid phenotype. We studied 44 patients with rhabdoid meningiomas lacking anaplastic features. Median age at diagnosis was 48.6 years (range 10-79). Location was supratentorial in 28 (63.6%), skull base in 15 (34.1%), and spinal in 1 (2.3%). Tumor grade was otherwise World Health Organization grade I (n = 22, 50%) or II (n = 22, 50%). Rhabdoid cells represented <20% of the tumor in 12 cases (27.3%), 20% to 50% in 18 (40.9%), and >50% in 14 (31.8%). Median clinical follow-up, available for 38 patients, was 5.0 years (range 0.17-14.2). Recurrence occurred in 9 patients (5-year recurrence-free survival, 73.7%) with a significantly higher risk in subtotally resected tumors (p = 0.043). Rhabdoid cell percentage was not associated with recurrence. Six patients died (4 of disease, 2 of unclear causes); 5-year overall survival was 86.7%, a mortality in excess of that expected in grade I-II meningiomas but much lower than originally reported. Review of 50 similar previously reported cases confirmed our findings. We suggest that rhabdoid meningiomas be graded analogously to nonrhabdoid tumors, with caution that some may still behave aggressively and close follow-up is recommended.

A case of cerebral astroblastoma with rhabdoid features: a cytological, histological, and immunohistochemical study

Astroblastoma is a rare neuroepithelial neoplasm of unknown origin, usually occurring in children and young adults. Here we report a case of astroblastoma with uncommon features in an 18-year-old female. The tumor was a well-circumscribed cystic and solid mass with marked gadolinium enhancement in the right frontal lobe. Cytological examination showed polarized monopolar cells with diminished cohesiveness. Tumor cells possessed eccentric round to oval nuclei with abundant eosinophilic cytoplasm, sometimes having cytoplasmic processes. Histopathologically, the tumor showed perivascular pseudorosettes with prominent vascular sclerosis. Foam cells were frequently infiltrated around blood vessels and among tumor cells. In some areas, a solid growth pattern of plump tumor cells with abundant inclusion-like eosinophilic cytoplasm showing rhabdoid appearance was observed. The immunohistochemical study revealed strong and diffuse positivity for vimentin and epithelial membrane antigen. Tumor cells were focally positive for glial fibrillary acidic protein and cytokeratin AE1/AE3. Nuclear immunoreactivity for INI1 protein was evident. The Ki-67 labeling index was 10.8%. This tumor was finally diagnosed as low-grade astroblastoma and the patient had no evidence of recurrence without postoperative radiotherapy or chemotherapy during the last 6 months of follow-up. This report describes novel cytological, histopathological, and immunohistochemical features of the rare tumor.

Intracranial meningioma with leptomeningeal dissemination : retrospective study with review of the literature

OBJECTIVE

The purposes of this article are to present 5 cases of intracranial meningioma with leptomeningeal dissemination (LD) and investigate the characteristics of this disease.

METHODS

We present a retrospective case series of 5 females at our institutions (age ranged 21-72 years, mean 54.6 years) diagnosed with LD of an intracranial meningioma after surgery between 1998 and 2013. A database search revealed 45 cases with LD of meningioma in the English literature. Characteristic features were analyzed and compared.

RESULTS

The incidence rate at our institutions of LD of meningioma was 0.9% (5/534). World Health Organization (WHO) grade was distributed as follows: I : 2, II : 2, and III : 1. Time to LD ranged from 2.5 months to 6.9 years; the patient with WHO grade III had the shortest interval to LD. The patient with an intraventricular meningioma (WHO grade II) had the second shortest interval to LD (1.7 years), and simultaneously revealed both LD and extraneuronal metastases. Four of 5 patients showed a disease progression, with the survival ranging from 1 month to 3.8 years after LD. Based on the literature, the initial tumor was an intraventricular meningioma in 9 patients, and their time to LD was shorter on average (mean 1.9 years). Histologically, 26 of 45 (58%) were initially diagnosed with a WHO grade II or III meningioma, and 6 of 19 patients (32%) with WHO grade I revealed malignant transformation.

