Unsuspected primary pulmonary meningioma.

Primary pulmonary meningioma is an uncommon, usually benign, soft tissue tumour which has rarely been reported. We report an additional case of primary pulmonary meningioma occurring in an asymptomatic 56-year-old man whose diagnosis was only established after resection. The features of this lesion together with a review of the previous literature are described.     

Primary pulmonary malignant meningioma.

Fewer than 20 cases of primary pulmonary meningioma have been reported. Most of these cases have been histologically and clinically benign. We report an unusual case of primary pulmonary malignant meningioma with atypical histologic features and malignant behavior. A computed tomography scan of the head did not show evidence of tumor. The right upper lobe mass was resected and showed features of an atypical meningioma with loss of architectural pattern, mild nuclear pleomorphism, increased mitotic counts (up to 15 mitotic figures per 10 high power fields), and focally prominent nucleoli. Focally, cells with rhabdoid features were identified. The tumor's immunohistochemical and ultrastructural profiles were consistent with a meningioma. The tumor stained negative for estrogen and focally positive for progesterone receptors and had a MIB-1 labeling index (marker of cell proliferation) of 9.2%. Approximately 5 months after the initial resection, the patient experienced a tumor recurrence with multiple lymph node metastases, spread to the middle and lower lobes of the right lung, and metastasis to the diaphragm. Rarely, primary pulmonary meningiomas may present as high-grade malignant lesions.     

Primary pulmonary meningioma presenting as lung metastasis

A benign primary pulmonary meningioma, an extremely rare tumour, was incidentally detected in a 57-year-old woman in association with a contralateral pulmonary adenocarcinoma. The meningioma was initially suspected to be a metastasis. Both tumours were excised, with excellent outcome. Anatomic features of primary pulmonary meningioma and differential diagnosis are discussed.     

Primary pulmonary meningioma first suspected of being a lung metastasis

Primary extracranial and extraspinal meningiomas are rare tumors. We describe a primary pulmonary meningioma first suspected of being a metastasis because it presented as a solitary subpleural pulmonary nodule in a patient with breast cancer. The absence of radiographic change after 6 months of chemotherapy led to resection of the breast and lung lesions. A complete central nervous system evaluation eliminated other locations of meningioma, allowing the diagnosis of primary pulmonary meningioma.     

Primary pulmonary malignant meningioma

Primary pulmonary meningiomas are relatively rare and mostly benign. To exclude pulmonary metastasis of an intracranial meningioma, imaging studies of the brain should be performed. We believe that only one primary pulmonary malignant meningioma in which a metastasis from the brain was excluded has been reported. In this report we describe a second case with malignant features.     

Pulmonary metastatic meningioma 26-years after craniotomy

A 68-year-old male, pointed out of bilateral lung tumors, was hospitalized for the evaluation of multiple lung tumors. Chest computed tomography demonstrated 10 x 10 mm and 30 x 60 mm tumors in left lower lung and a 16 x 16 mm tumor in right lower lung. He was operated under the diagnosis of intracranial meningioma 26-years ago. For purpose of diagnosis, partial resections of left lower lung were performed, and then these tumors were diagnosed as pulmonary metastasis of intracranial meningioma. This is a very rare case of pulmonary metastasis of meningioma 26-years after craniotomy.     

原发性纵隔非典型脑膜瘤一例分析并文献回顾

［摘要］ 目的 探讨原发性纵隔非典型脑膜瘤的临床及影像学表现。方法 分析我院一例原发性纵隔非典型脑膜瘤的临床表现、实验室检查、影像学及病理学特征,并结合文献进行回顾,总结该病的临床、病理及影像学特征。结果 患者进行实验室及影像学检查后,行纵隔肿物切除术,术后恢复良好。结论 原发性纵隔非典型脑膜瘤的组织来源及结构与颅内钙化型脑膜瘤一致,故有脑膜瘤的影像学特征,熟悉其影像学特征及病理改变,有助于对该病的诊断及鉴别诊断。     

Necrotizing neurosarcoidosis of the cranial base resembling an en plaque sphenoid wing meningioma: case report

OBJECTIVE AND IMPORTANCE: Necrotizing sarcoid granuloma (NSG) has been recognized as a histological variant of sarcoidosis. Two cases of neurosarcoidosis (NS) with NSG with concomitant systemic disease have been described previously. We present an unusual case of primary NS-NSG that resembled an en plaque cranial base meningioma. CLINICAL PRESENTATION: A 51-year-old man presented with a 3-month history of progressive left visual deterioration and proptosis. Brain magnetic resonance imaging demonstrated a large cranial base lesion occupying the left anterior clinoid process and sphenoid wing, extending to the left frontotemporal convexity. A second dura-based lesion was observed in the right parietal convexity. Both lesions enhanced homogeneously after administration of intravenous contrast medium. Magnetic resonance imaging characteristics were consistent with a typical clinoidal meningioma with an en plaque extension laterally. INTERVENTION: A left frontotemporal craniotomy with extradural removal of the anterior clinoid process was performed. When the dura was opened, a red fibrous mass was identified. Intraoperative histological analysis revealed the presence of necrotizing and noncaseating granulomas. Postoperatively, cerebrospinal fluid, erythrocyte sedimentation rate, C-reactive protein, and serum and cerebrospinal fluid angiotensin-converting enzyme values were normal. The search for acid-fast bacilli or fungi was negative. A diagnosis of primary NS-NSG was made. The patient began long-term high-dose corticosteroid therapy. One and a half years after surgery, his vision had improved significantly and the lesions were stable as revealed by magnetic resonance imaging. CONCLUSION: The first case of primary NS-NSG in the absence of systemic sarcoidosis is reported. NS should be included in the differential diagnosis of dura-based lesions resembling meningioma.     

