Transitional Meningioma Research Articles

Intraventricular meningioma with anaplastic transformation and metastasis via the cerebrospinal fluid

We report a surgical case of intraventricular meningioma that arose in the trigone of the right lateral ventricle of a 61-year-old woman. Local recurrence and metastasis (dissemination) via the CSF to the fourth ventricle developed about 52 months postoperatively. Further subarachnoid dissemination in the pontine base and spinal cord occurred 6 months later. The tumor exhibited a histopathological appearance of transitional meningioma without cellular atypism in the original specimen, but in the metastatic nodules in the fourth ventricle and spinal subarachnoid space the histopathology was that of typical anaplastic meningioma. Only four cases of anaplastic intraventricular meningioma that developed metastasis via the CSF have been reported. This report presents the fifth case, which is also the second case in which progression from ordinary low-grade meningioma to anaplastic meningioma was demonstrated histopathologically.

Relationship between DNA damage and total antioxidant capacity in patients with transitional meningioma

Purpose The purpose of this study was to assess oxidative DNA damage and total antioxidant capacity (TAC) in patients with transitional meningioma (TM) and to compare the results with normal brain tissues. Patients and methods Oxidative DNA damage and TAC were evaluated in TM extracted from 22 patients and in normal brain tissues of 15 subjects who underwent autopsy within first 4 h of death. Oxidative DNA damage was assessed by measuring 8-hydroxy-2-deoxyguanosine (8-OH-dG) using the 8-OH-dG enzyme immunoassay kit, a quantitative assay for 8-OH-dG, and TAC was analyzed using the ImAnOx colorimetric test system for the determination of antioxidative capacity. The results were compared between two groups and any correlation between 8-OH-dG and TAC was sought. Results The median level of TAC in TM (135 nmol/g wet tissue) was remarkably lower than in normal brain tissue (298 nmol/g wet tissue). The difference was statistically significant ( p = 0.00001). In contrast, oxidative DNA damage was significantly higher in patients with TM (71.61 ng/g wet tissue) than in controls (34.71 ng/g wet tissue). Again, the difference was statistically significant ( p = 0.00001). We also found a negative correlation between oxidative DNA damage and TAC ( p < 0.001). Conclusion These findings show that the degree of oxidative DNA damage is increased and TAC is decreased in TM and oxidative DNA damage is negatively correlated with the levels of TAC.

Follicular lymphoma of the dura associated with meningioma: A case report and review of the literature

A 70-year-old immunocompetent woman who had been radiologically diagnosed with a left parasagittal meningioma 5 years previously developed a palpable subgaleal mass and underwent neurosurgery. Histologically the tumor was composed of thickened fibrotic dural tissue, infiltrated by a follicular lymphoma, of grade IIIB. A coexistent transitional meningioma had been infiltrated by the neoplastic lymphoid tissue. Two months after surgery, the patient developed evidence of extracranial dissemination of the lymphoma to the cervical lymph nodes and was treated with polychemotherapy plus Rituximab and intrathecal methotrextate. The patient is alive and recurrence-free at 1-year follow up. A review of the literature indicates that lymphomas developing primarily in the meninges, have an indolent course and tend to be localized in areas rich in meningothelial cells.

Glutathione peroxidase, glutathione reductase and protein oxidation in patients with glioblastoma multiforme and transitional meningioma

The aim of this study was to assess glutathione peroxidase (GPx), glutathione reductase (GRx) and protein oxidation (POx) levels in patients with glioblastoma multiforme (GBM) and transitional meningioma (TM) and to compare with normal brain tissues. GPx, GRx and POx levels were measured in 48 brain tumors obtained during surgery and 15 normal brain tissues that were collected during autopsy. Results were compared between two groups. GPx and GRx activities were significantly lower in GBM and TM when compared to controls and the difference was statistically significant (P = 0.0001). Furthermore, the decrease in enzyme activities was more evident in GBM than in TM. In contrast, POx levels were found to be higher in both GBM and TM compared to controls and showed statistically significant difference (P = 0.00001). Increase in POx levels was clearer in GBM than TM. GPx and GRx decreased and POx increased significantly in both GBM and TM when compared to normal brain tissues. Further, clinical studies with a larger patient population are required to show the role(s) of antioxidant enzymes in brain tumors more accurately.