CONCLUSION

This study shows that intraventricular location and histologically aggressive features seem to increase the chance of LD of meningioma.

Rhabdoid meningioma: report of two cases

Rhabdoid meningioma is an uncommon anaplastic variant of meningioma. We describe the clinicoradiological and histomorphological features of two such cases of meningioma, with a brief review of literature. One case in a 9-year-old girl, presented initially as an atypical meningioma in the right fronto-parietal region, which on recurrence 18 months later, evolved into a rhabdoid meningioma. The second case in a 33-year-old male was located in the right parieto-occipital region.

Aggressive rhabdoid meningioma with osseous, papillary and chordoma-like appearance

Meningiomas are the most common primary intracranial tumors. They are usually benign and slowly growing; however, they may show histologically malignant features categorizing them into grade II or III of World Health Organization (WHO) classification. Rhabdoid meningioma (RM) is an uncommon meningioma variant categorized as WHO grade III. The clinical course of RM is determined by local recurrences, invasion of adjacent brain and/or dura, widespread leptomeningeal dissemination, remote metastases and fatal clinical outcome. Herein we report a case with recurrent aggressive left occipital parasagittal region RM in which the patient initially declined radiation treatment. The tumor was resected four times in 5 years. Histopathological examination revealed a rhabdoid meningioma with metaplastic, papillary and chordoid differentiation. Six months after her fourth operation the patient died of progressive disease. RM is a rare subtype of malignant meningioma and the role of different adjuvant therapeutic options are still unknown. Clinical presentation, radiological features and pathologic findings of this uncommon tumor are discussed.

Crush cytology of a primary intraspinal rhabdoid papillary meningioma: a case report

BACKGROUND

Both rhabdoid and papillary meningioma are rare variants of meningioma categorized as WHO grade III. Here, we report a rare case of combined rhabdoid papillary meningioma with discussion of its differential intraoperative cytologic diagnoses.

CASE

The patient was a 72-year-old female who presented with a huge mass at the cervical spine on MRI. The crush smears showed a radially arranged pattern of elongated tumor cells centered around the vessels, which formed a pseudorosette-like papillary structure, as well as singly scattered large gemistocyte-like rhabdoid cells with distinct cell borders. Rhabdoid cells had eccentrically placed vesicular nuclei with plump, fibrillary-to-hyaline cytoplasm with short broad processes. Nuclei had occasional nuclear inclusions with no nuclear grooves.

CONCLUSION

Rhabdoid papillary meningiomas, encountered less often, should be distinguished from metastatic tumors of rhabdoid or papillary configuration, astrocytomas, ependymomas and atypical teratoid/rhabdoid tumor. Search for eosinophilic hyaline cytoplasm, rather than a fibrillary one, is critical for distinguishing it from other commonly encountered spinal cord tumors in the total absence of meningothelial whorls, like the present case. We also emphasize that the present case is the first case of rhabdoid papillary meningioma with primary manifestation in the spinal cord.

[Papillary meningioma: a very rare and aggressive variant of meningioma]

Papillary meningioma (MP) is a rare and aggressive variant of meningioma, occurring preferentially in young subjects. Histopathological features of papillary meningiomas are characterized by papillary or perivascular pseudorosette patterns. We report the case of a right frontal MP in a 16-year-old boy. Differential diagnosis included other primitive or secondary intracranial papillary neoplasms. MP diagnosis should not be missed due to its aggressive behavior with brain invasion, local recurrence and metastases.

Unusual growth pattern of a meningioma

Background:

Rhabdoid meningioma exhibits high mitotic activity, anaplasia, and increased markers of cell proliferation. Here we describe a rhabdoid meningioma with a pattern of growth extending into the subarachnoid space and filled the cortical sulci.