Primary pulmonary meningioma

Primary pulmonary meningiomas are extremely rare. In this article we report one case with benign primary pulmonary meningioma. The literature is reviewed and the clinical manifestations, radiographic findings, and pathologic features are presented.     

Surgical resection of pulmonary metastases from meningioma: Report of a case

Meningiomas rarely metastasize, and little information on pulmonary metastasectomy from meningioma has been documented. We herein report a case of a potentially curative resection for meningioma that metastasized to the lung. A 67-year-old woman was admitted to our hospital because of two masses in the right lung. In 1993, when the patient was 52 years old, she underwent a craniotomy for an atypical meningioma. The meningioma recurred once in the local site and was re-excised in 1997. In 2008, a screening chest X-ray detected two lung nodules in the right lung field. A computed tomographic scan demonstrated round masses with sharp borders, in the right S2 (2.2 cm in diameter) and S4 (1.1 cm in diameter) regions. A whole-body [¹⁸F]2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/CT examination revealed intense focal FDG uptake (maximum standard uptake value [SUV_max] = 6.9) in the larger mass, and weak FDG uptake (SUV_max = 2.3) in the smaller mass. A wedge resection of S2 and a middle lobectomy of the right lung were performed, and the final diagnosis was pulmonary metastases from an intracranial meningioma. The patient is presently doing well 20 months after the surgery without any signs of recurrence. Our case demonstrates that surgery should be considered when pulmonary metastases are deemed completely resectable by a preoperative radiological examination, and that a good clinical outcome can be achieved.     

Follicular dendritic cell tumor of the parapharyngeal region

BACKGROUND: Follicular dendritic cell (FDC) tumors are rare. A majority of the reported cases were confined to the lymph nodes. We report a case of FDC tumor occurring in the parapharyngeal region in a 45-year-old woman. METHODS: Characteristic histopathologic features of the excised primary and recurrent parapharyngeal tumors in conjunction with immunohistochemistry and electron microscopy helped us to arrive at a diagnosis of FDC tumor. RESULTS: Histopathology of primary excision revealed a lobulated tumor with a suggestion of ill-defined whorls. The most striking feature was regular occurrence of aggregates of lymphocytes within the tumor, especially around the blood vessels. The anatomic location together with the histology indicated the possibilities of either a meningioma, a salivary gland tumor, or a nerve sheath tumor. Immunostains for cytokeratin (CK), S-100 protein, and smooth muscle actin (SMA) were negative. However, the tumor cells showed strong immunoreactivity for epithelial membrane antigen (EMA) and vimentin. A diagnosis of parapharyngeal meningioma appeared to be the closest possibility. One year later, the patient developed a recurrence at the same site. A reexcision showed an identical tumor with an additional feature of lymphatic embolization and angioinvasion. A review of the entire case with further immunoreactivity for CD21 and CD35 confirmed the diagnosis of FDC. CONCLUSIONS: Follicular dendritic cell tumor has distinctive morphologic features and immunohistochemical profile. It is also characterized by considerable potential for recurrences.     

Primary pulmonary meningioma; report of a case

Primary pulmonary meningiomas are quite rare, and their occurrence has been reported only sporadically. A 49-year-old, asymptomatic female was hospitalized for the evaluation of a coin lesion in the left lung radiography. She has no history of previous neoplasm or symptom referable to the central nervous system. Chest computed tomography (CT) demonstrated a 9 x 14 mm, round, noncalcified, well-demarcated lesion in the left upper lobe of the lung (S(1+2)). For diagnostic purposes, enucleation of the tumor was performed. The resected specimen revealed histologically classical typical meningioma. Because postoperative magnetic resonance imaging (MRI) of the brain did not show any intracranial mass, this case was and diagnosed as a primary pulmonary meningioma. The patient was discharged with no complication, and alive without recurrence of disease 14 months after surgery.     

Adamantinoma and meningioma occurring synchronously in a patient with breast cancer: a case report.

Screening mammography of a woman with no symptoms led to the diagnosis of carcinoma of the breast, an intracranial meningioma, and adamantinoma of the right tibia. This is the first reported case of three synchronous primary tumors of different tissue origins. Biopsy is essential for diagnosing or excluding primary tumor(s) in cases of suspected metastases occurring at a limited number of sites.     

