Sclerosing meningioma: immunohistochemical analysis of five cases

Sclerosing meningioma with a large peritumoral cyst: Case report

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.

Whorling-Sclerosing Variant Meningioma of the Spine: Surgical Management and Outcome of an Extremely Rare Case

STUDY DESIGN

Case report OBJECTIVE.: To report surgical resection of multiple ventral cervical and thoracic lesion being diagnosed as whorling-sclerosing variant meningioma (WSM) and subsequent stabilization of cervicothoracic spine.

SUMMARY OF BACKGROUND DATA

WSM is a rare histopathology variant of meningioma which is mostly reported in brain and only one case of cervical spine WSM has been reported. Because of the rarity of WSM, there is a paucity of information regarding the clinical, radiological, and histopathologic characteristics.

METHODS

A 57-year-old lady presented with progressive quadriparesis and myelopathy since 10 days. The spine magnetic resonance imaging (MRI) revealed multiple ventral cervical and thoracic lesions which were hypointense in T2-weighted images with heterogeneous and scant enhancement with gadolinium. The patient underwent anterior cervical corpectomy and gross total resection of the lesion along with 360° fixation in the first stage. The thoracic lesions were also resected totally through laminectomy and right lateral extracavitary approach followed by pedicular screw fixation.

RESULTS

The patient improved muscle powers and spasticity and is not independent (Frankel D). The histopathology examination revealed hypocellular lobulated sclerotic mass with whorling pattern of growth in the sclerotic part suggestive of WSM. Immunohistochemical evaluation demonstrated negative staining for epithelial membrane antigen, cytokeratin, Olig-2 and S-100 and immunoactivity for progesterone receptor (PR) and glial fibrillary acidic protein in the tumoral cells located at the periphery. Ki-67 indexing was low.

CONCLUSION

The spine multiple WSM is an extremely rare condition, which has a malignant behavior and it seems that it is spread by cerebrospinal fluid seeding. Surgical removal is hard and requires experience and appropriate equipment.

LEVEL OF EVIDENCE

4.

Sclerosing Meningioma : Radiological and Clinical Characteristics of 21 Cases

Objective

A rare subtype of meningioma, sclerosing meningioma is not included in the current World Health Organization classification of meningiomas and is classified into the category of other morphological variation subtypes. Sclerosing meningioma is often misdiagnosed to other non-benign meningioma or malignant neoplasm, so it is important to diagnose sclerosing type correctly. We analyzed the radiological and clinical characteristics of a series of sclerosing meningiomas.

Methods

Twenty-one patients who underwent surgery in one institute with a histopathologically proven sclerosing meningioma were included from 2006 to 2014. Eighteen tumors were diagnosed as a pure sclerosing-type meningioma, and 3 as mixed type. Magnetic resonance image was taken for all patients including contrast enhancement image. Computed tomography (CT) scan was taken for 16 patients. One neuroradiologist and 1 neurosurgeon reviewed all images retrospectively.

Results

In the all 16 patients with preoperative CT images, higher attenuation was observed in the meningioma than in the brain parenchyma, and calcification was observed in 11 (69%). In 15 of the 21 patients (71%), a distinctive very low signal intensity appeared as a dark color in T2-weighted images. Nine of these 15 tumors (60%) exhibited heterogeneous enhancement, and 6 (40%) exhibited homogeneous enhancement that was unlike the homogeneous enhancing pattern shown by conventional meningiomas. Ten patients had a clear tumor margin without peritumoral edema.

Conclusion

Although these peculiar radiological characteristics are not unique to sclerosing meningioma, we believe that they are distinctive features that may be helpful for distinguishing sclerosing meningioma from other subtypes.

Pathology and molecular genetics of meningioma: recent advances

Meningiomas are the most common intracranial primary neoplasm in adults. Although the spectrum of clinical and molecular genetic issues regarding meningiomas remains undefined, novel genetic alterations that are associated with tumor morphology, malignancy, or location have recently been discovered. This review focuses on recent advances in understanding of the heterogenous pathology of meningiomas, particularly on associations between the clinical, histological, etiological, epidemiological, and molecular genetical aspects of the neoplasm.

Rare nerve lesions of non-nerve sheath origin: a 17-year retrospective series

CONTEXT

Peripheral nerve masses are frequently encountered in surgical pathology practice. However, once a peripheral nerve mass is determined not to be a nerve sheath neoplasm, differential diagnostic considerations drop off sharply.

OBJECTIVE

To review our experience with surgically resected nerve masses.

DESIGN

Retrospective search of pathology database. Rare neoplasms were studied by cytogenetic analysis or gene microarray.

RESULTS

Four hundred fifty-eight cases were identified. After elimination of common lesions (mostly nerve sheath tumors), 37 cases (8%) remained, almost all of which were of non-nerve sheath origin: for example, hemangioma, metastatic neuroendocrine pancreatic carcinoma, meningiomas invading nerve fascicles, and primary extrarenal rhabdoid tumor and Ewing sarcoma of nerve. The latter showed rearrangement of the EWSR1 locus (22q12). The gene expression pattern of an undifferentiated sarcoma, presenting as ropelike nerve enlargement, clustered with malignant peripheral nerve sheath neoplasms but not other sarcomas or neuroepithelial tumors.

CONCLUSIONS

Diverse benign and malignant conditions can affect peripheral nerve.

Insights into meningioangiomatosis with and without meningioma: a clinicopathologic and genetic series of 24 cases with review of the literature

Meningioangiomatosis (MA) is a rare seizure-associated lesion of presumed hamartomatous or developmental origin. It is occasionally combined with a neoplasm, most commonly meningioma (MA-M). In the current study, we examined 24 cases (14 pure MA, 10 MA-M) using immunohistochemistry for merlin, protein 4.1 B, progesterone receptor (PR), and MIB-1, as well as FISH for NF2 and 4.1B gene dosages. Nine cases of MA-M (90%) had gene deletions (NF2/4.7B), protein losses (merlin/protein 4.1B), and/or PR positivity, with a similar or identical phenotype in both components. No PR positivity or gene deletions were seen in pure MAs, though merlin and/or protein 4.1B were immunonegative in six cases. Our data suggest that in most MA-Ms, the MA component is neoplastic, likely representing an exuberant perivascular pattern of spread from the meningioma, rather than an underlying hamartoma. This pattern of spread may be facilitated by meningiomas that are predominantly leptomeningeal or intracerebral in origin. It remains important to distinguish this pattern from true brain invasion, given the more ominous prognostic significance of the latter. In contrast, most perivascular spindled cells of pure MA are genetically and immunohistochemically similar to non-neoplastic meningothelial cells, consistent with current histogenetic theories.