Primary Extradural Meningiomas Research Articles

Association of imaging classification and histopathological grading in primary intraosseous meningioma of the skull

BackgroundPrimary intraosseous meningioma of the skull (PIMS) is a rare type of primary extradural meningioma (PEM) involving cranial bone. The existing literature strongly suggest the importance of radiological feacures in pathological diagnosis of PIMS. Thereby, the aim of this study is to investigate the association between imaging classification and histopathological grading in PIMS. MethodsIn this retrospective study, we retrospectively analyzed the computed tomography scan/magnetic resonance imaging and pathological data pertaining to patients with pathologically proven PIMS. The association between radiological features, imaging classification, and histopathological grading was analyzed using logistic regression analysis. ResultsIn this study, data of 25 patients with PIMS were assessed. The univariate logistic regression analysis results showed significant correlation between histopathological grading and imaging classification (OR: 22.5; 95% CI: 2.552–198.378; p = 0.005), intra- and extracalvarial extension (OR: 7.2; 95% CI: 1.066–48.639; p = 0.043), and tumor margin (OR: 7.19; 95% CI: 1.06–47.61; p = 0.043). According to the results of multivariate logistic regression analysis, imaging classification was the strongest independent risk factor for high-grade PIMS, and the risk of aggressiveness of osteoblastic type of PIMS was 16.664 times higher than that of osteolytic type of PIMS (OR: 16.664; 95% CI: 1.15–241.508; p = 0.039). ConclusionsImaging classification is an independent risk factor for high-grade PIMS.

Primary Intraosseous Osteolytic Meningioma with Aggressive Clinical Behaviour: Clinico-Pathologic Correlation and Proposed New Clinical Classification.

(1) Introduction: Primary intraosseous osteolytic meningiomas (PIOM) are non-dural-based tumors predominantly presenting an osteolytic component with or without hyperostotic reactions. They are a subset of primary extradural meningiomas (PEM). In this study, we present a peculiar case with a systematic literature review and propose a new classification considering the limitations of previous classification systems. (2) Materials and Methods: Using a systematic search protocol in Google Scholar, PubMed, and Scopus databases, we extracted all case studies on PIOM published from inception to December 2020. A 46-year-old female patient form Dhaka, Bangladesh, was also described. The search protocol was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. (3) Results: Here, we present a 46-year-old female patient with PIOM who successfully underwent bifrontal craniotomy and gross total removal (GTR) of the tumor. At 6-month follow-up, no tumor recurrence was shown. Including our new case, 55 total cases from 47 articles were included in the analysis. PIOMs were in closer frequency among males (56.4%) and females (43.6%). The most common tumor location was the frontal and parietal calvarium, most commonly in the frontal bone (29.1%). Surgical resection was the predominant modality of treatment (87.3%); only 1.8% of patients were treated with radiotherapy, and 5.4% received a combination of surgery and radiotherapy. Gross total resection (GTR) was achieved in 80% of cases. Extracranial extension was reported in 41.8% of cases, dural invasion in 47.3%, and recurrence in 7.3%. Whole-body 68 Ga-DOTATOC PET/CT has also been reported as a useful tool both for differential diagnosis, radiotherapy contouring, and follow-up. Current treatments such as hydroxyurea and bevacizumab have variable success rates. We have also suggested a new classification which would provide a simple common ground for further research in this field. (4) Conclusions: Surgical resection, especially GTR, is the treatment of choice for PIOM, with a high GTR rate and low risk of complications and mortality. More research is needed on the differential diagnosis and specific treatment of PIOM.

Incidental Diagnosis of an Arachnoid Granulation on Ga-68 DOTATATE PET/MRI.

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Meningeoma intraoseo primario. Reporte de caso y revisión de literatura

Los Meningiomas que se desarrollan en localizaciones ectópicas representan solo del 1 al 2% del total de los Meningiomas.El término Meningioma Extradural Primario (MEP) refleja que el origen de estos tumores es aislado de la cobertura dural decualquier parte del cerebro y la medula espinal. Meningioma Intraóseo Primario (MIoP) describe un subtipo de MEP que surge en el hueso y representa aproximadamente dos terceras partes de la totalidad de todos los Meningiomas Extradurales. La presentación clínica de las lesiones y los diagnósticos diferenciales dependen primariamente de la localización de la lesión, tamaño y estructuras vecinas. La apariencia radiologica de los Meningiomas intraóseos depende en gran medida de su localización y los efectos que producen al invadir el hueso. Los tumores son típicamente osteoblasticos u osteoliticos. Los Meningiomas intraóseos son indistinguibles Histologicamente e Inmunofenotipicamente de su contraparte los Meningiomas Intracraneales. Cuando la escisión quirúrgica es el tratamiento de elección la potencial curación del paciente es posible.

