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.     

Invasive character of an intradural spinal meningioma in early childhood

The authors report the case of a 2-year-old baby girl with an intradural meningotheliomatous meningioma of the cauda equina which recurred three times. Despite four operative procedures and localized radiotherapy, the lesion kept on growing to reach the retroperitoneal space. Extensive laminectomy and associated radiotherapy were probably responsible for a spinal dislocation which had to be operated on. The child was left paraplegic with major bladder dysfunction after all procedures. This is the first reported case of well-documented malignant evolution of a spinal 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     

Spinal meningioma becoming symptomatic in the third trimester of pregnancy

We report a rare case of a spinal meningioma leading to symptoms of spinal cord compression starting in the third trimester of gestation in a 32-year-old woman. Neurological symptoms, which continued to progress after the patient had given birth, were assumed to be sequelae of pregnancy and delivery, leading to a 6 month delay in diagnosis and treatment. Fortunately a gross total resection was achieved at surgery and the patient recovered fully, without permanent consequences. Associated symptoms of spinal cord compression may be falsely attributed to pregnancy, both by the pregnant women and her treating physician. A high index of suspicion and thorough history and physical examination to identify red flags should be performed in patients with neurological symptoms.     

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.     

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.     

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     

Medulloblastoma in pediatric age: a single-institution review of prognostic factors

We report a retrospective study of 35 cases of medulloblastoma in pediatric patients treated at our institution during an 18-year period. Ten of the patients were infants (age <2 years) and 25 were children (age >2 years). The main factors affecting prognosis were total removal of the tumor (P<0.01) and tumor stage (P<0.01). There were no differences between the survival rate of infants and children, infants had a worse prognosis in regard to quality of life than children.     

Spinal meningioma: Chronicles of contemporary neurosurgical diagnosis and management

Spinal meningiomas are uncommon entities that fortunately burden only a small minority of patients. Notwithstanding their overwhelmingly benign propensity, the occurrence of extramedullary meningioma may nonetheless cause significant morbidity and possible mortality. The consideration therefore, of spinal meningioma in the differential of patients presenting with radiculopathy or complaints of chronic back or neck pain should not be disregarded. The rapidity of diagnosis and the first neurosurgical encounter are cornerstones in patient longevity and neurological preservation. The advent of microsurgical techniques and magnetic resonance imaging and surgical techniques has notably improved clinical outcomes over the past two decades. However, surgical candidacy may be limited, particularly in those patients with significant preexisting medical comorbidities, aggressive or recurring tumors, or multiple lesions. Alternative management strategies such as stereotactic radiosurgery or less invasive surgical techniques are currently underway in clinical practice. A review on neurosurgical diagnosis and treatment modalities in the management of spinal meningioma is therefore pertinent.     

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.     

Intraventricular metaplastic meningioma in a child: case report and review of the literature

Childhood meningiomas are rare and display important differences from adult forms. We report the first case of an intraventricular metaplastic meningioma arising in a child. A 7‐year‐old female underwent resection of an enhancing tumor arising within the left lateral ventricle. It was composed of monomorphic cells embedded within an abundant myxoid stroma. The cells demonstrated epithelial membrane antigen and vimentin immunoreactivity. Ultrastructural analysis demonstrated intermediate filaments, complex intercellular interdigitations and desmosomes, and a diagnosis of myxoid (metaplastic) meningioma was rendered. This case reflects the higher incidence of intraventricular meningiomas in childhood and greater incidence of intraventricular meningiomas in the left lateral ventricle. Recognition of the grade I myxoid meningioma in this case is paramount since chordoid meningiomas, which share similar histologic features, are of a higher grade and worse prognosis.     

A case of neck ectopic meningioma

Primary extra cranial and extra spinal meningioma is rare and is usually limited to the head and neck region or to the paravertebral soft tissues. Histologic diagnosis (in particular for fresh specimens) is often difficult. A 16‐year‐old girl with a cervical mass is presented. It was a relatively large mass with an approximate diameter of 5 cm. It was diagnosed in fine needle aspiration as a pleomorphic adenoma. Intra‐operative diagnosis was paraganglioma and frozen section suggested an infiltrative tumor. Histologically, the lesion showed uniform spindle cell proliferation separated by hyalinized collagen bundles. The cells were often arranged in sweeping fascicles and concentrically wrapped in tight whorls. Immunohistochemically, tumor cells were positive for epithelial membrane antigen and vimentin, while showing no reaction for cytokeratin, chromogranin, neuron‐specific enolase and thyroglobulin. A diagnosis of ectopic meningioma was established based on microscopic appearance and immunohistochemical profile of the tumor. Despite its rarity, ectopic meningioma should be considered in differential diagnosis of any mass lesion in head and neck regions, containing spindle cells.     