Rare tumour mimicking meninigioma: A case of primary intracranial amelanotic malignant melanoma with negative staining of S100 and HMB‐45

Primary intracranial malignant melanoma is a rare disease, and the imaging findings usually mimic meningioma. Diagnosis is based on histology. Here, we report a case of primary intracranial malignant melanoma in a Chinese patient. A 27‐year‐old man presented with a 1‐month history of headache. Magnetic resonance imaging findings resembled features of a meningioma. Craniotomy with tumour excision was done and confirmed to be S100 and human melanoma black 45‐negative primary intracranial malignant melanoma. There was no extracranial involvement. The 9‐month follow up was reported. To our knowledge, this is the first reported S100 and human melanoma black 45‐negative primary intracranial amelanotic malignant melanoma.     

Extracranial meningioma and pregnancy: a rare diagnosis.

We report the first case of pregnancy-related primary cutaneous meningioma of the scalp in a 27-year-old female. Types, differential diagnosis, pregnancy-related growth and treatment of extracranial meningiomas are discussed.     

Intracranial non-Hodgkin's MALT lymphoma mimicking a large convexity meningioma

Primary presentation of an intradural Non-Hodgkin's lymphoma is rare. Recently these B cell lymphomas of mucosa associated lymphoid tissue (MALT) have gained acceptance as an important pathological subtype and are distinguishable from other primary CNS lymphomas that exhibit aggressive behaviour. Over the past decade a number of these lesions have been reported to resemble a meningioma both intra-operatively and radiologically. The authors outline such a case of marginal zone B cell lymphoma that clinically and radiologically resembled a meningioma. This case illustrates the rare occurrence of low grade dural B cell lymphoma and the need to consider this entity in the differential diagnosis of CNS lesions, if appropriate targeted therapy is to be administered.     

Intracranial Non-Hodgkin’s MALT lymphoma mimicking a large convexity meningioma

Summary Primary presentation of an intradural Non-Hodgkin’s lymphoma is rare. Recently these B cell lymphomas of mucosa associated lymphoid tissue (MALT) have gained acceptance as an important pathological subtype and are distinguishable from other primary CNS lymphomas that exhibit aggressive behaviour. Over the past decade a number of these lesions have been reported to resemble a meningioma both intra-operatively and radiologically. The authors outline such a case of marginal zone B cell lymphoma that clinically and radiologically resembled a meningioma. This case illustrates the rare occurrence of low grade dural B cell lymphoma and the need to consider this entity in the differential diagnosis of CNS lesions, if appropriate targeted therapy is to be administered.     

Pseudo-oligodendrogliomatous meningioma. Report of 2 cases and review of the literature]

We report two cases of oligodendroglioma-like meningioma revealed by symptoms of increased intracranial pressure, progressive hemiparesia and partial epileptic seizures. Brain CT-scan or scintigraphy and carotid arteriography were suggestive of a convexity meningioma. One patient had received radiation treatment for scalp tinea capitis 25 years previously. In spite of complete surgical removal, the tumor recurred in both cases respectively 17 years and 18 months later. The two patients were operated again, and one underwent a complementary radiotherapy. Pathologic diagnosis was particularly difficult in the first case where the pattern at conventional histologic technics was that of oligodendroglioma. On the occasion of recurrence, immuno-histochemistry and ultrastructural studies were performed. The tumor was positive for epithelial membrane antigen (E.M.A) and cytokeratin, but was negative for glial fibrillary acidic (G.F.A.) protein, S 100 protein (S 100), neuron-specific enolase (N.S.E.), vimentin, anti-LEU-7 (N.H.K.1), and neurofilaments (N.F.). Electron microscopy showed closely adjacent cells with tonofilaments and numerous desmosomes. These findings permitted to establish the diagnosis of oligodendroglioma-like meningioma instead of oligodendroglioma. In the second case, the histologic pattern was also reminiscent of oligodendroglioma, but presence of few cellular whorls in some part of the tumor permitted the correct diagnosis. The pathogenesis of this atypical form of meningioma, its tendency for recurrence, and usefulness of radiotherapy are discussed and literature is reviewed.     

Myxoid meningioma: a rare metaplastic meningioma variant in a patient presenting with intratumoral hemorrhage

Myxoid (metaplastic) meningioma is a rare WHO Grade I meningioma subtype arising from the leptomeninges. It has unique Alcian blue stromal staining and distinctive cellular interdigitations, junctional complexes, and nucleolar pseudoinclusions on ultrastructural pathology that help to distinguish it from other meningioma variants. The authors describe the case of a rare left middle fossa, extraaxial myxoid meningioma in a 50-year-old woman to emphasize the important histological characteristics and observations essential for making a precise diagnosis. To their knowledge this is the seventh reported case of a myxoid meningioma in the literature and the sixth case in an adult; however, it is the first reported instance of myxoid meningioma in a patient presenting with intratumoral hemorrhage.