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Feng Y, Wang P, Liu Y, Dai W. PET/CT imaging of giant primary pulmonary meningioma: a case report and literature review. J Cardiothorac Surg 2023; 18:171. [PMID: 37138316 PMCID: PMC10157941 DOI: 10.1186/s13019-023-02276-4] [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: 11/27/2022] [Accepted: 04/05/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND An ectopic meningioma, such as a primary pulmonary meningioma (PPM), is a rare type of tumor that primarily originates outside of the central nervous system. The most common presentation of PPM is isolated pulmonary nodules or masses, and most of them are benign. Only sporadic cases have been reported. This case reported a giant primary pulmonary meningioma and systematically reviewed previously reported cases in the literature. CASE PRESENTATION A 55-year-old female suffered from asthma after activity, chest tightness, and a persistent dry cough for 2 months. Chest computed tomography (CT) showed a huge mass with calcification in the left lower lobe. And positron emission tomography (PET)/CT revealed mild FDG accumulation of the mass. The mass was finally surgically removed and PPM was confirmed according to histopathologic examinations. CONCLUSION PPM is a rare disease with heterogeneity not only in CT features but also in glucose metabolism. FDG uptake levels do not identify benign from malignant, benign PPM may have high FDG uptake and malignant may have low.
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Affiliation(s)
- Yawen Feng
- Department of Nuclear Medicine, the First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China
| | - Peng Wang
- Department of Nuclear Medicine, the First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China
| | - Yufei Liu
- Department of Pathology, The First College of Clinical Medical Science of China, Three Gorges University and Yichang Central People's Hospital, No. 183, Yiling Avenue, Yichang, 443000, China
| | - Wenli Dai
- Department of Nuclear Medicine, the First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China.
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Qin X, Zeng C, Wei M, Li X, Qiu D. CT features of primary pleural gritty meningioma: A case report and review of the literature. Acta Radiol Open 2023; 12:20584601231174459. [PMID: 37179795 PMCID: PMC10170597 DOI: 10.1177/20584601231174459] [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: 01/28/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
Primary ectopic meningiomas, although widely reported in multiple sites of the body, are particularly rare in the pleura. Here, we report a 35-year-old asymptomatic woman who was found to have a large mass in the right pleural area on physical examination chest radiography. Chest CT scan showed a large irregular mass from the right second anterior costal pleura to the right supradiaphragm, in which calcified plaques of varying sizes were widely and heterogeneously distributed. The mass was connected to the pleura (anterior rib pleura, mediastinal pleura, diaphragmatic pleura) in a wide base, with oblique "Z" changes in the coronal view. After the contrast agent injection, the mass exhibited mild enhancement on both arterial and venous phase scans. Furthermore, a linear enhancement that was indicative of "pleural tail sign" changes in the pleura adjacent to the mass was observed. The disease was preoperatively misdiagnosed as malignant pleural mesothelioma, and the postoperative pathological diagnosis was right pleural meningioma (gritty type). Therefore, we carefully analyzed its imaging features and differential diagnosis by consulting relevant literature.
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Affiliation(s)
- Xiaojun Qin
- Depatment of Radiology, Zhongxian People 's Hospital of Chongqing City, No.25 Zhong Bo Road Zhong County, Chongqing 404300, China
| | - Chun Zeng
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Miao Wei
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xian Li
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dongni Qiu
- Depatment of Radiology, Zhongxian People 's Hospital of Chongqing City, No.25 Zhong Bo Road Zhong County, Chongqing 404300, China
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Yang B, Qiu J. Primary pulmonary meningioma with associated multiple micronodules: a case report and literature review. J Surg Case Rep 2023; 2023:rjad034. [PMID: 36755931 PMCID: PMC9902207 DOI: 10.1093/jscr/rjad034] [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: 12/21/2022] [Accepted: 01/17/2022] [Indexed: 02/08/2023] Open
Abstract
Primary pulmonary meningioma (PPM) is a rare and benign slow growing tumor with good prognosis. It often presents as an asymptomatic, well-circumscribed, solitary pulmonary nodule. Wedge resection is the management of choice for both diagnosis and treatment. Here, we report one case of PPM with increased fluorodeoxyglucose (FDG) uptake and associated micronodules, which was clinically suspicious for malignancy. The patient was a 60-year-old female who presented with persistent shortness of breath for 1 year. Chest computed tomography showed a 1.5-cm well-circumscribed homogenous nodule in the left upper lobe with increased FDG uptake and multiple smaller well-circumscribed micronodules scattered in both lungs. Left upper lobe wedge resection confirmed the diagnosis of PPM. PPM can deceptively mimic malignancy, so recognizing this rare entity and including it in the differential diagnoses of pulmonary nodules, especially with avid uptake of FDG, is crucial to avoid misdiagnosis and overtreatment.