Case Description:

A 72-year-old woman presented with headache and was admitted to our hospital. Neurologic and physical examinations revealed no abnormalities. Contrast-enhanced axial T1-weighted images showed a well-enhanced, dural-based mass compressing the right temporal and frontal lobes, and extending into the sylvian cistern and filling the cortical sulci. The patient underwent partial resection and the histologic findings demonstrated rhabdoid meningioma.

Conclusion:

Although this type of tumor is known to be aggressive in its growth, extension into the adjacent cisternal space and the filling of the cortical sulci are rare. The combination of histologic anaplasia with the highest reported proliferation rate, loss of cohesion of neoplastic cells, and the location of the tumor led to the unique growth pattern.

Rhabdoid papillary meningioma: a clinicopathologic case series study

World Health Organization (WHO) grade III meningiomas are subclassified on the basis of their architectural pattern into papillary and rhabdoid subtypes. Some meningiomas even combine papillary architecture with rhabdoid cytology. Additionally, they always show malignant histological features, follow an aggressive clinical course and tend to spread through the CSF after frequent local recurrence. We render the first series of rhabdoid papillary meningioma with review of the literature to further elucidate its biological behavior. From six patients (three male, three female), nine specimens of rhabdoid papillary meningioma were obtained between 1994 and 2010. Correlations of histologic parameters, immunohistochemical study, and clinical features were assessed. The mean age of patients was 44.7 years at their first operation. The mean postoperative follow-up period was 63.2 months. Five patients experienced tumor recurrence, and one of them died from the disease after diffuse leptomeningeal dissemination. The mean time to first recurrence was 28 months. Only one patient was free of tumoral recurrence after an 8-year follow-up. Immunohistochemically, all tumors were positive for vimentin and epithelial membrane antigen. MIB-1 labeling indices were higher following tumor recurrence. The present study expands the clinicopathologic horizon of rhabdoid papillary meningioma and suggests that it will behave aggressively based on its histology and concomitant features of atypia or malignancy or high MIB-1 labeling indices. Close follow-up and aggressive treatments of these tumors are warranted.

Atypical fungal granuloma of the sphenoid wing

A 29-year-old immunocompetent patient presented with a 3-month history of headache and vomiting. Computed tomography (CT) and conventional magnetic resonance imaging (MRI) revealed a mass lesion in the right sphenoid wing. The conventional imaging findings were typical of meningioma. However, diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI) and perfusion-weighted imaging (PWI) all revealed details that were unusual for a meningioma. DWI showed diffusion blackout, perfusion was not raised in PWI, and susceptibility effects were noted in SWI. Based on these findings, the possibility of granuloma was kept as the differential diagnosis. Histopathological examination of the lesion was suggestive of fungal granuloma. This case report highlights the importance of advanced neuroimaging techniques in differentiating meningioma and granuloma.

Diffuse craniospinal metastases of intraventricular rhabdoid papillary meningioma with glial fibrillary acidic protein expression: a case report

Rhabdoid papillary meningioma is a recently described clinically aggressive variant of meningiomas with a high recurrence rate. Additionally, only one case of intraventricular rhabdoid meningioma has been reported so far. We present a case of a 50-year-old man who developed an intracranial tumor of the left lateral ventricle at the trigone, for which he underwent total tumor resection followed by gamma knife radiosurgery for recurrence of the tumor. The histological diagnosis was rhabdoid papillary meningioma. Five years after surgery, diffuse craniospinal leptomeningeal metastases developed and subtotal removal of the spinal tumor was performed. The spinal tumor was considered to have metastasized via cerebrospinal fluid (CSF) in view of its histological features that were identical to those of the primary tumor. Immunohistochemistry revealed the unusual cytoplasmic expression of glial fibrillary acidic protein (GFAP) of tumor cells. To our knowledge, this is the first reported case of diffuse craniospinal metastases of intraventricular rhabdoid papillary meningioma with GFAP expression and the second reported case of the rhabdoid subtype amongst intraventricular meningiomas.