Meningioma Presenting Research Articles

Metastatic Meningioma Presenting as Cancer of Unknown Primary

We describe a case of anaplastic meningioma presenting in an extracranial osseous location, initially diagnosed as cancer of unknown primary. Although anaplastic meningioma comprise 3% of all meningiomas, this subtype is more likely to be associated with metastases. The increased degree of dedifferentiation in anaplastic meningioma makes diagnosis difficult, especially if characteristic imaging findings of meningioma are not identified. Adequate tissue for diagnostic purposes and appropriate imaging studies may help in establishing a definitive diagnosis.

Cerebral meningioma presenting as dystonic head tremor

Cerebral meningioma presenting as dystonic head tremor

Frontal lobe syndrome caused by a giant meningioma presenting as depression and bipolar disorder

Frontal meningiomas may present only with psychological symptoms that resemble depression, anxiety states, hypomania and schizophrenia. Herein, we present the case of a 55-year-old man who was initially thought to have depression and bipolar disorder, but was eventually diagnosed with frontal lobe syndrome caused by a giant frontal meningioma.

Oncocytic meningioma presenting with intratumoral hemorrhage

Oncocytic meningiomas have been recently reported as a rare variant of meningiomas. Immunohistochemical analysis shows that neoplastic cells are positive for antimitochondrial antibodies. We report our first patient with oncocytic meningioma, presenting with intratumoral bleeding. A 72-year-old woman suffered from a disturbance of consciousness. A CT scan showed a tumor with intratumoral hemorrhage. An emergency craniotomy was performed and the tumor and hematoma were removed. Examination of the tumor revealed meningothelial cells with oncocytic change. We discuss the clinicopathological considerations of this uncommon variant and review the pertinent literature.

메니에르병 증상을 보인 소뇌교각 뇌수막종 1예

메니에르병 증상을 보인 소뇌교각 뇌수막종 1예

Benign or malignant? Extensive pulmonary metastasis of an intracranial meningioma—unique radiographic and histopathologic features

Introduction: Meningiomas are slow growing benign tumors of the central nervous system. Although local recurrence does occasionally occur, extracranial metastasis of meningiomas is exceedingly rare and rarely reported, occurring in less than 1 per 1000 cases. Most commonly, metastasis occurs to the lung, and most cases of pulmonary cases are detected incidentally, followed by liver, lymph nodes, and bones. Case Report: A 67­year­old Caucasian male with a past medical history of intracranial meningioma status­post resection and radiation treatment who developed multiple pulmonary metastases 29 years following complete cranial tumor resection. He presented to our hospital with respiratory failure and subsequent imaging revealed multiple pulmonary nodules in his chest. These lesions were biopsied: the final diagnosis was metastatic malignant meningioma. He developed mitral valve endocarditis and passed away from multi­ system organ failure. Discussion: Extracranial metastasis of meningiomas is rare, occurring in approximately 0.1% of all meningioma cases. Several factors that are commonly associated with metastatic meningiomas include previous intracranial surgery for meningioma, dural sinus invasion, malignant histology, local recurrence, and a high Ki­67 labeling index. Conclusion: A doctor must be able to obtain a good history in the initial evaluation of a patient —the facts of which can help in narrowing down the list of differential diagnosis. Therefore, although distant metastases is a rare event, the possibility of pulmonary metastasis nevertheless is real and must not be ignored in patients with a past history of meningioma presenting with pulmonary symptoms.

Right Temporal Lobe Meningioma presenting as postpartum depression: A case report

Meningiomas are tumors which arise from arachnoid cells and can occur both in the brain and spinal cord. Meningiomas can present with psychiatric symptoms (such as depression, anxiety disorders, or personality changes) in the absence of any neurologic signs or symptoms. Literature review also shows few cases of postpartum depression seen in association with Frontal Lobe Meningiomas. Authors in this article present a unique case of Right Temporal Lobe Meningioma in a patient, who presented with chief complaint of postpartum depression. This presentation has never been reported to date. Routine use of neuroimaging in the evaluation of new onset psychiatric disorders has always been controversial but this case clearly underscores the value of a detailed history, careful physical examination, and consideration of other diagnostic studies in patients presenting for psychiatric evaluation. This case also provides an opportunity for clinical departments to improve and redefine its protocols and management strategies.