Malignant primary intraosseous meningioma in a pediatric patient: A case report and review

Abstract Introduction This is the first case of a malignant, pediatric PIOM reported in the United States. Primary extradural meningiomas (PEM) arise in locations other than dura, outside the intracranial compartment. Primary Intraosseous Meningiomas (PIOMs) are a rare subset of PEM that arise in bone. Case report A 16 year old female, neurologically intact, mildly tender swelling over her right forehead that increased in size, accompanied by headaches and dizziness. Imaging demonstrated a lesion infiltrating the frontal calvarium and the adjacent intracranial and extracranial soft tissues. Surgical resection was performed. Pathology supported the diagnosis of anaplastic meningioma (WHO grade III). Discussion PIOMs are a rare subset arising in bone. In an extensive review, less than 150 cases of PIOMs were found. It likely originates from entrapment of arachnoid cap cells, congenitally or after development. Treatment is similar to intradural meningiomas, namely a potentially curative resection. Resection and cranioplasty should be performed simultaneously. Adjuvant radiation, chemotherapy and bisphosphonates are recommended.

Evidence for ancient meningiomas and a probable case from Medieval Tarbat, Scotland

We report the case of a probable meningioma in a cranium excavated from the Medieval site of Portmahomack on the Tarbat Peninsula in Scotland (Carver, 2008). Stratigraphic evidence enabled dating of the remains to a post-Pictish and pre-Reformation date. Meningiomas usually arise from the arachnoid membrane of the meninges (Yamazaki et al., 2001) and now represent approximately 20% of all primary intracranial tumours (Yener et al., 2009). They can result in hyperostosis of adjacent bone, osteolytic reactions, or both. We review the evidence for ancient meningiomas and describe a differential diagnosis of the pathology from the Tarbat cranium, including vascular and osteoid lesions, intracerebral malignancies, metastases and other benign lesions. The cranium that we present is from an adult male, and has a frontoparietal lesion approximately 3cm in diameter, which is characterised by bone growth and remodelling of the outer table, and endocranial bone destruction. Supporting photographic and radiological evidence is presented. We conclude that a diagnosis of meningioma is most likely in this case, and may represent the rarer primary extradural meningioma.

Primary intraosseous atypical inflammatory meningioma presenting as a lytic skull lesion: Case report with review of literature

Primary extradural meningiomas of the skull comprise 1% of all meningiomas, and lytic skull meningiomas are still rarer and are said to be more aggressive. We present a case of 38-year-old male with an extradural tumor which on histopathological examination showed features of inflammatory atypical meningioma (WHO Grade II). The intense inflammatory nature of osteolytic primary intraosseous meningioma has not been reported before. This entity deserves special mention because of the need for adjuvant therapy and proper follow-up.

Malignant Primary Extradural Meningioma in Elderly Patients: Report of Two Cases and Literature Review

Summary Primary extradural meningioma, also known as ectopic meningioma, is uncommon and represents ∼2% of all meningiomas. Malignant primary extradural meningioma is even more rare. The rarity of cases means the condition is not readily suspected or diagnosed. In this report, we present one case of primary extradural meningioma in elderly patients who presented with a scalp nodule and another highly suspected case. Both patients underwent surgical resection of the tumors. Histological study and immunostaining confirmed the diagnosis. We also conducted a literature review regarding similar cases. Surgical resection with a wide margin remains the first choice of treatment.

Primary Extradural Meningioma Presenting as a Neck Mass

Background: Primary extradural meningiomas (PEMs) are rare, particularly those involving the paraspinal cervical area, so little is known about them.

Primary Intraosseous Osteolytic Meningioma of the Skull Mimicking Scalp Mass: A Case Report and Review of Literature.

