A case of lipomatous meningioma

We present a case of a 55-year-old woman with intracranial lipomatous meningioma attached to the left sphenoid ridge. A CT showed a mass lesion partially with a hypodensity area in the left fronto-temporal lobe. On MRI, the mass lesion contained a hyperintensity portion on T1 weighted images, which changed to hypointensity on fat-suppressed-T1 images. Histological examinations demonstrated a transitional meningioma containing lipomatous portions. Immunohistochemical studies showed negative reactivity for epithelial membrane antigen (EMA) and positive reactivity for vimentin and S-100 in the areas with lipomaous foci. This pattern of reactivity was different from that of lipomatous meningiomas reported previously. Further examinations are needed concerning the origin of tumor cells in lipomatous meningiomas.     

Cystic meningioma: Neuroradiological (MRI, CT) and macroscopic intraoperative appearance. A case report

Differential diagnosis of intracranial cystic meningiomas may present difficulties in about 10–15% of cases where anatomo-pathological alterations such as intratumoral necrosis, cystic cavity, hemorrhage or lipomatous infiltration are present. These alterations are responsible for an unusual radiological appearance which may suggest a false diagnosis. We describe a case of meningioma with a cystic appearance in which MRI was more helpful than CT, because it suggested an extra-axial meningiomatous lession and thus allowed more precise surgical planning.     

Lipomatous meningioma: report of 2 cases and review of the literature

BACKGROUND: Lipomatous meningioma is a rare but, most of the time, benign tumor. Its pathogenesis is still debated: it is usually considered to be part of the metaplastic meningioma, but several authors recently suggested that fat accumulation inside the tumor was related to metabolic disorders of the meningothelial cells. CASES DESCRIPTION: We report 2 cases of lipomatous meningioma. Both patients were women older than 60 years. One patient suffered from headache and seizures, the other one presented with behavioral disturbance. Radiological features depended on the amount of fat accumulation within the tumor. Surgical treatment allowed complete resection in both cases without any complications. Both meningiomas were of transitional-type and were apparently composed of 2 populations of cells: meningothelial cells and lipid-laden cells resembling mature adipocytes. Immunohistochemical study showed that lipid-laden cells expressed EMA, CD99, and progesteron receptor, favoring a meningothelial differentiation rather than an adipocytic lineage. CONCLUSION: Our study strongly suggests that lipomatous meningioma results from an accumulation of lipid inside meningothelial cells rather than a true metaplasia.     

Recurrent Lumbosacral Metastases from Intracranial Meningioma. Report of a Case and Review of the Literature

We report a case of a 31 year-old woman who in 1991 presented a clinical history of headaches, nausea and vomiting. CT scan showed a right frontotemporal meningioma. The first operation achieved a macroscopically complete resection. The tumour was histologically classified as a transitional meningioma. There were recurrences of the intracranial meningioma in 1994, 1996, 1997 and 1998. These recurrences were accompanied by differentiation to atypical and anaplastic meningioma. In all of these operations, a macroscopically complete resection of the tumour was performed. In 1996 adjuvant radiation therapy was given. In 1998 therapy with bromocriptine was adopted. In April 1999, the patient presented with lumbosacral pain associated with L5 bilateral sciatica. MRI showed a gadolinium enhancing mass lesion at L5-S1 level. Complete tumour resection was performed. The histological findings were the same as in 1998. In December 1999 the patient presented with perineal pain and MRI showed a L4 and S3 recurrence and the tumour was resected. The histological findings were those of a malignant meningioma. In February 2000 an intracranial recurrence was detected and operated on. The histological diagnosis was malignant meningioma. A review of the literature was undertake and is discussed.     

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.     

