A case of metaplastic meningioma with extensive xanthomatous change

We report a case of metaplastic meningioma with extensive xanthomatous change occurring in a 61‐year‐old woman. Magnetic resonance imaging demonstrated a well‐demarcated, dura‐based mass measuring 7 cm in maximal diameter in the right occipital to parietal area. Under a clinical diagnosis of meningioma, right parietal craniotomy was performed. Histologically, the tumor showed extensive xanthomatous change together with the common features of meningothelial meningioma. Tumor cells showed diffuse xanthomatous change in various quantities, and xanthomatous tumor cells frequently showed a gradual transition to the non‐xanthomatous counterpart. The xanthomatous tumor cells showed immunopositivity for epithelial membrane antigen (EMA), vimentin, fatty acid synthase and several histiocytic markers (CD68, Ki‐M1p, MAC387, lysozyme, alpha 1‐antitrypsin and alpha 1‐antichymotrypsin). In addition, there was patchy infiltration of foamy macrophages. Since these histiocytes did not show immunopositivity for EMA, these cells were distinguished from the xanthomatous tumor cells. These two types of xanthomatous changes comprised approximately two‐thirds of the whole tumor tissue. Any atypical features such as necrosis, frequent mitotic figures or brain parenchymal invasion were not observed. We diagnosed this case as xanthomatous meningioma, WHO grade I.     

Chordoid meningioma of the foramen magnum in a child: a case report and review of the literature

We report a 3-year-6-month-old boy with chordoid meningioma in the foramen magnum. Chordoid meningioma represents between 0.5 and 1.0% of all meningiomas, and it is frequently located in the supratentorial region. The patient started with an episode of instability, falls, and headache; after which, he developed cuadriparesis, cervical pain, and neck stiffness, which slightly improved after medical treatment, so he was referred to our hospital. Physical examination revealed left hemiparesis and cervical muscle spasm with left torticollis. Magnetic resonance imaging (MRI) demonstrated an intradural–extramedullary well-circumscribed, homogeneous enhancing mass, in the anterior part of the foramen magnum with cervical extension. The operative technique was the extreme-lateral craniocervical retrocondylar approach with total removal and dural coagulation. Histopathological examination demonstrated a chordoid meningioma, with meningotelial basophilic mucoid chordoma-like component in 80% of the tissue. The immunohistochemical stains were positive to epithelial membrane antigen, vimentin, and S-100 protein. At 10 months follow-up, the patient showed improvement in his neurological deficit with physical rehabilitation, and motor response in his extremities are now normal; neck stiffness with cervical spasm disappeared postoperatively. MRI showed no residual tumor. To our knowledge, this is the first report of a chordoid meningioma on the foramen magnum in a child.     

Intraparenchymal cystic chordoid meningioma: A case report and review of the literature

Meningiomas usually present as benign tumors corresponding to WHO grade I. The development of the intraparenchymal chordoid variant of meningiomas with cyst formation in the CNS is extremely rare. We report a case of cystic chordoid meningioma in a middle‐aged man occurring in the brain parenchyma of the left temporal region. The tumor exhibited a marked peritumoral cyst, with contrast enhancement on MRI in accordance with type 2 of Zee's classification of cystic meningioma. Histologically, the tumor displays a typical chordoid structure with trabeculae or cords of eosinophilic vaculoated cells in the abundant mucoid matrix. Tumor cells are diffusely positive for epithelial membrane antigen (EMA), vimentin and focally positive for D2‐40, but lack immunoreactivity for cytokeratin (CK) and GFAP. MIB‐1 labeling is low, focally accounting for 2% of the tumor. A diagnosis of primary intraparenchymal cystic chordoid meningioma (WHO grade II) was made. There was no evidence of tumor recurrence during the postoperative 6‐month follow‐up period. To our knowledge, there is no report describing the radiological and histological characteristics of cystic chordoid meningioma entirely presenting in the brain parenchyma. In addition, the biological behavior and histological differential diagnoses of this tumor are discussed.     