Primary extradural meningioma is about 1-2% of all meningiomas. Primary intraosseous meningioma is a rare form of intra-bone tumors that account for approximately 67% of extradural meningiomas. We report a primary intraosseous meningioma of a 69-year-old man who had headaches and a mass on right parietal scalp for the past few months. Remarkably, the brain tissue within the osteolytic cavity of the skull was normal in computed tomography and magnetic resonance images. Resection, duraplasty, and cranioplasty were performed. The patient's symptoms disappeared after surgery, and the histological diagnosis was an osseous meningothelial meningioma (World Health Organization grade I).

Clinical characteristics of primary extradural meningiomas in head

To explore the clinical characteristics, efficacy and prognosis of primary extradural meningiomas (PEMs) in head. A total of 19 treated surgically case of PEMs at Qilu Hospital, Shandong University between May 1994 and December 2012 were analyzed retrospectively with respects to their demographic features, presenting symptoms & duration, tumor location & type, imaging features, surgical results, pathological grade, histological subtype and follow-up outcomes. PEMs in head accounted for 1.2% of all meningiomas in this group. The male-to-female ratio was 1: 0.7. The mean age was 36.6 years with a bimodal distribution of age. The common presenting symptoms included nasal obstruction and a painless and gradually expanding mass in the region of lesion. The average duration of symptom was 3.07 years. The skull convexities, paranasal sinuses and nasal cavity, orbit and epidural space were common tumor sites. The most common type was typeII. The rate of total tumor removal was 100%. And no perioperative mortality occurred in this series. Benign and atypical meningiomas accounted for 94.7% and 6.3% respectively. Meningothelial and psammomatous meningiomas were common histopathological subtypes. There was one case of tumoral recurrence. And no mortality was reported during a mean follow-up period of 2.43 (0.25-8.5) years. PEMs in head have some marked clinical characteristics compared with primary intradural meningiomas. Total tumor removal together with a wide excision of all involved tissue followed by the reconstruction of tissue defects is the best surgical option. The prognosis is excellent in most cases after complete resection.

WITHDRAWN: A rare case of primary intraosseous calvarial osteoblastic meningioma of the frontal bone in a young child

Meningioma is a common intracranial neoplasm, accounting for 15–20% of all brain tumours. The “Primary Extradural Meningioma (PEM)” is an uncommon manifestation and a rare separate subset which arises outside the intracranial compartment, accounting for just 1–2% of all meningiomas. Primary calvarial intraosseous meningiomas comprise two thirds of these extradural meningiomas. They are usually seen in the 4th or 5th decades of life and have a predilection for females. We present a rare case of a very large Primary osteoblastic intradiploic calvarial meningioma in a young 11 year old male child, with a clinical and radiographic appearance simulating an Osteoma or Fibrous dysplasia. The findings on Radiographs, Computed Tomographic (CT) scans, Magnetic Resonance Imaging (MRI), the histological features and surgical treatment of this rare lesion are described.

Primary extradural meningioma arising from the calvarium

Meningiomas are the most common intracranial tumours. Meningiomas arising at other locations are termed primary extradural meningiomas (EDM) and are rare. Here we report a case of EDM arising from the calvarium – a primary calvarial meningioma (PCM).

Hyperplastic Intradiploic Meningothelial Tissue in the Orbital Roof Mimicking Metastatic Disease

Osteolytic lesions are highly suggestive of metastatic disease or in rare instances may result from primary extradural meningiomas. Herein, we describe a rare case of a patient who presented with a large area of osteolysis on the right orbital roof. An excisional biopsy revealed that the lesion was associated with the presence of hyperplastic intra-osseous meningothelial tissue. To our best knowledge, this is the first evidence that ectopic nonneoplastic meningothelial cells may induce osteolysis on the orbital walls.

Primary Intraosseus Meningioma Diagnosed by Fine Needle Aspiration Cytology

Primary extradural meningiomas presenting as scalp swelling is uncommon. Their diagnosis by fine needle aspiration is rare as majority of the lesions are hyperostotic. Primary intraosseus meningiomas involving the skull constitute only about 2% of meningiomas and are often mistaken for other primary or secondary bone tumors. The authors report a case of primary calvarial meningioma involving the parietal bone of a 52-year-old male diagnosed by fine needle aspiration cytology.

