Meningioma originating from the superior petrosal vein without dural attachment:A case report

BACKGROUND Meningioma in the cerebellopontine angle(CPA)without dural attachment is extremely rare.We report a unique case of meningioma derived from the superior petrosal vein without dural attachment.CASE SUMMARY A 44-year-old right-handed woman presented with a two-month history of headache and tinnitus.Brain magnetic resonance imaging showed a well-defined contrast-enhancing lesion in the right CPA without a dural tail sign.Tumor resection was performed using a right retro sigmoid approach.A dural attachment was not seen at the tentorium or posterior surface of the petrous pyramid.The tumor was firmly adherent to the superior petrosal vein.The origin site was cauterized and resected with the preservation of the superior petrosal vein.A diagnosis of meningothelial meningioma was made.The patient’s headache and tinnitus gradually disappeared,and a recurrence was not observed five years after the surgery.CONCLUSION The rare occurrence of meningioma without dural attachment makes it difficult to determine dural attachment before surgery.The absence of dural attachment makes it easy to completely resect such tumors.Vessels related to tumors should be removed carefully,considering the possible presence of tumor stem cells in the microvessels.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial,we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case.Pulmonary meningothelial proliferative lesions,including primary pulmonary meningiomas,minute pulmonary meningothelial-like nodules,and metastatic pulmonary meningiomas are rare pulmonary lesions.These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations.Herein,we briefly introduce the clinical,imaging,and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Surgical Management of a Collision Tumor: The Association of Intracranial Meningioma and Macroadenoma

Background: The simultaneous presence of a pituitary adenoma and a meningioma is a rare and underreported condition. The randomly encountered cases need to be reported to further allow our understanding of this collision tumors that are still not understood nor fully described. Patients and Method: We report a case of coexisting nonfunctioning pituitary adenoma and a left temporal lobe meningioma revealed by a 1-year history of progressive vision loss and occasional headaches in a 56-year-old woman. Her clinical condition worsened in the last 5 months with ptosis, cavernous sinus syndrome, and ophthalmoplegia of the right eye without papilledema. There was an improvement in the visual symptoms after subtotal resection of both lesions through a right frontotemporal craniotomy. Histology confirmed a collision tumor. The patient was referred for adjuvant treatment with gamma knife radiosurgery. He was doing well and back to his usual duties 6 months later. Conclusion: A gross total or subtotal resection with adjuvant therapy is the gold standard for the surgical management of collision tumors for a favorable patient outcome.

Malignant Meningioma: Two Cases Observed at the Hospital Center of Soavinandriana, Antananarivo

Introduction: Meningiomas are tumors formed by arachnoid cells, typically attached to the inner surface of the dura mater. Malignant forms are rare and no case has been reported in the Malagasy literature. The objective of our study is to report two Malagasy cases of malignant meningioma and to discuss the epidemiological and anatomical-clinical particularities of this tumor. Observation: The first patient, a 41-year-old woman, presented with a rapidly progressive intracranial hypertension syndrome. The patient had undergone surgery two years earlier for a grade II meningioma and had no family history of meningioma, neurofibromatosis, or personal history of brain irradiation or head trauma. Her brain scan showed a heterogeneous polylobed left parieto-occipital mass with a meningeal implantation base. The anatomopathological examination of the samples revealed a malignant meningioma. The second patient was a 33-year-old man, operated for grade I meningioma eleven months before admission, with no other personal or family history. The patient was hospitalized for tumor recurrence with signs of intracranial hypertension. The brain computed tomography (CT) scan showed a heterogeneous extra-axial tumor in right temporo-parietal lobe. Surgical excision was performed. On histological examination, a proliferation of tumor cells of meningothelial appearance with papillary architecture was observed, leading to the diagnosis of malignant meningioma. Conclusion: Malignant meningioma is a rare and serious entity. The clinical manifestations are nonspecific and imaging may mimic a low-grade meningioma. The diagnosis of certainty is histological and is based on essentially morphological criteria. The latter condition the overall survival of the patient and the therapeutic conduct.

