Synchronous intravascular large B‐cell lymphoma within meningioma

Intravascular large B‐cell lymphoma is a rare and aggressive lymphoma with a dismal prognosis. Synchronous intravascular large B‐cell lymphoma within meningioma has not previously been documented. We report a case of a 73‐year‐old woman of Asian descent who presented with fever of unknown origin with generalized weakness. CT scan and MRI of the head revealed a dural‐based mass lesion consistent with meningioma in the left frontal cerebral convexity. Surgery was performed to remove the tumor and histopathology showed a meningioma within which was a synchronous intravascular large B‐cell lymphoma. The hematology and oncology services were consulted and palliative treatment was initiated due to the patient's poor Eastern Cooperative Oncology Group performance status. The patient died within 30 days post‐surgery. To the best of our knowledge, this case represents the first report of synchronous intravascular large B‐cell lymphoma within a meningioma.     

Rhabdoid meningioma: a new subtype of malignant meningioma also apt to occur in children

Case report The case of a 14-year-old girl who presented with a 2-week history of raised intracranial pressure is reported. A left frontal extra-axial tumor was totally removed, whose histopathologic diagnosis was rhabdoid meningioma (RM).Discussion Rhabdoid meningiomas constitute a special malignant phenotype of meningioma that has been recently included in the WHO classification of tumors of the nervous system. Usually, RMs affect middle-aged and elderly individuals. We report the fourth case of a RM occurring in a child to illustrate that the diagnosis of this tumor subtype, given its prognostic implications, must also be considered in pediatric patients     

Supratentorial CAPNON associated with WHO grade II meningioma: A case report

Calcifying pseudoneoplasm of the neuraxis (CAPNON) is a rare benign tumor of uncertain etiology, arising in the craniospinal axis. CAPNON typically arises in isolation, with only two prior reports of a concurrent second neoplasm. Here, we report the case of a male 17‐year‐old who presented with new‐onset seizures. MRIs revealed a 2 cm extra‐axial solid‐cystic mass, arising at the left temporo‐occipital junction and abutting the dura with marked surrounding parenchymal vasogenic edema. The solid components demonstrated dense calcification and avid enhancement. Gross total surgical resection was performed. Histopathological examination revealed central regions showing characteristic features of CAPNON. Toward the periphery, the CAPNON was intimately associated with and sharply demarcated from a meningioma, which showed up to five mitoses per 10 high‐power fields and had invasion into the adjacent brain parenchyma, warranting a WHO grade II designation. This is the first report of CAPNON arising in association with a meningioma. The coexistence of these two tumors raises the possibility of a reactive/dysplastic etiology for CAPNON.     

Ki‐67 proliferative index predicts clinical outcome in patients with atypical or anaplastic meningioma

Meningiomas represent the second most common central nervous system neoplasms in adults and account for 26% of all primary brain tumors. Although most are benign, between 5% and 15% of meningiomas are atypical (grade II) whereas 1–2% are anaplastic meningiomas (grade III). Although histological grade is the most relevant prognostic factor, there are some unusual cases in which establishing a diagnosis of high‐grade meningioma following 2000 World Health Organization (WHO) histological criteria is extremely difficult. Therefore, the aim of the present study was to evaluate the predictive value of Ki‐67 labeling index and its contribution to current WHO classification in predicting tumor recurrence and overall survival in patients with high‐grade meningiomas. A total of 28 patients (with 16 atypical meningiomas and 12 anaplastic meningiomas) were evaluated for demographic, clinical, radiological and therapeutic variables, and for Ki‐67 immunohistochemistry. Median Ki‐67 labeling index in the whole series was 7.0 (0.5–31.5) with no differences with respect to the histological grade (P = 0.87). In the univariate analysis, Ki‐67 labeling index and postoperative Karnofsky performance status were identified as significant prognostic factors of tumor recurrence and overall survival. The multivariate analysis demonstrated that Ki‐67 labeling index is the only independent predictor of both tumor recurrence and overall survival. More importantly, this predictive value was maintained in both patients with atypical and patients with anaplastic meningioma.     

ALK‐positive anaplastic large cell lymphoma presenting as intradural spinal mass: First reported case and review of literature

Anaplastic large cell lymphoma (ALCL) is characterized by large anaplastic cells of T‐cell or null‐cell phenotype expressing CD30 (Ki‐1 antigen). In most cases this neoplasm expresses the anaplastic lymphoma kinase (ALK), a chimeric protein resulting from the t(2;5)(p23;q35) translocation. ALK‐positive anaplastic large cell lymphoma is most frequent in the first three decades of life and shows a male predominance, involving both nodal and extranodal sites, but rarely the CNS. We report a 21‐year‐old patient with a previous history of nodal ALK‐positive ALCL, lymphohistiocytic subtype, who was admitted for recent occurrence of left‐sided anesthesia with pain and progressive motor weakness of both legs. An MRI of the spine documented an intradural extramedullary mass dislocating the thoracic cord, suggesting a meningioma and the patient underwent surgical decompression. Histological examination revealed a lymphoproliferative neoplasm with morphology and immunophenotype of ALK‐positive anaplastic large cell lymphoma. After surgery, all preoperative symptoms disappeared. To our knowledge, no cases of ALCL presenting as secondary localization with an intradural extramedullary spinal mass have been reported in the literature.     