A case of cystic meningioma mimicking an astrocytoma

Summary In a 25-year-old woman, suddenly complaining of irritation and soon after of paretic symptoms in the right upper limb, a CT scan showed a large cystic mass in the left parietal lobe. As cerebral angiography was not helpful, a cystic astrocytoma was suspected. After total surgical removal of the cyst, the histological examination revealed, to our surprise, a syncytial meningioma. The rare cases of similar cystic meningioma reported in the literature are reviewed and the usefulness of biopsy on every suspected cerebral neoplasm is stressed.

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Zusammenfassung Eine 25jährige Patientin klagte zunächst über Gereiztheit und wies bald eine Parese des rechten Armes auf. Die Computertomographie des Schädels zeigte einen großen zystischen raumfordernden Prozeß im linken Parietallappen. Eine Arteriographie erlaubte keine Präzisierung, und es wurde deshalb ein zystisches Astrozytom vermutet. Nach vollständiger chirurgischer Exstirpation der Zyste ergab die histologische Untersuchung den überraschenden Befund eines synzitialen Meningeoms. Es werden die seltenen zystischen Meningeome der Literatur diskutiert, und es wird betont, wie nützlich eine Biopsie bei jedem Hirntumor sein kann.

     

An unusual case of lipoblastic meningioma of the falx cerebri

The clinicopathological features of a lipomatous meningioma of the falx cerebri with an unusual histological pattern are presented.     

Suprasellar cystic meningioma: unusual presentation and review of the literature

We report on a case of suprasellar cystic meningioma. The magnetic resonance imaging of this tumor resembled that of a craniopharyngioma. The definitive diagnosis of meningioma was made only after histopathological confirmation. We conclude that preoperative studies are often equivocal. The possibility of meningioma should be considered in the diagnosis of any intracranial neoplasms with radiological and surgical evidence of a cystic lesion.     

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.     

显微手术治疗低龄儿童幕上脉络丛肿瘤

目的总结6岁以下低龄儿童幕上脉络丛肿瘤的临床特点和手术经验。方法回顾性分析2004年1月至2010年12月显微手术治疗的13例6岁以下儿童脉络丛肿瘤患者的临床资料。本组13例,平均年龄为19．4月;肿瘤位于侧脑室7例、第三脑室内6例。结果肿瘤全切除10例,次全切除2例,部分切除1例。术后病理证实12例为脉络丛乳头状瘤,l例为脉络丛乳头状癌。术后随访3～92个月,平均38．1月;1例脉络丛乳头状癌患者术后6月复发并转移而死亡;1例脉络丛乳头状瘤患者术后16个月死于颅内感染;余11例存活。结论儿童幕上脉络丛肿瘤大部分为良性肿瘤,显微手术全切除肿瘤可达到满意的疗效。     

Diffuse craniospinal metastases of intraventricular rhabdoid papillary meningioma with glial fibrillary acidic protein expression: A case report

Rhabdoid papillary meningioma is a recently described clinically aggressive variant of meningiomas with a high recurrence rate. Additionally, only one case of intraventricular rhabdoid meningioma has been reported so far. We present a case of a 50-year-old man who developed an intracranial tumor of the left lateral ventricle at the trigone, for which he underwent total tumor resection followed by gamma knife radiosurgery for recurrence of the tumor. The histological diagnosis was rhabdoid papillary meningioma. Five years after surgery, diffuse craniospinal leptomeningeal metastases developed and subtotal removal of the spinal tumor was performed. The spinal tumor was considered to have metastasized via cerebrospinal fluid (CSF) in view of its histological features that were identical to those of the primary tumor. Immunohistochemistry revealed the unusual cytoplasmic expression of glial fibrillary acidic protein (GFAP) of tumor cells. To our knowledge, this is the first reported case of diffuse craniospinal metastases of intraventricular rhabdoid papillary meningioma with GFAP expression and the second reported case of the rhabdoid subtype amongst intraventricular meningiomas.