Spinal meningiomas: Surgical outcome and literature review

Background and purposeTo evaluate the incidence, clinical presentation, operative techniques and long-term outcome of spinal meningiomas following surgery. MethodsFifteen patients harboring spinal meningiomas were treated between 1998 and 2005 in our department. Diagnosis was made on magnetic resonance imaging and confirmed histologically. Microsurgical resection was carried out through a posterior approach in all cases. ResultsFollow-up extended from 60 to 156 months (mean: 99 and median 105 months). The most common site of spinal meningiomas was the thoracic region. Tumors were strictly intradural and extramedullary in 14 patients (93%) and macroscopic resection was considered as complete in all cases. Neurological improvement was observed in 13 patients (87%). There was no operative mortality and morbidity was low (20%). No patient underwent radiotherapy and the recurrence rate is 8%. ConclusionSpinal meningiomas are benign tumors for which advances in imaging tools and microsurgical techniques have yielded better results. The goal of surgery should be the total resection, which significantly reduces the risk of recurrence with an acceptable morbidity.

A Rare Cause of Stroke in Young Adults: Occlusion of the Middle Cerebral Artery by a Meningioma Postpartum

Meningioma is the most common nonglial intracranial primary tumor. It is a slowly growing tumor and presents clinically by causing seizures along with neurological or neuropsychological deficit. However, acute presentation of meningioma is possible. We are reporting a case of cerebral infarction due to a sphenoid wing meningothelial meningioma (with progesterone receptor positivity) leading to an occlusion of the middle cerebral artery (MCA) in a 30-year-old right-handed woman (1 month after childbirth). After surgery, no new neurological event occurred, and she recovered most of her neurological functions. Strokes due to meningioma are a highly rare clinical occurrence but should be given serious consideration, particularly in young patients.

Papillary Meningioma Presenting as Rapidly Progressive Dementia and Parkinsonism

In-Seok Park, M.D.*, Seung-Hee Na, M.D.*, Young-Do Kim, M.D.*, In-Uk Song, M.D.*, Lee-So Maeng, M.D.†, YoungSoon Yang, M.D.‡ Department of Neurology* and Pathology†, College of Medicine, The Catholic University of Korea, Seoul; Department of Neurology‡, Veterans Hospital, Seoul Medical Center, Seoul, Korea There are a variety of different causes of parkinsonism including PD, secondary parkinsonism, and the parkinsonism plus syndromes. Secondary parkinsonism is caused by structural, toxic, metabolic, or infectious mechanisms. Among structural causes, intracranial neoplasms are a rare cause of secondary parkinsonism. Moreover, there are almost never case reports with intracranial space-occupying lesions resulting in parkinsonism associated with rapid cognitive impairment. Therefore, we report herein a 37-yearold woman diagnosed with papillary meningioma who presented with parkinsonism associated with rapidly progressive cognitive impairment mimicking diffuse Lewy body disease.

Primary Extracranial Meningioma Presenting as a Cheek Mass

Meningioma is well known as common disease of the central nervous system, whereas primary extracranial meningioma is rare, representing 1% to 2% of all meningiomas. We have experienced a case of primary extracranial meningioma presenting as a right cheek mass. The tumor was completely excised via a right lateral rhinotomy incision. Histopathologic examination confirmed the diagnosis of primary extracranial meningioma.

Ectopic parapharyngeal meningioma: diagnosis of a rare entity on FNAC

Meningioma is a tumour most commonly located intracranially that may rarely extend extracranially. Ectopic meningioma presenting as parapharyngeal mass is a rare entity. We report a case of an 18-year-old female who presented with a complaint of swelling below the right angle of mandible associated with difficulty in swallowing for the last 3 months. The swelling measured 1.5 × 1 cm and was firm, fixed, non-pulsatile, non-transilluminant and non-tender. Computer tomography revealed a heterogenous enhancing mass with foci of calcification in parapharyngeal space without any intracranial component. Intraoral fine needle aspiration cytology was performed. A cytological diagnosis of spindle cell lesion of neural origin with the closest possibility of meningioma was rendered. Excision biopsy confirmed the diagnosis of ectopic parapharyngeal meningioma. It is important for clinicians and pathologists to be aware of this entity at the unusual site.

Intracranial anaplastic meningioma presenting as a cutaneous lesion: A case report of a cutaneous meningioma

Meningiomas are tumors of the central nervous system that rarely present as extracranial soft tissue masses. Meningioma of the skin is referred to as cutaneous meningioma. Cutaneous meningioma of the scalp is extremely rare and may cause diagnostic challenges. A 70-year-old female patient presented with a painless mass on her scalp. A punch biopsy was performed; histological examination of the specimen revealed an infiltration of spindle-shaped and epithelioid atypical cells arranged in whorls. Immunohistochemistry was positive for vimentin and epithelial membrane antigen. On magnetic resonance imaging, a large intracranial mass eroding through the skull was observed. A diagnosis of intracranial anaplastic meningioma was established and excision was performed in the Department of Neurosurgery. It is important to consider intracranial tumors in the differential diagnosis of nodules on scalp.