Primary ALK‐1‐negative anaplastic large cell lymphoma of the brain: Case report and review of the literature

Anaplastic large cell lymphoma (ALCL) is a type of non‐Hodgkin lymphoma composed of CD30‐positive cells. Anaplastic lymphoma kinase (ALK) ‐1 positive ALCL frequently involves both lymph nodes and extranodal sites. While primary extranodal involvement of ALK‐1 negative ALCL is rare, this case is unique in that it is a case of primary ALK‐1 negative ALCL of the brain. A 79‐year‐old man presented with dementia‐like symptoms. Neuroimaging revealed a well‐enhanced mass in the left parieto‐occipital region. The tumor was excised and histological diagnosis of primary ALK‐1‐negative ALCL was made. Primary ALK‐1‐negative ALCL in this case showed aggressive clinical behavior and fatal outcome. It is of great importance to avoid any delay in reaching an accurate diagnosis, as even primary ALCL of the brain is too seldom suspected clinically.     

Somatostatin suppression of meningioma cell proliferation in vitro

Considering the presence of a stereospecific receptor for somatostatin (SST) in human meningioma cells and the possible involvement of this neuropeptide in the growth control of certain meningioma cell lines, the effects of SST on the proliferation of human meningioma cells in vitro was investigated. Tumour tissues for primary cell cultures were obtained surgically from 2 women with histopathological diagnosis of meningothelial meningioma. The incorporation of [3H]-thymidine into meningioma cells DNA was measured as an index of the cells proliferation. It was shown that SST (10(-7)-10(-5) M) significantly inhibited the [3H]-thymidine incorporation. The results have indicated that SST may have an antiproliferative effects on the meningioma tumour cells in vitro.     

Postirradiation meningioma

A case of meningioma of the posterior cranial fossa is reported. The tumor developed 12 years after radiation treatment for a polar spongibolastoma of the cerebellum in an 8-year-old boy. The possible role of the radiation in the oncogenesis of the second tumor is discussed. In light of the information in the literature concerning the malignancy of such postirradiation tumors, the authors recommend careful evaluation for the real necessity of radiation therapy, particularly for children in whom the meninges may be hypersensitive to ionizing radiation.     

Meningioma–primary brain lymphoma association

The authors report a rare meningioma–primary cerebral B cell lymphoma association that occurred in an insulin‐dependent type‐I diabetic woman. The woman was initially operated on because of meningothelial meningioma of the fronto‐basal region, and 2 months later showed a primitive‐non‐Hodgkin B cell lymphoma, localized in the same area as the meningioma. The published literature on the meningioma–primary cerebral lymphoma association is revised.     

Giant congenital meningioma in a newborn

The authors report the case of a giant meningioma in a 5-day-old newborn. Congenital meningiomas are extremely rare. Five newborns with meningiomas have been reported in the literature to date. This is the first case of a newborn with a giant meningioma with supra-and infratentorial and intraorbital components.     

大型及巨大型岩斜区脑膜瘤的显微外科治疗

目的 总结大型及巨大型岩斜区脑膜瘤的治疗经验.方法 根据临床表现和影像学特征,将41例大型及巨大型岩斜区脑膜瘤分为3组:Ⅰ组(肿瘤位于上斜坡,18例)、Ⅱ组(肿瘤位于中下斜坡,17例)、Ⅲ组(肿瘤累及全斜坡,6例).Ⅰ组肿瘤采用颞枕下经小脑幕入路,Ⅱ组肿瘤采用枕下乙状窦后入路,Ⅲ组肿瘤采用幕上下联合入路切除岩斜区脑膜瘤.结果 肿瘤切除Simpson Ⅰ～Ⅱ级Ⅰ组7例,Ⅱ组7例;Ⅲ级切除Ⅰ组8例,Ⅱ组8例,Ⅲ组2例;Ⅳ级切除Ⅰ组3例,Ⅱ组2例,Ⅲ组2例.Ⅲ组病人死亡2例.结论 对于不同类型的大型及巨大型岩斜区脑膜瘤,选择不同的手术方式,对提高术后疗效和减少手术并发症有重要作用.     

