Meningothelial Components Research Articles

Lymphoplasmacyte-Rich Meningioma or IgG4-Related Disease

Lymphoplasmacyte-rich meningioma (LP meningioma) is a rare form of grade 1 meningioma. It shows dense lymphoplasmacytic infiltrate, mimicking an inflammatory lesion. We present a case of Lymphoplasmacyte-rich (LP) meningioma in the left parasagittal region in a 47-year-old female. On histological examination, it showed dense lymphoplasmacytic infiltrate masking the meningothelial component. There was dense fibrosis and numerous IgG4-positive plasma cells (100-120/hpf), admixed with lymphocytes and few histiocytes. The meningothelial component was highlighted by epithelial membrane antigen (EMA) immunostain. The patient had normal serum IgG4 level. This case highlights the morphological overlap between LP meningioma and IgG4-related disease. The presence of fibrosis and increased IgG4-positive plasma cells as a major inflammatory component in LP meningioma, as demonstrated in the present case and some other previous studies raise suspicion of its association with IgG4-related disease. However, this hypothesis requires further detailed studies for confirmation.

Collision tumour of cerebellopontine angle in a patient with no neurofibromatosis criteria: a rare, peculiarand interesting case

The co-existence or concurrent occurrence of brain tumours having different histomorphological features, in the absence of neurofibromatosis central (NF2) or history of irradiation is very rare. Such co-existence of brain tumours with different histology are referred to as collision tumours, concomitant tumours or contiguous tumours. The patient had no history of Von Recklinghausen’s disease nor had any personal or family history of phacomatoses, but, however, he had history of undergoing near total resection of left-sided vestibular schwannoma one year backThe simultaneous occurrence of meningioma and schwannoma is highly uncommon in cerebellopontine angle with only few published cases of co-existing meningioma and schwannoma in patients with no history of neurofibromatosis or other such phacomatoses, albeit this phenomeno of co-existence of these tumours is associated with neurofibromatosis 2 or other phacomatoses. It is also proposed that reactive meningothelial hyperplasia adjacent to the main tumour could be responsible for the presence of meningothelial component within schwannoma

Le méningiome malin avec métaplasie adénocarcinomateuse : une entité rare à ne pas méconnaître

We report on a 51-year-old woman who presented with a cervical spinal cord tumor clinically suspected to be a metastasis. Histological examination revealed an anaplastic meningioma containing epithelial nests arranged in a gland-like pattern suggestive of adenocarcinoma. This component strongly expressed cytokeratins whereas the meningothelial component was vimentin--epithelial membrane antigen--and progesterone receptor-immunoreactive, suggesting either anaplastic meningioma with adenocarcinoma-like metaplasia, or adenocarcinoma metastasis in a meningioma, but the search for a primitive neoplasia including thoracic-abdominal-pelvic computed tomography and mammography was negative. Anaplastic meningiomas with adenocarcinoma-like metaplasia are uncommon lesions, 4 cases having been reported in the literature so far. Their immunohistochemical and chromosomal characteristics are similar to those observed in secretory meningiomas. When available, fluorescence in situ hybridization detects the same chromosomal alterations in the two components, confirming a common clonal origin. This observation demonstrates the necessity to perform the correct diagnosis of malignant meningioma with adenocarcinomatous metaplasia, whose prognosis and treatment radically differ from those of metastatic adenocarcinoma located in a meningioma.

Lymphoplasmacyte‐rich meningioma: A convexity mass with regional enhancement in the adjacent brain parenchyma

Lymphoplasmacyte-rich meningioma (LPM) is a rare, benign variant of meningioma, characterized by massive inflammatory cell infiltration and a variable proportion of meningothelial tumorous elements. Here we report the clinicopathological features of an LPM located at the right frontal convexity in a 37-year-old woman. The patient had suffered an initial generalized tonic-clonic seizure when she was 32 weeks pregnant. The lesion exhibited low intensity on T1-weighted MRI and high intensity on T2-weighted images, with surrounding parenchymal edema. The mass exhibited gadolinium enhancement with dural tail signs. Moreover, multiple foci of linear enhancement spreading through the sulci and into the nearby brain parenchyma were evident. At 1 month after parturition, en bloc removal of the mass, the attached dura mater and adjacent brain tissue was performed. Histologically, the mass located in the subdural space was composed of a mixture of B- and T-lymphocytes and plasma cells. Within the mass, multiple small lobules of meningothelial cells showing immunoreactivity for epithelial membrane antigen and vimentin were observed. The inflammatory cells had also infiltrated the subarachnoid and Virchow-Robin spaces, and the dura mater. The cerebral cortex showed ischemic changes, but no tumor cell invasion. On the basis of these histological features, the lesion appeared to be LPM with an inconspicuous meningothelial component and extensive inflammatory infiltration. This case appears to provide useful information on the pathogenesis of this variant.