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Affiliation(s)
- Bei Yang
- Department of Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Jingxin Qiu
- Correspondence address. Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton St. Buffalo, NY 14263, USA. Tel: 7168453457; Fax: 7168458750; E-mail:
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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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Tang H, He Y, Wang L, Wu G, Wang L, Xu Y, Guo D. Coexistence of primary pulmonary meningioma and metastatic papillary renal cell carcinoma of the lung: A rare case report with review of the literature. Medicine (Baltimore) 2022; 101:e32157. [PMID: 36550861 PMCID: PMC9771236 DOI: 10.1097/md.0000000000032157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Primary pulmonary meningioma (PPM) is extremely rare tumor and only a few reports have been reported to date. PPM may be overlooked when it coexists with other types of tumors in the lung. It is essential to have a knowledge of the clinicopathological features of PPM and to recognize this rare coexistence. PATIENT CONCERNS A 57-year-old male underwent surgery for papillary renal cell carcinoma, when 2 pulmonary nodules were detected using chest computed tomography. DIAGNOSIS The coexistence of benign PPM and metastatic papillary renal cell carcinoma was histologically confirmed. INTERVENTIONS A lobectomy was performed. OUTCOMES The patient recovered well after surgery and was discharged on postoperative day 4. LESSONS Duo to the rarity of PPM, it is easily overlooked, especially when it coexists with other tumors in the lung. The possibility of PPM needs to be taken into account when diagnosing pulmonary nodules in clinical practice.
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Affiliation(s)
- Hao Tang
- Department of Pathology, Guiqian International General Hospital, Guiyang, Guizhou Province, China
| | - Yutao He
- Department of Laboratory Medicine, Guiqian International General Hospital, Guiyang, Guizhou Province, China
| | - Long Wang
- Department of Pathology, Guiqian International General Hospital, Guiyang, Guizhou Province, China
| | - Guomin Wu
- Department of Pathology, Guiqian International General Hospital, Guiyang, Guizhou Province, China
| | - Lina Wang
- Department of Pathology, Guiqian International General Hospital, Guiyang, Guizhou Province, China
| | - Yujuan Xu
- Department of Pathology, Guiqian International General Hospital, Guiyang, Guizhou Province, China
| | - Deyu Guo
- Department of Pathology, Guiqian International General Hospital, Guiyang, Guizhou Province, China
- * Correspondence: Deyu Guo, Department of Pathology, Guiqian International General Hospital, Guiyang, Guizhou Province 550000, China (e-mail: )
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Huang X, Mou YF, Ren FQ, Wang Y, Yang Y. Multiple primary pulmonary meningioma: A case report and literature review. Thorac Cancer 2022; 13:2257-2259. [PMID: 35734847 PMCID: PMC9346167 DOI: 10.1111/1759-7714.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022] Open
Abstract
Lung cancer has become a leading cause of cancer‐related deaths. With the conventional use of low‐dose spiral computed tomography (CT) in physical examinations, an increasing number of small pulmonary nodules are screened. However, primary pulmonary meningiomas (PPMs) are rarely reported. Here, we report the case of a 64‐year‐old woman who had a CT scan during physical examination, which revealed three ground‐glass‐like opacity pulmonary nodules in both lungs. The patient underwent video‐assisted thoracoscopic wedge resection of the right upper and lower lobes. Paraffin sections revealed pulmonary meningothelial‐like and collagenous nodules in the right upper and lower lobes which stained as follows: EMA+, VIM+, SMA‐, S‐100‐, CD34‐, STAT6‐, Ki‐67+ (2%), and CgA‐. Primary pulmonary meningiomas (PPMs) were finally diagnosed. PPM is a kind of rare and benign tumor. Surgery can provide a precise pathological examination, and patients can achieve an excellent prognosis after surgical resection.