Convulsive Seizures Revealing a Meningioma in Children: A Case Report from the Hospital Center of Soavinandriana

Meningiomas in children are rare. They represent only 1% to 3% of all intracranial tumors. It was a case report of a childhood girl meningioma, which is from the rare tumor and presenting by seizures, evolving in an apyretic context. She had no notion of irradiation or particular personal history apart from wearing glasses since the age of 5 years. She weighed 70 kg (BMI = 31). Biological examinations were normal. The brain scan showed a left frontal extra-axial tumor process measuring 76 × 60 × 55 mm. Tumor resection was performed. Macroscopically, the surgical specimen was found to be 8 firm, lobulated, yellowish-white fragments measuring 14 × 11 × 2 cm and weighing 150 g in total. The histological examination showed a proliferation of meningothelial cells, with a tendency to stratify and to roll up on each other in an onion bulb shape, without excess of mitoses and without cortical infiltration, evoking a meningioma. Meningioma in children remains a rare tumor. In our case, seizures were the only revealing signs of this disease. Cerebral computed tomography oriented the diagnosis. Anatomopathological examination was essential for confirmation.

Meningioma of the Optical Nerves in a Case at the Hospitalier Center of Saint Denis in Ile de France

Summary: Optic nerve tumors are rare tumors, representing 3% - 5% of intracranial tumors developing mainly along the optic nerve and/or the chiasm. Optic nerve meningiomas are histologically benign tumors whose severity is linked to diagnostic and especially therapeutic difficulties. The Optic nerve meningioma is the second leading cause of optic nerve tumor after glioma. Observation: We report the case of a 49-year-old woman from South Asia, who consults an ophthalmology department for progressive visual loss in her right eye for about a year with her glasses and would like to renew her optical correction. Having no particular medical history apart from left unilateral blindness is known for approximately 15 years. Magnetic Resonance Imaging (IRM) cerebral found a tissue mass with a clear outline and polylobules on the left temporo-peduncular. Through this case, we describe the circumstances of discovery of the disease, the clinical characteristics, as well as our diagnostic approach. Conclusion: In the majority of cases, these are benign tumours, the circumstances of which are discovered in multiple ways. A mostly unilateral and non-improvable loss of visual acuity must attract our attention. Renewing glasses may be the reason for discovering the disease. Today Magnetic Resonance Imaging (IRM) remains an important and capital examination for the diagnosis and monitoring of this pathology.

Metastases Extracranial Mimicking Meningioma: A Case Report

Background: Skull vault lesions are rare and represent 1% - 2% of all bone masses. Most cerebral metastases are the intra axial tumors, whereas extra-axial masses mimicking meningioma are extremely rare. Case presentation: A 35-year-old woman with a history of mastectomy left breast cancer 5 years below radiotherapy was referred to the neurosurgery department with a parietal extra-axial mass parietal evolving for one year. CT scan with Magnetic resonance imaging revealed an extra-axial tumor with lysis bone. A craniotomy was performed to remove the mass that was located extra-axial. Histopathological examination revealed metastasis. Conclusions: Lesion skull vaults are rare but they should be considered in the differential diagnosis of intraosseous meningioma lesions. In this report, we discuss the clinical aspects of cases we observed, in which the metastasis bone was found thanks to the histological examination of a calvarial mass after surgery.

The Evaluation of Efficacy and Side Effects of Radiotherapy in Cerebral Meningiomas

Aims: The current study aimed to evaluate the efficacy, side effects of radiotherapy and factors influencing treatment outcome in patients received radiotherapy for cerebral meningiomas. Methods and Material: In the last two decades, a total of 35 patients with cerebral meningioma who received radiotherapy in our clinic were evaluated statistically in terms of survival, toxicity and prognostic factors. The records of patients diagnosed with cerebral meningioma who underwent postoperative radiotherapy were retrospectively analyzed. Statistical analysis used: Statistical comparisons were made using IBM SPSS v24.0. Kaplan-Meier method was used to compare survival times. Results: Five of the patients had grade I meningioma showing recurrence, 18 were grade II meningioma and 12 were grade III meningioma. Patients were treated with 54 or 60 Gy adjuvant radiotherapy with 2 Gy daily fractions according to histopathological grade and operation type. Three and five-year overall survival rates were 56% and 40%, respectively and median overall survival was 36 months. Progression was observed in 15 of the 35 patients included in the study. Three and five-year progression-free survival (PFS) rates of the patients were 56% and 50%, respectively. There was a statistically significant correlation between histopathological grade and overall survival among patients. However;no statistical difference found in overall survival of patients in terms of tumor location, operation type and age. Conclusions: In the treatment of cerebral meningiomas, changes in radiotherapy dose and field designs can be predicted according to the tumor grade and operation type. In addition, it is thought that large scale studies are needed to determine prognostic factors more meticulously.

