Primary Extracranial Meningioma Research Articles

Palato-Antral Involvement of a Primary Extracranial Sinonasal Meningioma

Primary extracranial sinonasal meningiomas are one of the rarest tumours involving the head and neck region. Very few reports exist with additional involvement of the palato-antral region. This paper describes a case of primary extracranial sinonasal meningioma with palatal involvement and the management of the same. The patient was taken up for surgical excision via intra-oral and endoscopic approaches. Postoperative healing was uneventful with no recurrence noted over 2 years. A palatal obturator was used for rehabilitation. The diagnosis of this pathology needs additional immunohistochemistry testing for confirmation and treatment entails complete surgical excision which assures no recurrence or delayed presentation of residual disease in follow-up.
 Keywords: primary extra cranial meningioma; sinonasal; maxilla ; palate.

Cytological features of ectopic nasal meningioma. Report of a case diagnosed using FNAC.

We describe a case of primary extracranial meningioma of the nasal cavity. FNAC showed loose clusters of epithelioid cells with splayed cytoplasm, focal whorling, and occasional psammoma bodies suggestive of meningioma. This case highlights the importance of FNAC in diagnosing meningioma when encountering similar morphology at a rare location.

Primary Extracranial Meningioma Mimicking Musculoskeletal Malignancy: A Case Report

Primary extracranial meningioma (PEM) is a very rare disease that arises outside the dural covering of the brain or spinal cord. It is essentially an extracranial tumor and can mimic musculoskeletal malignancies. A 74-year-old woman presented with a mass on the right frontotemporal scalp that had been present for 2 years. Magnetic resonance imaging revealed osteolysis in the right frontal, temporal, and sphenoid bone and involvement of the right temporalis muscle, mimicking a musculoskeletal malignancy. The mass was resected, and the confirmed histological diagnosis was primary extracranial meningothelial meningioma (World Health Organization grade I). The patient was discharged without complications, and no evidence of tumor recurrence was apparent 48 months after surgery. This case supports complete surgical excision without adjuvant therapy as the modality of choice for PEM since meningioma is radioresistant and recurrence is very rare after adequate surgical resection.

Primary Extracranial Meningiomas of the Head and Neck.

Meningiomas represent the most common benign histological tumor of the central nervous system. Usually, meningiomas are intracranial, showing a typical dural tail sign on brain MRI with Gadolinium, but occasionally they can infiltrate the skull or be sited extracranially. We present a systematic review of the literature on extracranial meningiomas of the head and neck, along with an emblematic case of primary extracranial meningioma (PEM), which provides further insights into PEM management. A literature search according to the PRISMA statement was conducted from 1979 to June 2021 using PubMed, Web of Science, Google Scholar, and Scopus databases, searching for relevant Mesh terms (primary extracranial meningioma) AND (head OR neck). Data for all patients were recorded when available, including age, sex, localization, histological grading, treatment, possible recurrence, and outcome. A total of 83 published studies were identified through PubMed, Google Scholar, and Scopus databases, together with additional references list searches from 1979 to date. A total of 49 papers were excluded, and 34 manuscripts were considered for this systematic review, including 213 patients. We also reported a case of a 45-year-old male with an extracranial neck psammomatous meningioma with sizes of 4 cm × 3 cm × 2 cm. Furthermore, whole-body 68Ga-DOTATOC PET/CT was performed, excluding tumor spread to other areas. Surgical resection of the tumor was accomplished, as well as skin flap reconstruction, obtaining radical removal and satisfying wound healing. PEMs could suggest an infiltrative and aggressive behavior, which has never found a histopathological correlation with a malignancy (low Ki-67, <5%). Whole-body 68Ga-DOTATOC PET/CT should be considered in the patient’s global assessment. Surgical removal is a resolutive treatment, and the examination of frozen sections can confirm the benignity of the lesion, reducing the extension of the removal of healthy tissue surrounding the tumor.