Chordoid meningioma: Rare variant of meningioma

Chordoid meningioma is a rare variant of meningioma that bears a striking histological resemblance to chordoma and has greater likelihood of recurrence. Although most meningiomas occur in the intracranial, orbital and intravertebral cavities, rare meningiomas have been reported in extracranial organs; thus, it is important to be able to distinguish them from other neoplasms that have similar histology but different biological behavior and therapies. A case of chordoid meningioma in a 48‐year‐old woman who did not have Castleman's syndrome is described in the present report. The patient presented with a mass in her left frontoparietal region, and had been suffering from headaches for many years. Magnetic resonance imaging of the brain demonstrated an expansive lytic lesion in the squamous portion of the left temporal bone. The lesion extended in both directions. Histological examination of the surgical specimen revealed a tumor composed of cords and nests of eosinophilic vacuolated cells embedded in a myxoid matrix. A typical meningiomatous pattern was observed focally, and positive staining of the tumor cells for vimentin and epithelial membrane antigen confirmed the diagnosis of chordoid meningioma.     

Ossified thoracic spinal meningioma in childhood: A case report and review of the literature

Spinal ossified meningiomas are extremely rare. This is a report of a study on a 15-year-old boy with thoracic spinal ossified meningioma. The meningioma was resected totally. Histopathological examination revealed a transitional meningioma (psammomatous+meningothelial). Immunohistochemically, Ki 67 antibody was applied but no positive staining was present. The surgical and pathological aspects of spinal ossified meningiomas were reviewed.     

Spinal cartilaginous meningioma in a child: a case report

Cartilage-containing meningiomas are extremely uncommon, and such tumors located in the spinal cord of a child have not previously been reported. We describe a case of cartilaginous spinal meningioma in a 13-year-old girl. The tumor lacked typical histopathological features of meningioma on light microscopic examination, and the final diagnosis was possible only after an extensive study by electron microscopic examination. The case is evaluated with a focus on differential diagnosis and review of the literature. Received: 15 September 1998 Accepted: 30 April 1999     

颅内多发动脉瘤合并颅底脑膜瘤1例报告并文献复习

颅内多发动脉瘤合并脑膜瘤在临床上较为少见。该文报道1例颅内多发动脉瘤合并颅底脑膜瘤患者的临床资料及治疗过程,并结合相关文献进行探讨。[国际神经病学神经外科学杂志,2023,50(4):44-49]     

Lipomeningioma: case report and review of the literature

We present a case of histologically confirmed lipomeningioma, the first to our knowledge reported in Australia. A 61-year-old man presented with seizures and confusion, and was found to have a non-enhancing left extra axial temporo-parietal lesion on CT and MRI scan. On MRI, the mass lesion showed hyper-intensity on the T1 weighted images, hypo-intensity on fat suppressed T2 weighted images and no enhancement with intravenous gadolinium, indicating a mass consisting predominately of fatty tissue. A subsequent CT also showed the mass lesion to be hypodense with Hounsfield units indicating fatty tissue. A durally based tumour with high fat content macroscopically was excised at craniotomy under ultrasound guidance. Post-operative recovery was uneventful. Histology demonstrated a meningioma with high lipid content in the form of mature adipocytes and without atypical features. While not exceedingly rare, fewer than 30 cases of lipomeningioma, lipomatous meningioma, or lipidised meningioma have been reported in the world literature.     

Clinical analysis for an unusual large cystic meningioma: case report and review of the literature

The authors report the case of a 17-year-old boy with an unusual large cystic meningioma (Nauta type II) in the right hemisphere. The imaging appearances of this patient were very unusual. The shape of the huge cyst was crescentic and similar to subdural hematoma. It lay between the dura and the solid tumor parts. In addition there was a small intracystic nodule attached to the cyst wall. The patient underwent a right hemisphere craniotomy. At surgery it was found that the cyst contained a large amount of xanthochromic fluid and some semitransparent serumlike sediment. The intracystic nodule was proved to be necrotic substance without tissue and cell structure. Histological examination displayed an anaplastic meningioma, of which the cyst wall also consisted of meningioma tissue. To the best of the authors' knowledge, such an unusual case of cystic meningioma has not been reported. The authors review the literature with reference to intratumoral cyst associated with meningiomas, analyze the unusual imaging appearances of this patient, and explore the mechanism of cyst formation. The mechanism of cyst formation associated with meningiomas is not perfectly understood. Intratumoral cyst formation may be attributed to microcystic degeneration, ischemic necrosis, intratumoral hemorrhage, transudation and secretory changes within the tumor.     