Falx meningiomas: surgical results and lessons learned from 68 cases.

The purpose of this study was to review the characteristics of falcine meningioma retrospectively and to identify the parameters associated with tumor recurrence. The analysis included; age, sex, extent of resection, and radiologic and pathologic findings. Falcine meningiomas were classified by location as anterior, middle, or posterior as described for parasagittal meningiomas. Of the 795 meningioma patients treated between 1990 and 2004 at the authors' institution, 68 patients with meningiomas arising from the falx underwent craniotomies. There were 22 male and 46 female patients (1 : 2.1). Mean age was 55 years and ranged from 14 to 77 years. Locations of falcine meningioma were; the anterior third in 33 cases, middle in 20, and posterior in 15. Mean tumor volume was 42 cc and ranged from 4 to 140 cc. In 58 of the 68 patients tumors were totally removed. Additional surgery for recurrence was performed in 6 patients over 15 years. Of these 6 patients, only two patients underwent gross total tumor resection at first operation; the other four underwent subtotal tumor resection. Based on pathologic reports, the largest tumor subtype was transitional. There were four patients with a high grade tumor-three atypical and one anaplastic meningioma. Of the 68 patients, 59 achieved a good outcome (no neurological deficit or recurrence), six had temporary complications, two suffered new permanent postoperative deficits, and the remaining one died due to severe brain swelling despite postoperative intensive care. Extent of surgical resection was found to be significantly related to tumor recurrence. Falcine meningioma accounted for 8.5% of intracranial meningiomas and the transitional meningioma was the most common subtype of falcine meningioma. Gross total resection of tumor was the single most important predictor of an improved surgical outcome.

Primary intra-orbital optic nerve sheath meningioma in an adolescent: a case report

Background : Primary optic nerve sheath meningioma is rare, but nearly always results in blindness; whether left alone or surgically treated. Case report : A 19-year-old male student without antecedents presented to the ophthalmic service of the University of Ilorin Teaching Hospital, Ilorin, Nigeria, with a two-month history of progressive proptosis, pain, and a foul smelling discharge in the right eye. Upon clinical examination with a Hertel's exophthalmometer, the degree of axial proptosis of the right eye was found to be 20mm compared with 16mm in the left eye. Visual acuity was 6/18 in the right eye and 6/5 in the left eye, with a right relative afferent pupillary defect. An ocular ultrasound revealed intra-orbital soft tissue mass. Computed tomography (CT) scanning of the head was not done at this time due to financial constraints on the part of the patient. He thereafter defaulted from follow-up but re-presented a year later with more severe proptosis, conjuctival chemosis, infected exposure keratitis and total loss of vision in the right eye. A computed tomography of the head revealed an enhancing right retro-bulbar intra-orbital soft tissue mass. Enucleation of the right eye and complete extirpation of both the tumour and the intra-orbital optic nerve were carried out without complications. The histopathology revealed transitional meningioma of the optic nerve sheath. The patient is now socially rehabilitated, wears an artificial eye and has returned to his former occupation and society. Conclusion : This case typically illustrates the complications that could arise if a treatable benign condition is left untreated because of limited affordable diagnostic facilities or the adoption of an unmonitored ‘observational strategy' in the early phase of the disease. Nigerian Journal of Ophthalmology Vol. 14(1) 2006: 35-38

The role of matrix metalloproteinases and tissue inhibitors of matrix metalloproteinase in microcystic meningiomas