A Case of Primary Extracranial Meningioma in the Maxillary Sinus

Meningioma is one of the most common tumors of the central nervous system. However, primary extra cranial meningioma is rare as it consists 1%-2% of meningioma. It is very rare in paranasal sinus and accounts for about 0.1% of the paranasal sinus tumor. The treatment of choice is complete surgical excision of the tumor. Herein, with a review of the literature, we report a rare case of primary extra cranial meningioma in a 38-year-old male.

Primary extracranial meningioma: A case report

Primary extracranial meningioma: A case report

Sinonasal Tract Meningioma

A 63-year old Filipino female presented with epistaxis of undisclosed duration. Examination showed a vascular, pulsating, rubbery intranasal mass involving both nasal cavities. The clinical impression was that of a nasal hemangioma. She underwent excision of the tumor and the specimen was sent for histopathologic evaluation.&#x0D; &#x0D; The specimen consisted of several tan-brown irregular tissue fragments with an aggregate diameter of 2 cm. Microscopic examination showed a cellular spindle cell tumor underneath the respiratory mucosa. (Figure 1) The tumor cells formed a syncytial pattern arranged in whorls that were separated by thin fibrovascular bands. (Figure 2) The cells had round to oval nuclei with nuclear clearing and moderate amount of syncytial cytoplasm compatible with a meningothelial derivation. (Figure 3) There was absence of nuclear atypia, significant mitotic activity, and necrosis. Immunohistochemistry studies showed positivity for Epithelial Membrane Antigen (EMA) and Progesterone Receptors (PR), and absence of reaction for Smooth Muscle Actin (SMA) and CD34. (Figure 4) Our diagnosis was sinonasal tract meningioma.&#x0D; &#x0D; Primary extracranial meningioma of the sinonasal cavity is rare and thus secondary extension from a primary intracranial tumor should be ruled out. It involves a wide age range with no striking gender predilection.1,2 Most common symptoms include nasal obstruction, epistaxis, exophthalmos, and a mass. Etiogenesis is not completely established and is postulated to arise from meningocytes that are entrapped during closure of midline structures, very similar to the development of meningoceles.3&#x0D; &#x0D; Histopathologic examination discloses a spindle cell tumor arranged predominantly in whorls composed of cells showing meningothelial differentiation. Most are histologically grade 1 tumors. Grade 2 and 3 sinonasal tract meningiomas are rare.4 Histologic differential diagnoses include a glomangiopericytoma, leiomyosarcoma, and a solitary fibrous tumor/hemangiopericytoma. Close histologic evaluation with appropriate immunohistochemistry studies point to the correct diagnosis. Meningioma shows strong diffuse positivity with EMA and PR, and is usually negative for other immunohistochemistry markers such as muscle actins (for glomangiopericytoma and leiomyosarcoma), and CD34 (for solitary fibrous tumor/hemangiopericytoma).1,3 A diagnosis of primary sinonasal meningioma should not be made if an intracranial mass is identified.4&#x0D; &#x0D; Sinonasal meningiomas are benign tumors with no documented distant metastases.1,2 Although recurrences occur in about 30% (mostly due to incomplete excision), metastasis and malignant transformation has not been reported.4&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Primary extracranial nasopharyngeal meningioma in a dog.

An 8-year-old Labrador Retriever was presented for inspiratory efforts with stertor. A rhinoscopy and a magnetic resonance imaging scan were performed and revealed a naso-pharyngeal mass. The mass was identified in the nasopharynx without meningeal extension. This mass was both T1- and T2-hyperintense, compared to normal brain parenchyma without significant postcontrast enhancement. The mass was surgically removed and the histologic diagnosis was a mesenchymal tumor. Immunohistochemistry with antibodies was conducted and consistent with an extracranial meningioma. To the authors' knowledge, this is the first case report documenting a primary extracranial nasopharyngeal meningioma in a dog.

Primary extracranial meningioma presenting as a forehead mass.

Meningioma originates from arachnoid cap cells and is the second most common intracranial tumor; however, it can also be found in an extracranial location. A very rare primary extracranial meningioma without the presence of an intracranial component has also been reported. Primary extracranial meningiomas have been found in the skin, scalp, middle ear, and nasal cavity. A computerized tomography or magnetic resonance imaging scan is necessary to determine the presence or absence of an intracranial meningioma, and a biopsy is essential for diagnosis. We report a case of primary extracranial meningioma located in the forehead skin of a 51-year-old male.