伽玛刀治疗辐射诱导老年人脑膜瘤1例及文献复习

目的探讨辐射诱导脑膜瘤的临床特点,并结合文献比较其与散发型脑膜瘤的差异。方法1例76岁女性病人,46岁时因ACTH腺瘤行全脑放射治疗,病程中先后出现甲状腺癌、淋巴瘤和颅内多发性脑膜瘤,脑膜瘤分别位于右侧颅后窝、右额凸面、鞍结节。并对右侧颅后窝脑膜瘤行伽玛刀治疗。结果随访6年,右侧颅后窝处脑膜瘤控制良好。右额凸面、鞍结节肿瘤体积明显增大,且出现新病灶。结论辐射诱导脑膜瘤多表现为高级别、多发、易复发的特点。高精度立体定向放射外科治疗可控制病灶,同时避免额外的辐射。     

Tentorial papillary meningioma in a child: case report and review of the literature

We report a usual case of papillary meningioma arising from tentorium cerebelli occurring in a 13-year-old boy. This patient presented a 3-month history of a mildly poor coordination of the left side of his body. Computed tomography showed a homogenous enhanced mass lesion in the left posterior fossa. At surgery, gross total resection of the tumor was accomplished. Upon microscopic examination, some tumor cells were arranged in the papillary pattern and a resulting diagnosis of papillary meningioma was made. Electron microscopic studies showed typical meningioma features such as interdigitations and desmosomes, which were, however, detectable in only few tumor cells. Cytological and ultrastructural features of pediatric papillary meningioma and of high-grade meningioma in general are sparse. Since papillary meningioma rarely presents in children, we report this case and review the literature.     

手术治疗快速进展的高龄囊实性脑膜瘤1例并文献报道

报告1例高龄且进展较快的囊实性脑膜瘤患者,经及时手术治疗,取得较良好的临床疗效,回顾其诊治过程并复习相关文献资料,分析该病例特点及处理方式,以期为该类型患者诊治提供参考。[国际神经病学神经外科学杂志, 2021, 48(2):207-210]     

Parkinsonian syndrome in a patient with a pterional meningioma: case report and review of the literature

The onset of a Parkinsonism in a patient with intracranial meningioma is definitely rare. The authors described the case of a patient suffering from a Parkinsonian syndrome for 10 years with no evidence of clinical improvement after medical treatment. A CT-scan of the brain evidenced a right pterional intracranial meningioma. The complete surgical removal of the neoplasm succeeded in resolving the Parkinsonian syndrome. The extension of the neoplasm and of the peritumoral edema may play an important role in compressing and consequently impairing perfusion of the basal ganglia region.     

Follicular lymphoma of the dura associated with meningioma: A case report and review of the literature

A 70‐year‐old immunocompetent woman who had been radiologically diagnosed with a left parasagittal meningioma 5 years previously developed a palpable subgaleal mass and underwent neurosurgery. Histologically the tumor was composed of thickened fibrotic dural tissue, infiltrated by a follicular lymphoma, of grade IIIB. A coexistent transitional meningioma had been infiltrated by the neoplastic lymphoid tissue. Two months after surgery, the patient developed evidence of extracranial dissemination of the lymphoma to the cervical lymph nodes and was treated with polychemotherapy plus Rituximab and intrathecal methotrextate. The patient is alive and recurrence‐free at 1‐year follow up. A review of the literature indicates that lymphomas developing primarily in the meninges, have an indolent course and tend to be localized in areas rich in meningothelial cells.     