Misdiagnosis of malignant meningioma in subcutaneous soft tissue of the forehead: A case report

Meningiomas, the most common intracranial primary tumors, are always benign. Extracranial and distant metastases can occur in malignant meningiomas. This case report describes a male in his 50 s with malignant meningioma and metastases to the subcutaneous soft tissue. Preoperative color Doppler ultrasound showed that the tumor had an abundant blood flow. Intraoperative pathological examination revealed a malignant tumor. Postoperative pathological examination revealed malignant tumors in the forehead;thus, malignant meningiomas were suspected. Immunohistochemistry revealed grade Ⅲ malignant meningioma. Malignant meningiomas have the ability to readily spread and metastasize;however, cases of malignant meningiomas disintegrating the bone and metastasizing to the subcutaneous part of the head have not been reported.

Metaplastic meningioma with pure and extensive cartilaginous transformation: A diagnostic dilemma

Meningiomas are the most common extra-axial central nervous system tumours and often discovered in the middle to late adult life and especially in women. About 85%-90% of meningiomas are benign, 5%-10% are intermediate-grade, and 3%-5% are malignant. Metaplastic meningioma is a rare subtype of WHO Grade I meningioma histologically characterized by the presence of mesenchymal components. The presence of pure and extensive cartilaginous differentiation in meningiomas is extremely rare and remains a diagnostic dilemma. We report, perhaps the first case of this entity in a 52-year-old woman and discuss the pathogenesis, the imaging features and the histopathologicals data.

Application of 3D-computed tomography angiography technology in large meningioma resection

Objective:To discuss the role of 3D-computed tomography angiography(3D-CTA) technology in reducing injuries of large meningioma surgery.Methods:3D-CTA preoperative examinations were done in 473 patients with large meningioma(simulated group).The images were analyzed by 30 post-processing workstation.By observing the major intracranial blood vessels,venous sinus,and the compression and invasion pattern in the nerve region,assessing risk level of the surgery,simulating the surgical procedures,the surgical removal plan,surgical routes and tumor blood-supplying artery embolisation plan were performed.Two hundred and fifty seven large meningioma patients who didn’t underwent 3D-CTA preoperative examination served as control group.The incidence of postoperative complications,intraoperative blood transfusion and the operation time were compared between these two groups.Results:Compared with the control group,the Simpson’s grade 1 and 11 resection rate was 80.3%(380/473),similar with that of the control(81.3%,209/257).The incidence of postoperative complications in 3D-CTA simulated group was 37.0%which was significantly lower than that(48.2%) of the control(P【0.01). The intraoperative blood supply for simulated group and the control was(523.4±208.1) mL and (592.0±263.3) mL,respectively,with significant difference between two groups(P【0.01).And the operation time[(314.8±106.3)]min was significantly lower in simulated group than that in the control[(358.4±147.9) min](P【0.01).Conclusions:Application of 3D-CTA imaging technology in risk level assessment before large-scaled meningioma resection could assist in the rational planning of tumor resectin,surgical routes,and is helpful in reducing injuries and complications and enhancing the prognosis of the patients.