Growth dynamics of meningiomas in patients with multiple sclerosis treated with interferon: report of two cases

Summary. Summary.   Background: Although multiple sclerosis (MS) is a common disease of the central nervous system, the association of intraparenchymal tumour has been rarely reported and the potential relationship between intracranial meningioma and MS has not been seriously analysed. This report addresses the association of multiple sclerosis and intracranial meningioma and discusses the effect of interferon treatment on tumour progression.   Clinical Presentation: We report two cases with multiple sclerosis, who developed meningioma four and twenty years after the diagnosis of MS was made. Neither patient had a history of meningioma initially and both were being treated interferon when the meningioma was progressed.   Findings: Histological examination of two cases revealed meningothelial meningioma. The first patient's KI67 level was 2.5% and was positive for the progesterone and estrogen receptor. Chromosomal analysis showed some abnormalities. In the second case, mild atypical change by presence of nuclear enlargement and rare mitotic figures were noted and PCNA, KI67 levels were less than 2%.   Conclusions: We reported the association of multiple sclerosis and intracranial meningioma and observed the progression of the meningiomas during interferon treatment. Although, we cannot exclude the coincidence between the two diseases we discussed suspicious relationship between the interferon treatment and the tumour progression.     

Mixed tumour of schwannoma and meningioma components in a patient with NF-2

Summary The authors present the case of an intracranial tumour consisting of both schwannoma and meningioma within the same tumour, in a patient with neurofibromatosis-2 (NF-2). A pre-operative diagnosis of this mixed tumour was not made. However, retrospectively, a meningiomatous area was found inside the acoustic neurinoma on magnetic resonance (MR) images. Predominant schwannoma with a minor component of meningioma was confirmed by histopathological and immunohistochemical examinations. The transitional zones of these two different tumours were macroscopically sharp but microscopically interdigitated. The patient had another meningioma and schwannoma in a separate section of the cranial cavity. Based on this patient, it is suggested that the collision of two kinds of tumours is the most likely hypothesis to explain the development of mixed components of schwannoma and meningioma within the same tumour.     

Multicystic, heterogeneously enhancing meningioma in an octogenerian

A multicystic meningioma in an octogenerian whose tissue diagnosis was ill-defined and misleading on preoperative neuroradiologic imaging is presented. Nauta has described four cyst types that can develop in cystic meningiomas. We report the first case in which three cyst types are demonstrated concurrently, describe the histopathology and surgical management. This case represents a rare variant of a common tumour in an unusual age group, and underscores the need for definitive biopsy and resection as indicated. Furthermore, the diagnosis of multicystic meningioma does not favour an aggressive histopathology in this case.     

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.     

Rare case of paratesticular solitary fibrous tumour (lipomatous hemangiopericytoma)

A 26-year-old male presented with an asymptomatic 6-cm left paratesticular mass. Ultrasound and magnetic resonance imaging confirmed this mass as extratesticular, likely a tumour arising from the left spermatic cord. The mass demonstrated marked avid enhancement on post-contrast images, suggestive of a spermatic cord sarcoma. A left inguinal exploration was performed and gross examination of the mass revealed a well-circumscribed tumour with a discrete capsule separating it from the ipsilateral spermatic cord. The mass was resected without performing an orchiectomy and histology demonstrated a solitary fibrous tumour (lipomatous hemangiopericytoma), with minimal proliferative activity and negative margins. The occurrence of a paratesticular solitary fibrous tumour is exceedingly rare, with only a handful of case reports. We review the literature regarding this rare entity and discuss its diagnosis and management.     

Intra-suprasellar meningioma mimicking pituitary apoplexy

Summary The clinical and radiological features of an intra-suprasellar meningioma diagnosed as a pituitary macro-adenoma are presented. It is emphasized that this unusual tumour can mimic pituitary apoplexy. Differential diagnosis and surgical treatment of intrasellar meningioma versus pituitary adenoma are discussed with a review of the literature.     

Meningioma Manifesting Intracerebral Haemorrhage: A Possible Mechanism of Haemorrhage

We present a possible mechanism of intracerebral peritumoural haemorrhage in meningioma based on the clinical data of three of our cases. A meningioma manifesting intracerebral haemorrhage is uncommon and some sporadic case reports have been presented, but without any proven mechanisms. We are presenting three cases of convexity meningioma manifesting spontaneous intracerebral haemorrhage with apoplectiform onset. All three patients had no evidence of bleeding tendency or other predisposing factors for haemorrhage. Preoperative radiological studies showed a solid mass attached to the dura with intracerebral peritumoural haematoma. Total removal of the tumour and haematoma could be achieved in every case. Histological investigation revealed extensive tumour infarction in two cases and fibrosis related to pre-existing ischaemia in the other case. The diagnoses were atypical meningioma in two cases and transitional type in one case. We suggest that extensive tumour infarction might be a cause of spontaneous intracerebral peritumoural haemorrhage in our series of patients.     