Giant meningioma of the III ventricle in a child: case report and review of the literature

We report the case of an 11-year-old girl with a giant meningioma of the III ventricle who presented with signs and symptoms of raised intracranial pressure. The tumor was removed through a transcallosal approach. A review of current literature yielded 16 previous cases of meningiomas of the III ventricle in the pediatric age group. The usual form of presentation is that of a midline syndrome with no localizing signs. In the cases that were operated on, surgical intervention was rewarding and mortality was low. A very unusual finding in the meningioma that we report was its origin in the floor of the III ventricle, a circumstance that has only once been described previously.     

Intraventricular meningioma: case report in infancy

Meningiomas are infrequent tumours in infancy but when they appear in this age group, the intraventricular location is more frequent than in adults. We report the case of a 5-year-old girl with intracranial hypertension and a VI nerve palsy. Computed tomography and magnetic resonance imaging of the brain revealed a tumoral lesion involving the right lateral ventricle with intense enhancement after contrast administration. It was completely resected through a mean temporal circunvolution route. Histological diagnosis was of atypical meningioma.     

Fourth ventricular meningioma: a case report and literature review

A 60-year-old man was admitted with slowly progressive dizziness. Cranial nerve evaluation found no abnormalities. Magnetic resonance imaging revealed a well-circumscribed mass with homogeneous enhancement located in the fourth ventricle. The patient underwent surgery for the removal of the tumor via the bilateral suboccipital approach. Subtotal removal of the tumor was achieved in a piecemeal fashion. Histological diagnosis was meningothelial meningioma. Fourth ventricular meningiomas are extremely rare. We reviewed the literature and discussed the features of fourth ventricular meningiomas.     

Chordoid meningiomas: Incidence and clinicopathological features of a case series over 18 years

Chordoid meningioma (CM) is a rare subtype of meningioma, classified as grade II, which exhibits a high rate of recurrence following subtotal resection. We retrospectively examined nine cases of chordoid meningioma over a case series of 1743 meningiomas (0.52%) operated upon at our institution from 1995 to 2013. All the reported clinicopathological findings were analyzed. Two hundred and twenty‐one CM cases have been published to date worldwide and few single‐center large case series have been issued. Seventy‐five percent of the cases that underwent subtotal resection at our institution had recurrence within 1 year. Total resection of the tumor should be the major objective of surgery to reduce the possibility of tumor recurrence. The percentage of chordoid features within the tumor specimen could assist in predicting the pathogenesis of the lesion. The correlation of the index of proliferation to recurrence rate is still controversial. Much debate exists with regard to the role of adjuvant radiotherapy in CM cases. Immunohistochemical, cytological and ultrastructural studies should be used in combination to assure a correct diagnosis of CM. Owing to the rare occurrence of this meningioma subtype, larger case series are required to assist in providing a reference for diagnosis and to improve the therapeutic management of CM.     

Choroid plexus adenoma: case report and review of the literature

Case report An 8-month-old infant with macrocephaly was found to have hydrocephalus and a cystic third ventricular tumour; biopsy of the tumour showed a choroid plexus adenoma. The tumour was attached to the ependymal lining and was strongly adherent to the walls and floor of the anterior third ventricle.Treatment After biopsy, it was felt that a radical resection would carry a high risk of injury to the floor of the third ventricle and cause new neurological deficits. Therefore, an external ventricular drain was inserted and bilateral ventriculo-peritoneal shunts were inserted 1 week post-operatively. In view of the benign nature of the tumour, no adjuvant radiotherapy or chemotherapy was given.Outcome There was no further tumour growth or clinical deterioration over a 6-year follow-up period.     

Deep sylvian meningioma: a case report and review of literature

Case report  A 6-year-old boy presented with seizures. Computed tomography and magnetic resonance imaging showed a large enhancing mass in the left temporo-parietal region. Treatment  He underwent left temporo-parietal craniotomy and total excision of the lesion. At surgery, there was no dural attachment, and the tumor was mainly in the posterior part of left sylvian fissure. The biopsy was reported as WHO grade I meningioma. Outcome  At 4-year follow-up, he was asymptomatic, and there was no tumor recurrence.