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Affiliation(s)
- Xin Huang
- Department of Thoracic Surgery, Chengdu Third People's Hospital, the Affiliated Hospital of Southwest Jiaotong University, Chendu, China
| | - Yun-Fei Mou
- Department of Thoracic Surgery, Chengdu Third People's Hospital, the Affiliated Hospital of Southwest Jiaotong University, Chendu, China
| | - Fu-Qiang Ren
- Department of Thoracic Surgery, Chengdu Third People's Hospital, the Affiliated Hospital of Southwest Jiaotong University, Chendu, China
| | - Yuan Wang
- Department of Thoracic Surgery, Chengdu Third People's Hospital, the Affiliated Hospital of Southwest Jiaotong University, Chendu, China
| | - Yi Yang
- Department of Thoracic Surgery, Chengdu Third People's Hospital, the Affiliated Hospital of Southwest Jiaotong University, Chendu, China
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Zhang DB, Chen T. Primary pulmonary meningioma: A case report and review of the literature. World J Clin Cases 2022; 10:4196-4206. [PMID: 35665099 PMCID: PMC9131207 DOI: 10.12998/wjcc.v10.i13.4196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/28/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary pulmonary meningioma (PPM) is a rare disease that is usually benign. The most common presentation of PPM is isolated pulmonary nodules or masses, so the disease can mimic any other lung tumor on imaging, especially lung cancer or metastasis.
CASE SUMMARY A 47-year-old asymptomatic woman presented with a well-defined, lobulated pulmonary mass with calcification in the left lower lobe. The mass measured 69 mm × 57 mm × 61 mm and was found during a chest computed tomography (CT) performed for physical examination. Contrast-enhanced CT and positron emission tomography (PET)/CT revealed mild enhancement of the mass, with accumulation of 18-fluoro-2-deoxy-D-glucose (18F-FDG). Transbronchial biopsy suggested a provisional diagnosis of low-grade neuroendocrine tumor. Subsequent enhanced head magnetic resonance imaging revealed no positive lesions. An open cuff resection of the left lower lobe and wedge resection of the lingual segment were performed. Histopathological and immunohistochemical examination revealed that the mass was a PPM.
CONCLUSION PPM should be considered in the differential diagnosis of isolated pulmonary masses found incidentally on CT and should be diagnosed based on a combination of radiological and histological features. Surgical resection is currently the main treatment strategy. No recurrence of benign PPMs has been reported after complete resection.
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Affiliation(s)
- Dan-Bin Zhang
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Tao Chen
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Primary pulmonary meningiomas: report of two cases and review of the literature. Pathol Res Pract 2020; 216:153232. [PMID: 33045659 DOI: 10.1016/j.prp.2020.153232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Meningiomas rarely occur outside the skull, and primary pulmonary meningiomas (PPMs) are more rare. Only a few cases have been reported in the literature. The clinicopathological characteristics are not clear and it is easy to be misdiagnosed, so it is very important to master its diagnosis and differential diagnosis. METHODS We report two women with primary pulmonary meningioma. At the time of physical examination, the small solitary pulmonary nodules were detected on chest radiograph, and wedge resection was performed by Video-assisted Thoracoscope Surgery(VATS), and histologic evaluation showed that the lesions were benign PPMs. The clinicopathological features, immunophenotype and differential diagnosis of PPMs were analyzed, with a review of the cases published in the literature. RESULTS The study group comprised of 40 patients, 14 males and 26 females. The median age was 56.5 years (range 18-108). Thirty patients who underwent routine screening studies were asymptomatic but had a pulmonary nodule detected on chest X-ray. Nine patients had respiratory symptoms. Only 1 patient had non-specific symptoms. Most of the PPMs were benign, only 3 cases were malignant. Benign PPMs ranged from 0.6 cm to 6 cm in diameter (median 2 cm). The 3 malignant PPMs were 5 cm, 6.5 cm and 15 cm in diameter. The prognosis of benign PPM resection is good, with almost no recurrence or metastasis. But the two of three malignant PPMs relapsed. CONCLUSIONS PPM is very rare. It needs to be diagnosed by combining histology and immunohistochemistry. Diseases that need to be identified include spindle cell mesothelioma, spindle cell thymoma, spindle cell carcinoma, metastatic tumor, etc.
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