Primary Extracranial Meningioma: A Rare Location

Meningiomas are benign extraaxial tumors of the central nervous system (CNS). Extracranial meningiomas are extremely rare (2%) and can develop as a direct extension from a primary intracranial meningioma or as true primary extracranial meningioma originating from ectopic arachnoid cells. Only eight cases of primary meningioma in the jaw have been reported to date. Extracranial meningiomas are frequently misdiagnosed, resulting in inappropriate clinical management. The aim of this article was to describe the case of a man with an asymptomatic swelling in the right retromolar area over a period of 2months. Cone beam computed tomography was performed to determine the extension and involvement of the adjacent structures. Histopathological findings and immunohistochemical analysis aided in the diagnosis of primary extracranial meningioma in the mandible and several aspects of this unusual neoplasm are reviewed. The treatment of choice was a partial resection of the mandible and reconstruction with autogenous iliac tricortical bone. Five years after surgery, the patient remains free of disease.

Primary Extracranial Meningioma: The Royal Pearl Experience.

The extracranial occurrence of meningioma, which is a tumour of the central nervous system, is rare. Two cases of primary extracranial meningioma of the psammomatous variant are reported here. Both cases were managed successfully by endoscopic endonasal approach. Literature has been reviewed and their clinicopathological features are described.

Primary Calvarial Meningioma

Introduction: Although meningioma is the most common non-glial tumor of intracranial space, primary extra cranial meningioma is rare and comprises less than 2% of all meningioma. Case Presentation: We report a case of slowly progressing extracranial meningioma that was presented in a young adult woman. The tumor was asymptomatic but large enough to cause cosmetic discomfort. Patient underwent successful and complete surgical resection of her tumor and eventually fully recovered. Conclusions: Primary Extracranial Meningiomas (PEMs) without intracranial origin are very rare and because of their slow growing nature are initially managed by primary care physicians.

Primary extracranial sino-nasal tract meningioma in a child: A rare lesion with diagnostic pitfall

Extracranial meningiomas are rare in children and are frequently misdiagnosed. We report a case of primary extracranial meningioma of the nasal cavity in a 2-year-old child who presented with a recurrent, gradually increasing swelling over the nasal bridge. Computed tomography scan revealed a mass protruding through a rent in the nasal bridge. Fine-needle aspiration cytology showed features suggestive of a benign mesenchymal neoplasm. Histologically, a diagnosis of meningothelial meningioma was made which was confirmed by immunohistochemistry. The neoplastic cells were strongly positive for vimentin and epithelial membrane antigen, weakly positive for S-100 and negative for neuron specific enolase, and glial fibrillary acidic protein. The case is documented for the rarity of its occurrence and varied prognosis.

Primary Extracranial Meningioma of the Sphenoid Sinus: A Hidden Menace

DOI: http://dx.doi.org/10.3126/njenthns.v3i2.10160 Nepalese Journal of Head and Neck Surgery Vol.3(2) 2012: 21-22

Extracranial spheno-ethmoidal sinus meningioma: case report

Extracranial meningiomas of the paranasal sinus are the rare tumors of unclear etiology. We report a case of primary extracranial meningioma arising from the roof of the sphenoid sinus. A 60-year-old female presented with 5-month history of right visual disturbance. Imaging studies showed a mass in the sphenoid sinus extending into posterior ethmoid sinus. The tumor was resected completely including the affected bone of anterior cranial base via the endonasal endoscopic approach. Pathological diagnosis was meningothelial meningioma. On the basis of imaging features and intraoperative findings, the tumor was diagnosed as primary extracranial meningioma of the sphenoethmoid sinus. Recent advancement of skull base surgery technique allows removing this rare tumor completely and safely without complications such as cerebrospinal fluid leakage. This is the first report of the management of spheno-ethmoid sinus meningioma with the skull base surgery technique.

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.