Clinicopathological analysis of metaplastic meningioma: report of 15 cases in Huashan Hospital

Objective： Metaplastic meningioma is a rare subtype of benign meningiomas, classified as WHO grade I with well prognosis. Here we presented our experiences on 15 cases of metaplastic meningioma, to investigate the clinicopathological features, therapies and prognosis of these cases. Methods： 15 patients underwent surgical treatment for intracranial metaplastic meningioma between 2001 and 2010 at Neurosurgery Department of Huashan Hospital, Shanghai, China. The clinical data, radiological manifestation, treatment strategy, pathological findings and prognosis of all patients were analyzed retrospectively. Results： Among the 15 cases （10 males and 5 females）, the age ranged from 22 to 74 years old （the mean age was 50.67-year old）. The clinical manifestations include headache, dizziness, seizure attack, vision decrease, and weakness of bilateral lower limbs. All the patients received surgical treatment, combined with radiotherapy in some cases. In the follow-up period, recurrence occurred in 2 cases, of which 1 patient died of other system complications. Conclusions： Metaplastic meningiomas are characterized by focal or widespread mesenchymal differentiation with formation of bone, cartilage, fat, and xanthomatous tissue elements. Surgical removal is the optimal therapy, and the overall prognosis is well. But recurrence may occur in some cases, thus radiotherapy is necessary for such kind of patients.

Expression levels ofβcatenin and galectin-3 in meningioma and their effect on brain invasion and recurrence:a tissue microarray study

Objective:Meningiomas are neoplasms that arise from the meninges of the central nervous system(CNS).They constitute about25.6%of CNS tumors diagnosed in Egypt.Some morphological variants of meningiomas display aggressive behavior,leading to brain-invasive growth pattern.Although meningiomas are usually treated by complete surgical excision,the risk of postoperative recurrence remains.Hence,additional biomarkers for predicting aggressive behavior must be discovered.This study aims to explore the clinical and biological relevance of the protein expression levels ofβ-catenin and galectine-3 in meningioma and to understand the pathobiology of this neoplasm.Methods:This retrospective study was carried out on 153 cases of meningioma by using tissue microarrays and immunohistochemistry forβ-catenin and galectine-3.Results:Highβ-catenin expression was significantly associated with transitional and meningiotheliomatous meningiomas,low tumor grade,low recurrence rate,and low incidence of brain invasion.Meanwhile,high galectin-3 expression was associated with brain invasion,recurrence,high tumor grade,and tumor type.Logistic regression analysis indicated that among all variables included in the model,β-catenin and galactin-3 expression levels were significant predictors of tumor recurrence(P<0.001).Conclusions:Galectin-3 andβ-catenin are involved in meningioma recurrence but not in brain invasion.These molecules could be important potential therapeutic targets and predictors for meningiomas.

Analyses on the misdiagnoses of 25 patients with unilateral optic nerve sheath meningioma

AIM：To investigate clinical features of optic nerve sheath meningioma（ONSM） that was misdiagnosed,and to find methods to reduce the misdiagnoses.METHODS：Retrospective series study.Twenty-five misdisgnosed patients with unilateral ONSM were collected from Jan.2008 to Jan.2015 and the clinical records reviewed.RESULTS：Patients were misdiagnosed with acute papillitis most frequently（P=17）,immediately followed by optic atrophy（P=8）,ischemic optic neuropathy（P=5）,acute retrobulbar optic neuritis（P=5）,optic disc vasculitis（P =3）.For each patient,the minimum frequency of misdiagnoses was once and the maximum was 4 times.As for the lasting time of being misdiagnosed,the shortest was 1.5mo and the longest was 45 mo.Twentyone cases（84%） were once treated with glucocorticoids,and its side effects was found in seventeen patients.Twenty patients（80%） complained with varying degree of vision loss.When a definite diagnosis was made,sixteen cases（64%） showed slight exophthalmos and eighteen cases（72%） had the tubular ONSM.CONCLUSION：ONSM without loss obvious exophthalmos is easily misdiagnosed in clinic,and for most of these ONSMs are tubular.

