Cutaneous Meningioma

Department of Pathology, University of North Carolina, Chapel Hill, 27514, USA.
Archives of pathology & laboratory medicine (Impact Factor: 2.84). 02/2012; 136(2):208-11. DOI: 10.5858/arpa.2010-0505-RS
Source: PubMed


Cutaneous meningioma is a rare tumor that most commonly occurs on the scalp and occurs in both congenital and acquired forms. It invokes a wide clinical differential diagnosis, but diagnosis is based on characteristic histologic and cytologic findings. Congenital lesions can often present years after birth and even in adult patients. Acquired lesions occur in adulthood. We review histologic, cytologic, and electron microscopic findings and explore how these are used to separate this entity from other entities in the differential diagnosis. While ultrastructural and cytologic findings are similar to those of more common intracranial meningiomas, these tumors exhibit a range of histologic differences. A lack of awareness of this entity precludes correct diagnosis.

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    ABSTRACT: Pleural Case Report PostersSESSION TYPE: Affiliate Case Report PosterPRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PMINTRODUCTION: Metastatic Pleural and Pulmonary Parenchymal involvement is rare with intra-cranial or extra-cranial meningioma. Cases of Primary Pulmonary meningioma as solitary pulmonary nodule have been reported(1). We are presenting a case of primary pleural cavity meningioma.CASE PRESENTATION: 50 year old female with history of right upper extremity lymphedema for 8 years presented with gradual onset of shortness of breath and right sided pleural effusion (Figure 1). Initial diagnostic and therapeutic thoracentesis revealed an exudative pleural effusion. No lung parenchymal lesions were visible after thoracentesis. Lymphscintigraphy showed distal obstruction in her right upper extremity. Patient presented with recurrence of the pleural effusion at 4 weeks. A high suspicion for malignancy led to pleuroscopy and pleural biopsy. Pathology demonstrated nodular neoplastic proliferation of small spindled to ovoid cells with eosinophilic cytoplasm and bland nuclei within a predominantly myxoid stroma (Figure 2). On Immunohistochemistry a soft tissue meningioma was suspected due to the expression of epithelial membrane antigen and progesterone receptor (PR) (2). No brain and spine lesions were evident. Due to lymphedema of right upper chest and poor wound healing, complete pleurectomy was deferred.DISCUSSION: Soft tissue Meningioma tumors are formed by Neoplastic growth of ectopic arachnoid cells. Pleural involvement has been reported with metastatic meningioma with intracranial or extracranial primary tumors. Primary Pleural or Pulmonary menigioma is a rare occurence. Surgery is the mainstay of treatment with pleurectomy and Pleurodesis.CONCLUSIONS: Our case may represent a Primary Pleural Cavity Meningioma. Treatment options were limited in our case due to lymphedema. Early intervention in these cases with closed pleural biopsy or Pleuroscopy guided biopsy could lead to early therapy.Reference #1: 1) Lung Cancer. 2008 Dec Primary pulmonary meningioma: report of a case and review of the literature. Incarbone M et alReference #2: 2) Jayson R. Miedema, Daniel Zedek, (2012) Cutaneous Meningioma. Archives of Pathology & Laboratory Medicine: February 2012, Vol. 136, No. 2, pp. 208-211.Reference #3: 3) Meningioma. Fathi AR, Roelcke U. Current Neurology and Neuroscience Reports. 2013 AprDISCLOSURE: The following authors have nothing to disclose: Rajani Jagana, Nikhil Meena, Thaddeus Bartter, Brendon ColacoNo Product/Research Disclosure Information.
    Chest 10/2013; 144(4_MeetingAbstracts):488A. DOI:10.1378/chest.1704300 · 7.48 Impact Factor
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    ABSTRACT: Introduction: Extracranial meningiomas may infrequently be encountered as ectopic or metastatic tumors. Their rarity and unique cytomorphology often pose significant diagnostic dilemmas. The aim of this study was to report our experience with a series of ectopic and metastatic meningiomas, characterizing their cytomorphology with histological correlation. Materials and methods: A retrospective analysis involving 13 patients with cytological preparations from extracranial meningiomas was performed. Cytology cases were correlated with available surgical resection specimens. Data regarding clinical findings, tumor information, cytomorphology, follow-up histological features and immunohistochemistry were recorded and analyzed. Results: There were 5 cases with metastases and 8 ectopic meningiomas. Metastases occurred in the scalp/skull, lung, paraspinal soft tissue and liver. Primary ectopic meningiomas were located in the paranasal sinuses and ear, orbit and neck. Cytomorphological features characteristic of meningiomas were identified in the majority of samples including tightly cohesive clusters of spindled cells, whorls, intranuclear inclusions, nuclear grooves and psammomatous calcification. Unusual cytomorphological features identified in only a few cases included epithelioid cell predominance, abundant inflammatory cells, small-cell change, papillary structures and pseudoacinar growth. Metastatic tumors exhibited more nuclear atypia and occasionally mitoses or necrosis. Meningiomas were shown to be immunoreactive for epithelial membrane antigen, pancytokeratin and vimentin. Conclusion: Although rare, extracranial meningiomas can be encountered in cytologic specimens and should be included in the differential diagnosis when characteristic morphological features of meningiomas are seen. Cytopathologists should be aware that these lesions could be mistaken for other tumors, especially when confounded by atypia and unusual cytomorphological features.
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    ABSTRACT: Cutaneous meningiomas are rare tumors in human beings and animals. Two canine cases of cutaneous meningiomas affecting the eyelid are described in the current study: the first from a 5-week-old female Springer Spaniel dog with an 8 cm in diameter congenital mass expanding the left upper eyelid and medial canthus; the second from a 10-year-old female spayed Maltese-Poodle mix dog with 3 firm subcutaneous nodules affecting the right upper eyelid. All masses were removed surgically. Histologically, tumors were composed of spindle-to-epithelioid cells arranged in small lobules forming solid concentric whorls. Neoplastic cells were positive for vimentin and S100 and negative for pancytokeratin, glial fibrillar acid protein, and neurofilament. Transmission electron microscopy revealed meningothelial cells with convoluted interdigitating processes, desmosomes, and hemidesmosomes, and moderate numbers of cytoplasmic microfilaments. None of the cases presented a primary neuroaxial meningioma. The first case presents clinicopathological features consistent with human type I (congenital) cutaneous meningioma. The second case is consistent with a type II (acquired ectopic) tumor, and both are hypothesized to arise from ectopic arachnoid cells displaced during development.
    Journal of veterinary diagnostic investigation: official publication of the American Association of Veterinary Laboratory Diagnosticians, Inc 05/2014; 26(4). DOI:10.1177/1040638714533116 · 1.35 Impact Factor
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