Intraventricular meningioma with anaplastic transformation and metastasis via the cerebrospinal fluid

We report a surgical case of intraventricular meningioma that arose in the trigone of the right lateral ventricle of a 61‐year‐old woman. Local recurrence and metastasis (dissemination) via the CSF to the fourth ventricle developed about 52 months postoperatively. Further subarachnoid dissemination in the pontine base and spinal cord occurred 6 months later. The tumor exhibited a histopathological appearance of transitional meningioma without cellular atypism in the original specimen, but in the metastatic nodules in the fourth ventricle and spinal subarachnoid space the histopathology was that of typical anaplastic meningioma. Only four cases of anaplastic intraventricular meningioma that developed metastasis via the CSF have been reported. This report presents the fifth case, which is also the second case in which progression from ordinary low‐grade meningioma to anaplastic meningioma was demonstrated histopathologically.     

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.     

Co‐occurrence of astrocytoma and astroblastoma: Case report and literature review

A 41‐year‐old man presented to us with left arm and leg weakness and mild word finding difficulties. His preoperative magnetic resonance imaging (MRI) demonstrated abnormal T1 and T2 signal changes in the right temporal lobe and basal ganglia, indicative of possible glioma. An awake craniotomy for right temporal lobectomy was performed and the tumor was resected. Full pathologic workup later revealed the patient had two distinct tumors occurring simultaneously, anaplastic astrocytoma and astroblastoma. We review the literature regarding the treatment of anaplastic astrocytoma and astroblastoma and discuss their co‐occurrence.     

Spinal epidural meningioma in a child

A case of spinal epidural meningioma in a 14-year-old girl is presented. Myelographic and computed tomographic findings led to the preoperative diagnosis of a metastatic lesion. Histological examination revealed the tumor to be a meningioma. Total resection was accomplished and the patient made a very good neurological recovery. A review of the literature reveals that these tumors have rarely been reported, especially in childhood.     

Sellar and suprasellar granular cell tumor of the neurohypophysis: A rare case report and review of the literature

Granular cell tumors of the neurohypophysis are rare tumors with a WHO grade of I. Symptomatic tumors are even more rare. In this case, we present a 50‐year‐old patient with a sellar and suprasellar granular cell tumor of the neurohypophysis, who reported headaches, blurred vision and unsteady gait. CT imaging showed a sellar and suprasellar mass approximately 2.9 cm in diameter with clear boundaries. Histologically, the tumor lacked any obvious atypia and contained densely arranged polygonal tumor cells with abundant granular eosinophilic cytoplasm. Staining for Alpha‐1 AntiChymotrypsin (AACT), TTF‐1 and PAS was diffusely positive, and S‐100 staining was focally positive in the tumor cells. CD34, CK, EMA, GFAP and HMB45 staining were negative. The Ki‐67 index was < 1%. According to these findings, the tumor was diagnosed as a symptomatic granular cell tumor of the neurohypophysis. We suggest that identifying the location of the tumor with imaging is helpful for understanding the granular cell tumor of the neurohypophysis. Prompt diagnosis and treatment are critical for patients.     

Primary large B-cell lymphoma of the fourth ventricle

We present a patient with an isolated primary central nervous system lymphoma (PCNSL) of the fourth ventricle. A 77-year-old man had a 1 week history of intermittent vertigo, nausea, vomiting, and progressively unsteady gait. CT scans of the brain showed a fourth ventricle tumor. MRI revealed a 2.5 cm dumbbell-shaped avidly-enhancing tumor in the fourth ventricle. Metastasis or high-grade glioma was suspected. The neuropathological findings were compatible with a diffuse large B-cell lymphoma. A slit lamp examination, bone marrow biopsy, and imaging studies for extracranial lesions were unremarkable. We suggest that PCNSL be listed in the differential diagnosis of fourth ventricle tumors with well-circumscribed margins and homogenous contrast enhancement.     

A glioblastoma arising from the attached region where a meningioma had been totally removed

The co‐occurrence of different histological tumors in the nervous system is rare and is mainly associated with phakomatoses or radiation exposure. A 72‐year‐old man underwent surgery for a frontal convexity meningioma. Four years after the surgery, a new lesion was detected in the attached region where the meningioma had been removed. The second tumor exhibited a high degree of cellularity, atypical mitosis, pseudo‐palisading and microvascular proliferation, and was immunohistologically positive for GFAP and was diagnosed as a glioblastoma. Wild‐type isocitrate dehydrogenase 1 was found in the second specimen. A genetic analysis using comparative genomic hybridization showed a DNA copy number loss on 1p35, 9pter‐21, 10, 11q23, 13q, 14q, 20q, 22q and a gain on 7 in the second specimen. Although the mechanism responsible for the consecutive occurrence of meningioma and glioblastoma has not been elucidated, five hypotheses are feasible: (i) the lesions occurred incidentally; (ii) a low‐grade astrocytoma present at the time of the first operation transformed into a high‐grade glioma during the next 4 years; (iii) radiation received during the endovascular treatment induced glioblastoma; (iv) a brain scar created at the time of the first operation for meningioma led to the occurrence of a glioblastoma; and (v) the previous meningioma affected the surrounding glial cells, causing neoplastic transformation.