Angioarchitecture and CD133^+ tumor stem cell distribution in intracranial hemangiopericytoma A comparative study with meningioma

Angioarchitecture plays an important role in the malignant development of intracranial hemangiopericytoma. It remains poorly understood whether high frequency of hemorrhage during clinical surgery for intracranial hemangiopericytoma is associated with angioarchitecture. The present study utilized hematoxylin-eosin staining, and immunohistochemical staining with epithelial membrane antigen, vimentin, CD34, von Willebrand factor （vWF） and CD133 to observe characteristics of angioarchitecture. In addition, silver stains were used to demonstrate changes in reticular fibers in the wall of vessel channels in intracranial hemangiopericytoma and meningioma. Five patterns of angioarchitecture were identified in intracranial hemangiopericytoma, namely tumor cell islands, vasculogenic mimicry, mosaic blood vessels, sprouting angiogenesis, and intussusceptive angiogenesis. Several CD133＋ tumor cells were found to form tumor cell islands. A connection between vWF ^＋ and vWF channels was detected in the pattern of intussusceptive angiogenesis, and some vimentin^＋ tumor cells were embedded in the periodic acid-Schiff positive channel wall. Incomplete threads of reticular fibers formed the walls of larger pseudo-vascular channels and some tumor clumps or scattered tumor cells were detected ＂floating＂ in them. The angioarchitecture, specific markers and reticular fibers of intracranial hemangiopericytoma were significantly different from meningioma. Angioarchitecture provides a functional vascular network for vascular evolution in intracranial hemangiopericytoma and contributes to significant intra-operative bleeding.

Intraoperative ultrasound assistance in resection of intracranial meningiomas

Objective： Intracranial meningiomas, especially those located at anterior and middle skull base, are difficult to be completely resected due to their complicated anatomy structures and adjacent vessels. It＇s essential to locate the tumor and its vessels precisely during operation to reduce the risk of neurological deficits. The purpose of this study was to evaluate intraoperative ultrasonography in displaying intracranial meningioma and its surrounding arteries, and evaluate its potential to improve surgical precision and minimize surgical trauma. Methods： Between December 2011 and January 2013, 20 patients with anterior and middle skull base meningioma underwent surgery with the assistance of intraoperative ultrasonography in the Neurosurgery Department of Shanghai Huashan Hospital. There were 7 male and 13 female patients, aged from 31 to 66 years old. Their sonographic features were analyzed and the advantages of intraoperative ultrasonography were discussed. Results： The border of the rneningioma and its adjacent vessels could be exhibited on intraoperative ultrasonography. The sonographic visualization allowed the neurosurgeon to choose an appropriate approach before the operation. In addition, intraoperative ultrasonography could inform neurosurgeons about the location of the tumor, its relation to the surrounding arteries during the operation, thus these essential arteries could be protected carefully. Conclusions： Intraoperative ultrasonography is a useful intraoperative technique. When appropriately applied to assist surgical procedures for intracranial meningioma, it could offer very important intraoperative information （such as the tumor supplying vessels） that helps to improve surgical resection and therefore might reduce the postoperative morbidity.

Basic Fibroblast Growth Factor and Fibroblast Growth Factor Receptor-1 in Human Meningiomas

The expression of basic fibroblast growth factor (bFGF) and fibroblast growth factor receptor-1 (FGFR-1) in human meningiomas and the relationships between their expression and the tumors' histological features and angiogenesis were investigated by means of immunohistochemical technique. The expression of bFGF and FGFR-1 was detected by antibody of bFGF or FGFR-1. The tumors' angiogenesis was evaluated by microvascular density (MVD) and, which was observed by use of CD34-antibody immunohistochemically. The results showed that there were varied degrees of the expression of bFGF and FGFR-1 proteins in meningiomas. The expression was correlated with the tumors' histological characters and angiogenesis. It was concluded that bFGF and FGFR-1 might play important roles in meningiomas' angiogenesis and proliferation. The expression positive rate of bFGF and FGFR-1 may provide an indication of evaluating the histological and malignant degree of the tumor.