Cervical Spinal Meningioma Mimicking Intramedullary Spinal Tumor

Case report. To report a very unusual spinal meningioma, mimicking an intramedullary spinal tumor. Spinal meningiomas, usually associated with signs and symptoms of cord or nerve root compression, are generally encountered in women aged over 40. Radiologic diagnosis is often established by their intradural extramedullary location on magnetic resonance images. A 60-year-old woman had a 6-month history of progressive weakness in her upper extremities, difficulty in walking, and cervical pain radiating through both arms. Neurologic examination revealed motor strength deficiency in all her extremities, with extensor reflexes, clonus, and bilateral hyper-reflexiveness. A sensory deficit was present all over her body. Magnetic resonance images revealed that the spinal cord appeared expanded with an ill-defined, homogeneously contrast-enhanced, lobulated, eccentric mass at the C1-C3 level. The patient was operated with a preliminary diagnosis of an intramedullary tumor. At surgery, the mass was found to be extramedullary, and gross total resection was performed. Histopathological examination revealed a meningioma characterized by the presence of fibrous and meningothelial components. The patient was able to ambulate with a cane, and extremity strength and sensation improved 2 months after surgery. Spinal meningiomas can mimic intramedullary tumors, and should be considered in differential diagnosis of intradural tumors with atypical appearance.

Intracranial collision tumor mimicking an octreotide-SPECT positive and FDG-PET negative meningioma

OBJECTIVE/IMPORTANCE: Cancer metastasis to a pre-existing intracranial tumor is rare, but several cases have been reported. We report an unusual case of a "collision tumor" consisting of a renal cell carcinoma metastasis to an intracranial meningioma. A 67-year old male with renal cell carcinoma had an asymptomatic right posterior frontal dural-based lesion identified on a screening CT scan. MRI characteristics of the tumor were consistent with meningioma. On octreotide-SPECT and F-18 fluorodeoxyglucose (FDG)-PET scans, the lesion showed octreotide uptake but did not accumulate FDG, both of which are consistent with a diagnosis of benign meningioma. One week later, he presented with a 1-day history of progressive left-sided weakness. The intracranial tumor was resected, and subacute subdural blood was found overlying a soft, reddish tumor. Microscopic examination was consistent with renal cell carcinoma with a minor portion consisting of meningioma. The meningothelial component was strongly immunoreactive to vimentin and weakly reactive to epithelial membrane antigens. Neither area reacted with glucose transporter-1 (GLUT-1), correlating with low FDG-PET uptake. Collision tumor involving metastatic renal cell carcinoma to an intracranial meningioma is a rare occurrence. Diagnosis by non-invasive means, with use of a combination of octreotide-SPECT and FDG-PET may not accurately reflect the malignant component of such a collision tumor. In this case, the collision tumor also demonstrated a propensity to undergo spontaneous hemorrhage. A high degree of suspicion of intracranial metastasis should be maintained for patients who have known systemic cancer and are found incidentally to have a dural-based mass lesion.

Primary meningeal sarcomas with leiomyoblastic differentiation: a proposal for a new subtype of primary meningeal sarcomas.

Two cases of primary meningeal sarcoma with leiomyoblastic differentiation are presented. In case no. 1, the tumor showed anaplastic spindle cell tumor components intermingled with anaplastic meningothelial components. Meningothelial tumor cells gradually became transformed into spindle tumor cells. Spindle tumor cells reacted with antisera to muscle actin (HHF-35) and alpha-smooth muscle actin. However, unchanged meningothelial tumor cells did not react with the antisera to HHF-35 and alpha-smooth muscle actin. Electron microscopy showed condensations of cytoplasmic fibers and pinocytotic vesicles in spindle tumor cells similar to those seen in smooth muscle cells. In case no. 2, the tumor cells consisted predominantly of sheets of round or polygonal cells as seen in an epithelioid leiomyosarcoma. The neoplastic cells had frequent nuclear inclusions, such as those seen in meningiomas. Immunohistochemically, the tumor cells reacted with antisera to desmin and to HHF-35. Electron microscopy showed a basal lamina around the cytoplasm of tumor cells. Intranuclear inclusions with various cytoplasmic organelles were frequently observed in the tumor cells, as in meningiomas. Interdigitating cytoplasmic processes and intercellular junctional complexes, however, were not found in the tumor cells. Two possible hypotheses explain the occurrence of leiomyoblastic characteristics of these cases. In case no. 1, leiomyoblastic cells originated from meningothelial cells with the advancement of meningothelial anaplasia. In case no. 2, pluripotential mesenchymal cells in the meninges differentiated into meningothelial and smooth-muscle cell lines at the time of tumor growth. With consideration of previous publications on primary meningeal sarcoma, these cases are the first reported primary meningeal sarcoma with leiomyoblastic and meningothelial differentiation.

Immunohistochemical study of glutathione S-transferase-pi in meningiomas.