Primary Extracranial Meningioma of Paranasal Sinuses

Meningioma is the most common nonglial intracranial neoplasm, arising from meningocytes (arachnoid cap cells) of arachnoid granulation tissue and constitutes 15-20% of all intracranial tumors. Approximately 6-17% of all meningiomas can be found in extracranial or extra spinal sites. The head and neck is the most frequent location of extraneuraxial meningiomas, commonly seen as an extension of primary intracranial tumor (secondary extracranial meningioma). Less than 2% of all meningiomas arise at a primary ectopic site (primary extracranial meningioma). Meningioma of nose and paranasal sinuses is a very rare tumor. The overall incidence is about 0.1% of all tumors in the nose and sinuses. To date, very few cases of this primary extracranial meningioma of paranasal sinuses have been reported. In this report we are going to present three rare cases of primary extracranial meningioma of paranasal sinuses operated in our department over a period of 22years (1986-2008).

Primary extra-cranial meningioma in the right submandibular region of an 18-year-old woman: a case report

IntroductionExtra-cranial meningioma or ectopic meningioma is a rare tumor. This tumor has been reported in various anatomic sites in the head and neck, mediastinum, skin and soft tissues. We report a rare case of ectopic meningioma in the submandibular region detected by using fine-needle aspiration cytology, histopathology and immunohistochemistry. This case represents another unusual site for extra-cranial meningioma, which prompted us to report it.Case presentationAn 18-year-old Dravidian woman presented with swelling in the right submandibular region. The computed tomographic scan findings were suggestive of a neoplastic mass lesion in the right submandibular region. Fine-needle aspiration cytology led to the differential diagnosis of a monomorphic adenoma of a salivary gland or an ectopic meningioma. The patient underwent excision of the submandibular gland and tumor. The histological examination and immunohistochemistry studies confirmed that the lesion was an extra-cranial meningioma. At her two-year follow-up examination, there was no recurrence of the tumor.ConclusionOur experience with this case indicates that, although rare, meningioma should be entertained in the differential diagnosis of a mass lesion in the head and neck region.

Primary extracranial meningioma of the maxillary sinus presenting as buccal swelling

Meningiomas are usually benign tumors that originate from the meningothelial arachnoidal cells that are normally found in arachnoid villi of the meninges surrounding the brain and spinal cord. Rarely, these tumors are found extracranially, primarily in the head and neck region. A 14-year-old boy presented with a lesion in the left premolar area of his maxilla that appeared to be a buccal swelling. Computed tomography on bone window setting demonstrated an expansile mass with high density area in the left maxillary sinus. The anterior wall of the maxillary sinus was thinned by the expanding mass. Magnetic resonance imaging revealed the well-circumscribed lesion to be homogeneously and relatively hypointense on T2-weighted imaging. The lesion was weakly enhanced by gadolinium. Imaging study of the lesion revealed a mass with no intracranial extension and no metastasis nests. The mass was removed surgically, and pathological studies showed a fibrous meningioma. Five years have elapsed since this surgical excision, with no evidence of recurrence. Primary meningiomas of the paranasal sinuses may arise from heterotopic meningeal tissues displaced during closure of midline structures during fetal development. Symptoms include progressive exophthalmos, nasal obstruction, and epistaxis. No cases in the maxillary sinus presenting as buccal swelling have been described.

Primary retroperitoneal meningioma: A case report

Primary extracranial meningiomas are rare disease entities, occurring primarily in the head and neck. We herein present a very rare case of primary extracranial meningioma of the retroperitoneum, observed in a 56-year-old man who presented with a retroperitoneal mass measuring 11 cm in its greatest dimension. Histological examination revealed sheets of spindle cells with frequent whorling patterns. The neoplastic cells had abundant light eosinophilic cytoplasm with minimal mitosis or cellular atypism. Immunohistochemical analysis demonstrated diffuse and strong positivity for vimentin and epithelial membrane antigen. Ultrastructural findings revealed abundant intermediate filaments, complex interdigitating cellular processes, and desmosome-like intercellular junctions, all of which are characteristic ultrastructural features of meningiomas. The patient was free of recurrence or metastasis 11 months after surgery. To the best of our knowledge, this is only the second reported case of primary retroperitoneal meningioma.