Expression of Androgen Receptor in Meningiomas

In order to investigate the expression of androgen receptor in meningiomas and its relation to tumor proliferative potential, we examined the expression of AR and proliferating cell nuclear antigen by avidine biotin complex immunohistochemistry in 39 cases of meningiomas. Of the 39 cases of meningiomas, 20 showed positive AR immunoreactivity. The AR expression positivity rates were 31 % in benign meningiomas, 58 % in atypical meningiomas, 87.5 % in malignant meningiomas, respectively. In addition to the tumor cells, cells of microvascular endothelial proliferation were frequently AR positive. Malignant meningiomas had a significantly higher percentage of AR positive cells compared with atypical and benign meningiomas . The mean proliferating cell nuclear antigen labeling index was significantly higher in the malignant meningiomas when compared with atypical meningiomas and benign meningiomas . AR positive meningiomas had higher PCNA LI than AR negative meningiomas . The expression of AR in tumor tissues was significantly related with PCNA LI. These data indicated that AR in the meningiomas was correlated with histological grade and AR might participate in the growth of these tumors and tumor angiogenesis. The measurement of AR in these tumors may indirectly represent tumor growth potential.

Clinical and pathological features in 49 elderly patients with meningiomas

BACKGROUND： As aging in elderly people, their brain tissue has degeneration and brain atrophy of different severity, and the volume of cranial cavity is relatively enlarged, it has greater compensatory ability to the space occupying lesion, and it is difficult to detect the meningioma because it grows to expand slowly, the tumor locates in non-functional region, and there are atypical symptoms and deficiency of localization signs. OBJECTIVE： To investigate the clinicopathologic features of senile meningiomas. DESIGN： A retrospective analysis. SETTING： Affiliated Hospital of Hebei University. PARTICIPANTS： Forty-nine elderly patients with meningioma were selected from the Department of Neurosurgery, Affiliated Hospital of Hebei University from May 1999 to March 2005, including 15 males and 34 females, 60-74 years of age, and they were all diagnosed by CT and MRI. METHODS： The sites of tumors were identified by CT and MRI examinations in all the patients. The tumors were partially or totally resected according to their own conditions. The types of the resected tumor were pathologically observed. The conditions of postoperative recovery were observed after 1, 3 and 6 months, and without new neurological dysfunction or complication was considered as good outcome. MAIN OUTCOME MEASURES： ① Sites and pathological types of the tumor; ② Postoperative outcomes and complications. RESULTS： All the 49 patients were involved in the analysis of results. ① The tumors had wide distributions with a main location in brain convexity. Among the 49 cases of meningioma, there were 25 cases of fibrocystic type, 12 cases of meningothelial type, 6 cases of psammomatous type, 4 cases of angiomatous type and 2 cases of microcystic type. ② Among the 49 patients, 35 had good outcome, 8 had self-care ability, 4 required care by others, 2 （4.1%） died postoperatively. No long-term complication related to the operation was observed during the follow-up postoperatively. CONCLUSION： Meningioma has a main location in brain convexity, and its pathological type is mainly fibrocystic one, and there is good operative outcome.

Primary pulmonary meningioma:A case report and review of the literature

BACKGROUND Primary pulmonary meningioma(PPM)is a rare disease that is usually benign.The most common presentation of PPM is isolated pulmonary nodules or masses,so the disease can mimic any other lung tumor on imaging,especially lung cancer or metastasis.CASE SUMMARY A 47-year-old asymptomatic woman presented with a well-defined,lobulated pulmonary mass with calcification in the left lower lobe.The mass measured 69 mm×57 mm×61 mm and was found during a chest computed tomography(CT)performed for physical examination.Contrast-enhanced CT and positron emission tomography(PET)/CT revealed mild enhancement of the mass,with accumulation of 18-fluoro-2-deoxy-D-glucose(18F-FDG).Transbronchial biopsy suggested a provisional diagnosis of low-grade neuroendocrine tumor.Subsequent enhanced head magnetic resonance imaging revealed no positive lesions.An open cuff resection of the left lower lobe and wedge resection of the lingual segment were performed.Histopathological and immunohistochemical examination revealed that the mass was a PPM.CONCLUSION PPM should be considered in the differential diagnosis of isolated pulmonary masses found incidentally on CT and should be diagnosed based on a combination of radiological and histological features.Surgical resection is currently the main treatment strategy.No recurrence of benign PPMs has been reported after complete resection.