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Trabzonlu L, Martinez-Lage M, Deschler D, Paly JJ, Faquin WC. FNA of Meningioma with Rhabdoid Features Presenting as a Lateral Neck Mass. Head Neck Pathol 2024; 18:32. [PMID: 38658429 PMCID: PMC11043294 DOI: 10.1007/s12105-024-01644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
Primary meningioma at extracranial head and neck sites is uncommon. Since fine needle aspiration (FNA) is often the first line diagnostic modality for the evaluation of masses in the head and neck, extracranial meningiomas can create a significant diagnostic pitfall for FNA. We report a case of meningioma with rhabdoid features and BAP1 loss in a 26-year-old woman, presenting as a large neck mass along the carotid sheath. FNA biopsy of the mass demonstrated a highly cellular specimen with clusters of uniform, epithelioid cells with round to ovoid nuclei and moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel performed on cell block sections showed that the tumor cells were weakly EMA positive, progesterone receptor was focally positive, and SSTR2A was diffuse and strongly positive. BAP1 immunohistochemistry showed a diffuse loss of expression in the tumor cells. After the cytologic diagnosis of meningioma, a tissue biopsy was performed, and the diagnosis of meningioma with rhabdoid features and BAP1 loss was confirmed. We also perform a literature review of meningioma cases presenting as a neck mass and evaluated by FNA. Our case highlights the significant diagnostic challenges that can be caused by extracranial meningiomas on FNA and the importance of ancillary studies to avoid diagnostic pitfalls.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA
| | - Maria Martinez-Lage
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
| | - Jonathan J Paly
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA.
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Liu X, Liu J, Nai T, Yang Y, Hu Y. Primary ectopic meningioma in the thoracic cavity: A rare case report and review of the literature. Front Oncol 2023; 13:1149627. [PMID: 37114141 PMCID: PMC10126498 DOI: 10.3389/fonc.2023.1149627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background Meningioma is a common type of intracranial tumor in adults. It rarely arises in the chest, with only a few case reports in the English literature. Here, we report the case of a patient with a primary ectopic meningioma (PEM) located in the thoracic cavity. Case presentation A 55-year-old woman presented with exercise-induced asthma, chest tightness, intermittent dry cough and fatigue for several months. Computed tomography revealed the presence of a huge mass in the thoracic cavity, with no connection to the spinal canal. Lung cancer and mesothelioma were suspected, and surgery was performed. Grossly, the mass was a grayish-white solid 9.5 cm × 8.4 cm × 5.3 cm in size. The microscopic morphology of the lesion was consistent with that of typical central nervous system meningioma. The pathological subtype was transitional meningioma. The tumor cells were arranged in a fascicular, whorled, storiform and meningithelial pattern, with occasional intranuclear pseudo-inclusions and psammoma bodies. In focal areas tumor cells were considerably dense, and the cells were round or irregular in shape, with less cytoplasm, uniform nuclear chromatin, and visible nucleoli and mitoses (2/10 HPF). By immunohistochemistry, the neoplastic cells showed strong and diffuse staining with vimentin, epithelial membrane antigen and SSTR2 with variable expression of PR, ALK and S100 protein. However, the cells were negative for GFAP, SOX-10, inhibin, CD34, STAT6, smooth muscle actin, desmin, CKpan, D2-40, WT-1, CK5/6 and CD45. The highest proliferation index by Ki-67 was 15%. The abnormal expression of ALK led to the initial misdiagnosis of an inflammatory myofibroblastic tumor. After 12 months of follow-up, no disease progression was observed. Conclusion The presence of primary ectopic meningiomas in the thoracic cavity is extremely rare, and this tumor is easily misdiagnosed clinically. Imaging is suggested to determine the location and possible differential diagnosis, while the final diagnosis should be via pathological examination. Immunohistochemistry is crucial for disease diagnosis. Owing to our limited knowledge of PEM, its pathogenesis and tissue of origin remain unclear. Clinicians should pay close attention to such potential patients. The present case report may provide insights into the diagnosis and therapy of patients with this tumor.