Case of the Month #178: Intraosseous Orbital Meningioma Presenting With Diplopia and Proptosis

A 58-year-old woman presented with a week-long history of diplopia. She further described a 3-year history of abnormal left eyelid alignment and, more recently, a 1-month history of pain behind the left globe that spread to the right cheek. There was no history of antecedent trauma, no other neurologic symptoms or signs, and results of a physical examination revealed left proptosis. Her medical history was significant for right eye glaucoma, with intraocular pressure of 28 mmHg. Left-sided pressures were normal, at 16 mmHg. Visual acuity was normal. After a computed tomography (CT) of the head, she was referred for neurosurgical consultation, after which, magnetic resonance imaging (MRI) of the brain was also performed. Selected images of those studies are included below (Figures 1 and 2).

Pediatric meningiomas: a single-center experience with 15 consecutive cases and review of the literature

The goal of this study was to determine the epidemiology, clinical presentation, associated factors, pathological features, and treatment outcome of pediatric meningiomas in a single-center institution. Clinical data of 15 patients under 18 years of age operated on for meningiomas from January 1994 to December 2010 were reviewed. The study group included nine males and six females (mean age of 13 years at surgery). The most common symptoms at presentation were headaches in 6 out of 15 (40 %), raised intracranial pressure in 3 out of 15 (20 %), and seizures in 3 out of 15 (20 %). Sole operated tumors were found in 12 out of 15 (80 %), whose location is as follows: parasagittal in 4 out of 12 (33.3 %), 2 in the convexity (16.6 %), 2 at the skull base (16.6 %), and 4 in other sites (33.3 %). Six children presented with radiation-induced (RT) meningiomas and five had evidence of neurofibromatosis type 2 (NF2). Three patients had multiple meningiomas (all of them had NF2). Simpson's grade I excision was achieved in 12 out of 15 (80 %). On histopathology, 11 out of 15 (73.3 %) were grade I and 4 out of 15 (26.6 %) were grade II (all of them atypical). Five tumors (33.3 %) recurred, four of which had RT or NF2. During the mean follow-up period of 5 years, 12 out of 15 (80 %) had a good outcome (GOS=5). Childhood meningiomas are uncommon lesions with a slight male predominance. Absence of large series with long follow-up precludes any definite conclusions on the clinical course and outcome of these tumors. Associated factors (such as RT and NF2), location, and extent of excision appear to be more important than histopathological grade in predicting outcome.

Bifrontal Meningioma Presenting as Postpartum Depression with Psychotic Features

The use of neuroimaging is of uncertain value in the routine evaluation of new-onset psychiatric disorders. We present the case of an apparent postpartum depression with psychosis in a woman with a history of childhood acute lymphoblastic leukemia (ALL) treated with central nervous system (CNS) radiation. Neuroimaging during an inpatient psychiatric hospitalization revealed a large bifrontal meningioma. Patients treated with CNS radiation for childhood cancer may be a subset of patients in whom neuroimaging is warranted in the setting of new-onset psychosis.

Surgical management of extracranial meningioma presenting in the parapharyngeal space in a pediatric patient

Abstract Extracranial meningiomas are reported to occur from 0.9% to 2% of cases. The presentation of this rare parapharyngeal space meningioma reflects the difficulty in diagnosing parapharyngeal space tumors especially in the pediatric population. Furthermore, the histopathological features of this meningioma offer a learning experience. We describe our multi disciplinary team approach to management and surgical techniques employed to treat this tumor.

Imaging Features of Extra Cranial Parapharyngeal Space Meningioma: Case Report

Parapharyngeal tumors are less common in clinical practice and are often difficult to diagnose upon clinical examination due to the anatomic complexity of the region. We report a rare case of extracranial parapharyngeal space meningioma presenting as a cervical mass with encasement of cranial nerves giving tram track appearance and features on various imaging modalities [Radiographs, Ultrasound, Computed tomography (CT) scan and Magnetic resonance imaging (MRI)].

Meningioma: review of the literature with emphasis on the approach to radiotherapy

Meningiomas are tumors that arise from arachnoid cap cells, which surround and adhere to the dura mater. Currently, meningiomas comprise 13–30% of primary intracranial tumors and are only less frequent than gliomas. In this article an overview of meningiomas is presented, with brief mention to their epidemiology, clinical presentation, histopathological and imaging features. The main therapies for meningiomas are also presented, focusing on radiation. In this article the authors conclude that the epidemiological, imaging and histopathological features and the clinical presentation of meningiomas are well-defined. Despite the need for randomized trials and larger studies with long median follow-up, radiotherapy can be used as an alternative treatment to surgery either as a first-line treatment or at its recurrence. Various conventional radiotherapy techniques can be employed for residual tumor or at recurrence.

Sphenoid ridge meningioma presenting as ischemia stroke

Sphenoid ridge meningioma presenting as ischemia stroke