Lipomatous meningioma--an uncommon tumor with distinct radiographic findings

A case of lipomatous (lipoblastic) meningioma is described. Atypical radiographic features of low density on computed tomography scanning and high intensity on T1-weighted magnetic resonance imaging corresponded to the presence of adipose tissue within the tumor. A review of the literature indicates few similar reported cases.     

Hyperglycaemia and cerebral oedema in a patient with a meningioma receiving dexamethasone

Dexamethasone is prescribed routinely to reduce cerebral oedema in neurosurgical patients undergoing craniotomy for tumour and is used increasingly as an anti-emetic. Dexamethasone, however, has been shown to cause hyperglycaemia. We describe a case of hyperglycaemic crisis, cerebral oedema and death secondary to dexamethasone in a patient with a frontal meningioma. We highlight the risks of peri-operative dexamethasone and discuss the diagnosis, treatment and complications of hyperglycaemic crises and cerebral oedema.     

Unique Radiological Appearance of a Microcystic Meningioma

Summary  A 35-year-old female presented with partial complex seizures. Computed tomography (CT) showed a slightly high density mass over the right frontal convexity, with heterogeneous contrast enhancement. T1-weighted magnetic resonance (MR) imaging showed the tumour as a hypo-intense lesion, with faint reticular enhancement after intravenous injection of gadolinium-diethylenetriaminepenta-acetic acid. The tumour was totally removed. The specimen was extremely soft and moist. The histological diagnosis was microcystic meningioma. The tumour cells were composed of typical meningothelial cells and stellate cells. The degenerative character of the tumour may be reflected in the poor enhancement on CT and MR imaging. This faint enhancement effect may be a neuro-imaging characteristic indication of this rare microcystic variant of meningioma.     

Giant lipomatous tumours of the hand and forearm

This study examines the presentation, management and outcomes of a series of 10 patients with giant lipomatous tumours (defined as greater than 5 cm diameter) of the hand and forearm who presented to our orthopaedic oncology service. All patients underwent local staging and were discussed at our multidisciplinary tumour meeting prior to definitive surgery. In all cases, neurovascular structures required mobilization in order to excise the tumour. Seven of the tumours were benign lipomas and one was a neural fibrolipoma. The other two were well differentiated lipoma-like liposarcomas/atypical lipomatous tumours. Giant lipomas and well differentiated lipoma-like liposarcomas/atypical lipomatous tumours of the hand and forearm present infrequently and a multidisciplinary approach is recommended in the investigation and surgical management of these patients.     

Extraskeletal osteochondroma in the nape of the neck: a case report

Extraskeletal osteochondroma in the nape of the neck is rare and its pathological diagnosis is based on radiological and histopathological examination. It is vital that such a diagnosis be considered when a discrete, ossified mass is localised in soft tissues, even at atypical sites. Differential diagnoses include myositis ossificans, a lipomatous lesion, a pseudomalignant osseous tumour, an ossifying fibromyxoid tumour, an extraskeletal chondroma with endochondral ossification, synovial (osteo) chondromatosis, tumoural calcinosis, a synovial sarcoma, and an extraskeletal osteosarcoma. Clinical awareness of this benign entity is important as no malignant transformation or metastasis has been reported. Marginal excision with histopathological identification is the treatment of choice.     

Immunopathological significance of Ig G in meningioma in relation to the pseudopsammoma bodies

Summary We described two histochemical patterns of Ig G deposits in meningioma and discussed the pathogenesis of Ig G deposits. In meningioma with pseudopsammoma bodies, Ig G was secreted from tumour cells which differentiated to secretory epithelial cells, and was found to deposit in the pseudopsammoma bodies. However, in meningioma without pseudopsammoma bodies, Ig G was derived from plasma and became deposit around the blood vessels in the meningioma tissue.     

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.