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Affiliation(s)
- Xu Liu
- Institute of Pathology, China Three Gorges University, Yichang, China
- Department of Pathology, Yichang Central People’s Hospital, Yichang, China
| | - Jiao Liu
- Department of Obstetrics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, China
| | - Ting Nai
- Institute of Pathology, China Three Gorges University, Yichang, China
- Department of Pathology, Yichang Central People’s Hospital, Yichang, China
| | - Yuxia Yang
- Institute of Pathology, China Three Gorges University, Yichang, China
- Department of Pathology, Yichang Central People’s Hospital, Yichang, China
| | - Yuchang Hu
- Institute of Pathology, China Three Gorges University, Yichang, China
- Department of Pathology, Yichang Central People’s Hospital, Yichang, China
- *Correspondence: Yuchang Hu,
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Mundi I, Pankaj R, Malhotra M. Fine needle aspiration of a superficial scalp swelling with a deeper connection. Diagn Cytopathol 2018; 46:981-982. [PMID: 30488671 DOI: 10.1002/dc.24031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Irneet Mundi
- Department of Lab Medicine, Fortis Hospital, Mohali, Punjab, , India
| | - Ritu Pankaj
- Department of Lab Medicine, Fortis Hospital, Mohali, Punjab, , India
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Viswanathan K, Sung S, Facey KT, Alperstein SA, Pisapia DJ, Rao RA, Hoda RS. Fine needle aspiration of meningioma: Cytologic features on ThinPrep. Diagn Cytopathol 2017; 46:98-100. [PMID: 29024513 DOI: 10.1002/dc.23832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/03/2017] [Accepted: 09/27/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Kartik Viswanathan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Simon Sung
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Kirk T Facey
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Susan A Alperstein
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - David J Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Rana S Hoda
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
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Olofson A, Marotti J, Tafe LJ, Linos K. Intranodal meningothelial proliferation in a patient with Cowden syndrome: a case report. Hum Pathol 2017; 66:183-187. [PMID: 28315423 DOI: 10.1016/j.humpath.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/26/2017] [Accepted: 03/03/2017] [Indexed: 01/28/2023]
Abstract
Ectopic meningothelial proliferations are rare and can occur in a multitude of extracranial/spinal anatomic locations. Perineurioma is another uncommon entity that shares similar histological characteristics to those found in meningothelial proliferations. These include bland spindle cells with thin, bipolar nuclei; eosinophilic cytoplasm; and indistinct cell borders, arranged in short fascicles with whorl formation. Given their uncommon occurrence and shared histological and immunohistochemical features, their distinction can present a diagnostic challenge. Immunohistochemical studies can provide guidance when attempting to distinguish between these 2 lesions. Here, we present an unusual case of a patient with Cowden syndrome who was discovered to have a meningothelial proliferation within an axillary lymph node. To the best of our knowledge, this is the first case in which a meningothelial proliferation has been identified in a lymph node. Furthermore, the occurrence in a patient with Cowden syndrome is intriguing and raises the possibility of a pathogenetic link.
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Affiliation(s)
- Andrea Olofson
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Jonathan Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Laura J Tafe
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Konstantinos Linos
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA.
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Ma C, Li X, Li Y, Qu X. Primary Ectopic Meningioma of the Tongue: Case Report and Review of the Literature. J Oral Maxillofac Surg 2016; 74:2216-2228. [PMID: 27235182 DOI: 10.1016/j.joms.2016.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
Primary ectopic (extracranial) meningiomas (PEMs) are very rare and have been reported only sporadically. Histologically speaking, PEMs are similar to their intracranial counterparts in being composed of neoplastic arachnoidal (meningothelial) cells. In addition, several types of microscopic cellular morphologies have been observed in intracranial meningiomas: meningothelial (syncytial), psammomatous, atypical, anaplastic, fibrous, and angioblastic. To the best of the authors' knowledge, PEM presenting as a mass in the tongue has not been reported previously. This report describes a case of lingual PEM in a 17-year-old boy. Special attention is given to the unique clinical presentation and management. The literature was reviewed to provide valuable knowledge to clinicians.
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Affiliation(s)
- Chunyue Ma
- Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Xiaoguang Li
- Resident, Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Youpeng Li
- Resident, Emergency Intensive Care Unit, The Third Affiliated Hospital of Wenzhou Medical University, Ruian, China
| | - Xingzhou Qu
- Professor, Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
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Bokhari A, Hibshoosh H, Tiscornia-Wasserman PG. Cytomorphology of Recurrent Osseous Extracranial Meningioma of Right Pubic Ramus:: Report of a Case and Literature Review. Diagn Cytopathol 2016; 44:618-22. [PMID: 27079302 DOI: 10.1002/dc.23483] [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: 02/12/2016] [Revised: 03/14/2016] [Accepted: 03/26/2016] [Indexed: 12/24/2022]
Abstract