Immunostaining for glutathione S-transferase-pi was investigated in various subtypes of meningioma for the purpose of biological characterization. Specimens included five normal meninges and 25 meningiomas (10 meningothelial type, 6 fibrous type, 5 transitional type, 3 microcystic type, and 1 secretory type). In the meningothelial type, most cells showed strongly positive staining. In the fibrous type, all cells were negative. In the transitional type, only the meningothelial components were positive. In the microcystic type, meningothelial cell clusters and arachnoid trabecular cells were positive. In the secretory type, the meningothelial components and the pseudopsammoma-body-producing cells were positive. These results suggest that the meningothelial type and the fibrous type have a different basis of development and biological features. The results also suggest that arachnoid trabecular cells and meningothelial cells share the same origin, and that the arachnoid trabecular cells serve as supportive cells and as cells which detoxify harmful substances in the subarachnoid space. The pseudopsammoma-body-producing cells in the secretory type represent the outcome of epithelial differentiation of meningothelial cells with their biological character being preserved.

Secretory meningioma with elevated serum carcinoembryonic antigen level

We recently encountered a 68-year-old woman with right sphenoid wing meningioma of the secretory type accompanied by an elevated serum carcinoembryonic antigen level. This case was neuroradiologically characterized by marked brain edema. Histologically, the lesion was rated as having meningothelial components and was rich in blood vessels and pseudopsammoma bodies. Carcinoembryonic antigen, epithelial membrane antigen, keratin, and cytokeratin were immunohistochemically detected in the pseudopsammoma bodies and the cells producing these bodies.

Neurotensin high affinity binding sites and endopeptidase 24.11 are present respectively in the meningothelial and in the fibroblastic components of human meningiomas

The presence of neurotensin receptors and endopeptidase 24.11 (E-24.11) in 16 human meningioma specimens, obtained at surgery, was assessed by measuring the binding of 125I-[tyrosyl 3]neurotensin(1–13) ( 125I-NT) and the inhibitor 3H-N((2RS)-3-hydroxyaminocarbonyl-2-benzyl-1-oxopropyl)glycine ( 3H-HACBO-Gly), for the receptor and enzyme, respectively. E-24.11 activity was also measured. Autoradiography, on the 16 meningiomas, showed that specific 125I-NT labeling (nonspecific labeling was assessed in the presence of excess NT) was exclusively located in the meningothelial regions. In contrast, specific 3H-HACBO-Gly labeling (nonspecific labeling was assessed in the presence of an excess of the E-24.11 inhibitor thiorphan) was exclusively found in fibroblastic regions. No specific labeling of either ligand was found on collagen or blood vessels. In vitro binding assays were performed on membranes of 10 of the 16 meningiomas. In the 4 meningiomas rich in meningothelial cells, 125I-NT specifically bound to one population of sites with B max ranging from 57 to 405 fmol/mg protein and K d around 0.3 nM. These sites share common properties with the brain NT receptor, since the carboxy terminal acetyl NT(8–13) fragment bound to the same sites but with a higher affinity. The carboxy terminal analogue of NT, neuromedin N, also bound to the same sites with a 10-fold lower affinity and the sites were bradykinin and levocabastine insensitive. In the 4 meningiomas rich in fibroblastic cells, 3H-HACBO-Gly specifically bound to one population of sites with B max ranging from 251 to 739 fmol/mg protein and K d around 2.8 nM. In agreement with the binding data, E-24.11 activity, expressed in fmol 3H-[D-Ala 2]leucine enkephalin degraded/min/mg protein, ranged from 102 to 281 and was specifically inhibited by the E-24.11 inhibitor retrothiorphan R, indicating the presence of biologically active E-24.11 in the meningiomas. In the 2 meningiomas poor in tumoral cells and rich in collagen bundles, no specific binding was found with either ligand. The presence, in abundance, of NT receptors and E-24.11 on the meningothelial components and on the fibroblastic components of the meningiomas, respectively, is a new indicator of the duality of the arachnoid cell from which these tumors arise. These markers may be useful for the classification of the histologic phenotypes of the meningiomas, and for clinical diagnosis of small meningiomas using SPECT and for the treatment of surgically inaccessible meningiomas.

Hamartoma of the Scalp with Ectopic Meningothelial Elements

Five cases of a distinctive benign soft tissue lesion of the scalp in patients ranging from 4 months to 40 years of age are described. Clinically, the lesions appeared as solitary, subcutaneous nodules suggestive of a cystic vascular malformation or other benign condition. Histologically, however, the lesions were characterized by a monotonous, pseudoinfiltrative proliferation of cuboidal epithelioid cells arranged in clusters within the dermis and subcutaneous tissue in intimate association with vessels, adipose tissue, and other connective tissue elements. A prominent feature in all cases was the presence of areas simulating freely anastomosing vascular channels lined by round to spindle-shaped, slightly hyperchromatic epithelioid cells reminiscent of angiosarcoma. Immunohistochemically, these cells were negative for factor VIII-related antigen and Ulex europaeus lectin but were strongly positive with vimentin and epithelial membrane antigen antibodies, this latter being in keeping with the immunohistochemical profile of meningothelial cells. The meningothelial nature of these cells was supported by the electron microscopic demonstration in one case of cells with complex, interdigitating cytoplasmic processes that were joined by scattered cell junctions and contained abundant intracytoplasmic intermediate filaments. The intimate admixture of meningothelial elements with haphazardly arranged connective tissue elements sets these lesions apart from cutaneous meningiomas and warrants their designation as hamartomas with an ectopic meningothelial component.