71‐YEAR‐OLD FEMALE WITH RIGHT EYE PROPTOSIS

Meningiomas that arise outside the cranial vault without a dural connection comprise about 1–2% of all meningiomas and are referred to as primary extradural meningiomas (PEMs), intraosseous type 1. When these tumors occur within bone, they may be initially misinterpreted radiologically as a primary bone lesion.We report the case of a 71-year-old woman found to have a right lateral orbital wall mass without dural involvement. Pathology confirmed a PEM and we review the clinical, radiologic, and pathologic features of this case.

Treatment recommendations for primary extradural meningiomas

Primary extradural meningiomas (PEMs) represent about 2% of all meningiomas and are often encountered by non-neurosurgeons. These lesions typically present as enlarging, painless, benign masses that can be surgically cured. Imaging is critical for defining involvement of adjacent structures; however, diagnosis depends on classic histologic patterns. Treatment for benign PEMs (WHO I) consists of resection with wide margins, whereas adjuvant therapy after resection of atypical (WHO II) or malignant (WHO III) PEMs should be considered. By using the collective experience from our comprehensive cancer center, including neuro-oncologists, neuroradiologists, and neurosurgeons, in addition to a complete literature review, the authors have established treatment guidelines not previously reported. This manuscript describes key features of these challenging tumors to aid in diagnosis, presents the largest published review of all reported PEMs (n = 163), and provides salient treatment guidelines to surgeons unfamiliar with these challenging tumors.

Meningioma of the scapula

Meningiomas account for approximately 15% of all intracranial tumors and are the most common non-glial primary tumors of the central nervous system. Most meningiomas are benign neoplasms with characteristic imaging features. Primary extradural meningiomas account for only 1-2% of all meningiomas. They must be differentiated from intradural meningiomas with secondary extradural extension and/or metastases. The vast majority of extradural meningiomas are found in the skull or in the head and neck region. We report on an extremely rare case of primary extradural meningioma that was located in the scapula. The lesion was resected. Radiographic findings and pathologic features are discussed. To the best of our knowledge, this form of presentation of an extradural meningioma has not been previously described.

Primary intraosseous meningioma

Primary intraosseous meningiomas are a subtype of primary extradural meningiomas and constitute fewer than 2% of meningiomas overall, but they represent approximately two thirds of all extradural meningiomas. These types of meningiomas originate within the bones of the skull and thus can have a clinical presentation and radiographic differential diagnosis that is different from those for intradural meningiomas. Primary intraosseous meningiomas are classified based on their location and histopathological characteristics. Treatment primarily involves resection with wide margins if possible. Very little literature exists regarding the use of adjuvant therapies such as radiation and chemotherapy for these tumors. In fact, the literature regarding primary intra-osseous meningiomas consists mostly of clinical case reports and case series. This literature is reviewed and summarized in this article.

Dural involvement in primary extradural meningiomas of the cranial vault

The authors retrospectively analyzed a consecutive series of patients with cranial vault primary extradural meningioma (PEM), with particular regard to the tumor's dural involvement. The pertinent literature was reviewed. Clinical data were retrospectively obtained in a consecutive series of 16 patients treated for a PEM at two institutions between 1992 and 2004. The authors created a classification system based on dural involvement of the tumors. Nine women and six men (mean age 55 years) presented with a painless, slowly progressive swelling. Preoperative magnetic resonance (MR) imaging revealed dural enhancement at the site of tumor in 11 patients. On surgical inspection, the tumor infiltrated the dura in all but three patients. Histological examination of tissue samples demonstrated tumor infiltration of the dura in all 14 patients in whom the dura had been resected. Three recurrent tumors were observed on follow-up examination during a mean period of 5.8 years (range 1.5-13 years) and required extirpation. In addition to one patient in whom there was histological evidence of malignancy, the other two cases involved two patients in whom no apparent dural involvement was observed during the first surgery. In a review of the literature, the authors found that histological examination showed dural involvement in 22%; the dura was not histologically evaluated in the remaining patients (78%). Postoperative follow-up data exceeding 2 years were only provided in two of the reported cases. Tumor infiltration of the dura should be assumed in PEMs of the cranial vault, and resection of the dura at the site of craniotomy is recommended to prevent tumor recurrence.