Meningiomas are well-recognized neoplasms of the central nervous system. Primary extracranial meningiomas (ECMs) are extremely rare and arise in various anatomic sites. We present a 56-year-old female with 13-year history of primary grade I meningothelial meningioma of right pubic symphysis, orthotopic heart transplant, and right total hip arthroplasty, who presented with progressive right hip pain for 3 weeks. Primary intracranial, intraspinal and other tumors were excluded. Imaging revealed a destructive lytic lesion at right superior and inferior pubic rami and body, associated with extensive bone destruction and soft tissue mass. Touch imprint (TI) cytology of computed tomography (CT)-guided core biopsy from the right pubic ramus (PRA) lesion showed a spindle cell neoplasm, with classical syncytial, lobular, and whorling cellular arrangement, composed of spindle, oval or round nuclei with occasional pseudoinclusions, consistent with known history of osseous meningioma. Tumor was further characterized by histopathology as grade 1 meningioma with meningothelial features. To our knowledge, primary osseous ECM arising specifically at the PRA has not been reported previously. ECM at this site may pose a diagnostic challenge for cytologists as its features may resemble other more commonly observed lesions. Accurate diagnosis requires awareness of occurrence of ECM at PRA and recognition of its characteristic cytomorphology. TI cytological features of our case are presented and previously described cytology of ECMs and diagnostic pitfalls are reviewed. Diagn. Cytopathol. 2016;44:618-622. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Aqiba Bokhari
- Division of Cytopathology, New York Presbyterian-Columbia University Medical Center, New York.,Department of Pathology and Cell Biology, New York Presbyterian-Columbia University Medical Center, New York
| | - Hanina Hibshoosh
- Department of Pathology and Cell Biology, New York Presbyterian-Columbia University Medical Center, New York.,Division of Surgical Pathology, New York Presbyterian-Columbia University Medical Center, New York
| | - Patricia G Tiscornia-Wasserman
- Division of Cytopathology, New York Presbyterian-Columbia University Medical Center, New York.,Department of Pathology and Cell Biology, New York Presbyterian-Columbia University Medical Center, New York
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ZHANG YI, TENG WEIQIANG, CHEN XIAOPING, WU JIAN. Ectopic meningioma in the bilateral nasal olfactory cleft: A case report and literature review. Oncol Lett 2015; 9:1743-1746. [PMID: 25789034 PMCID: PMC4356408 DOI: 10.3892/ol.2015.2970] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 01/23/2015] [Indexed: 11/10/2022] Open
Abstract
Certain nasal neoplasms, such as ectopic menigioma, present as nasal polyps, together with similar symptoms. The present study reports the diagnosis and treatment of ectopic meningioma in the bilateral nasal olfactory cleft in order to improve the diagnosis and treatment of ectopic meningioma in the nasal cavity. By retrospectively analyzing the clinical data and reviewing the associated literature, a detailed introduction to the clinical manifestation, diagnosis and treatment of ectopic meningioma of the nasal cavity was ascertained. The tumor was removed from the sinus by functional endoscopy surgery. Regular follow-up appointments were scheduled every three months, with no evidence of recurrence to date. The olfactory recovery and nasal ventilation were normal subsequent to surgery. Meningiomas are infrequently occurring tumors with unpredictable clinical behavior. A clear understanding of the etiology and appropriate diagnostic and management principles may aid in overcoming the challenges of treating primary extracranial meningiomas.
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Affiliation(s)
- YI ZHANG
- Department of Otolaryngology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China
- Correspondence to: Dr Yi Zhang, Department of Otolaryngology, Shanghai Pudong New Area Gongli Hospital, 219 Miaopu Road, Shanghai 200135, P.R. China, E-mail:
| | - WEI-QIANG TENG
- Department of Otolaryngology, Postgraduate Education College, Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
| | - XIAO-PING CHEN
- Department of Otolaryngology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China
| | - JIAN WU
- Department of Pathology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China
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Ocque R, Khalbuss WE, Monaco SE, Michelow PM, Pantanowitz L. Cytopathology of extracranial ectopic and metastatic meningiomas. Acta Cytol 2014; 58:1-8. [PMID: 24192779 DOI: 10.1159/000355284] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Extracranial meningiomas may infrequently be encountered as ectopic or metastatic tumors. Their rarity and unique cytomorphology often pose significant diagnostic dilemmas. The aim of this study was to report our experience with a series of ectopic and metastatic meningiomas, characterizing their cytomorphology with histological correlation. MATERIALS AND METHODS A retrospective analysis involving 13 patients with cytological preparations from extracranial meningiomas was performed. Cytology cases were correlated with available surgical resection specimens. Data regarding clinical findings, tumor information, cytomorphology, follow-up histological features and immunohistochemistry were recorded and analyzed. RESULTS There were 5 cases with metastases and 8 ectopic meningiomas. Metastases occurred in the scalp/skull, lung, paraspinal soft tissue and liver. Primary ectopic meningiomas were located in the paranasal sinuses and ear, orbit and neck. Cytomorphological features characteristic of meningiomas were identified in the majority of samples including tightly cohesive clusters of spindled cells, whorls, intranuclear inclusions, nuclear grooves and psammomatous calcification. Unusual cytomorphological features identified in only a few cases included epithelioid cell predominance, abundant inflammatory cells, small-cell change, papillary structures and pseudoacinar growth. Metastatic tumors exhibited more nuclear atypia and occasionally mitoses or necrosis. Meningiomas were shown to be immunoreactive for epithelial membrane antigen, pancytokeratin and vimentin. CONCLUSION Although rare, extracranial meningiomas can be encountered in cytologic specimens and should be included in the differential diagnosis when characteristic morphological features of meningiomas are seen. Cytopathologists should be aware that these lesions could be mistaken for other tumors, especially when confounded by atypia and unusual cytomorphological features.
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Affiliation(s)
- Rebecca Ocque
- Department of Pathology, University of Pittsburgh Medical Center, Shadyside Hospital, Pittsburgh, Pa., USA
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