We studied the expression of matrix metalloproteinases (MMP) and tissue inhibitors of matrix metalloproteinase (TIMP) in microcystic meningiomas to investigate a possible underlying mechanism for the development of microcysts and of peritumoral edema, which are frequent characteristics of this rare subtype. Between October 1995 and June 2004, 10 of 19 patients who had histologically confirmed pure microcystic meningiomas were enrolled in the study. Six patients with meningothelial meningiomas, three with atypical meningiomas, and one with a transitional meningioma were included as a control group. Immunohistochemistry with paraffin blocks and real-time RT-PCR analysis for MMP-2, MMP-9, TIMP-1, TIMP-2 and vascular endothelial growth factor (VEGF) were performed using stored frozen tissues. Compared with the control group, MMP-9 was invariably and highly expressed in immunohistochemical staining of microcystic meningiomas. MMP-2, TIMP-1, TIMP-2 and VEGF were weakly expressed or not expressed in both microcystic and non-microcystic meningiomas. Real-time RT-PCR showed increased ratios of MMP-9 to TIMP-1 in microcystic meningiomas compared with the control group (55.855 +/- 106.353 vs. 1.858 +/- 2.575, respectively; p = 0.00). The expression of MMP-2 (0.72 +/- 1.20 vs. 2.54 +/- 3.01, p = 0.01) and TIMP-2 (1.22 +/- 1.67 vs. 1.61 +/- 1.82, p = 0.02) was higher in the control group. The results suggested that the increased ratio of MMP-9 to TIMP-1 might be associated with the formation of microcysts and peritumoral edema in microcystic meningioma.

Malignant Lymphoma Arising in the Cerebral Parenchyma Adjacent to a Parasagittal Meningioma-Case Report-

A 70-year-old woman with an asymptomatic parasagittal meningioma had been under observation with follow-up imaging for 2 years. She gradually developed motor weakness in the left hand. Magnetic resonance (MR) imaging disclosed a newly developed well-enhanced area in the cerebral parenchyma adjacent to the stable original meningioma. The new lesion was enhanced more intensely and less well demarcated. We suspected that the meningioma had enlarged into the brain parenchyma, although MR imaging suggested a border between the extra-axial and intra-axial portions. Craniotomy was performed. Two separate tumors were identified with quite different histological features. The extra-axial tumor was identified as benign transitional meningioma and the intra-axial tumor as diffuse large cell type malignant lymphoma. Immunostaining revealed the lymphoma had B cell origin. After surgical resection, stereotactic radiosurgery was performed for the residual lymphoma. The original site of the lymphoma remained free from relapse, but another lesion developed in the right frontal lobe 3 months later and chemotherapy was performed. The main concern for follow-up imaging of asymptomatic meningioma without surgical resection is growth of the meningioma. However, development of new different tumors is possible, although thought to be rare.

Sylvian meningioma without dural attachment in an adult

This paper presents a rare case of a sylvian meningioma in a 35-year-old male. The patient visited our hospital because of a 10-year history of simple partial seizures. Magnetic resonance imaging revealed a 3.5-cm, well-circumscribed, homogenously enhanced, circular mass without dural attachments in the left insular region. The tumor was not stained on angiogram. The tumor was located in the extra-axial space of the sylvian fissure without any dural attachment, and was strongly attached to the middle cerebral artery. The tumor was excised, and a histological diagnosis of a transitional meningioma without a malignancy was made. A Sylvian meningioma without dural attachment is quite rare, and a preoperative differentiation of this lesion is generally difficult. This paper discusses the characteristics and possible pathogenesis of meningiomas without a dural detachment.

Petroclival mixed meningioma

We present a 47-year-old lady with a large dumb-bell petroclival-cavernous sinus meningioma. The tumour was of mixed histopathology; the anterior part, in relationship to the cavernous sinus, was a syncitial meningioma and the posterior part in the petroclival region was a transitional meningioma. The two histological subtypes of meningioma within the same tumour displayed remarkable differences in their radiological features, nature of extensions, relationship with the adjoining structures and consistency. The clinical course of the two subtypes was also different. The unusual features of this case are reported and the relevant literature briefly reviewed.

Imaging ex vivo healthy and pathological human brain tissue with ultra-high-resolution optical coherence tomography

The ability of ultra-high-resolution optical coherence tomography (UHR OCT) to discriminate between healthy and pathological human brain tissue is examined by imaging ex vivo tissue morphology of various brain biopsies. Micrometer-scale OCT resolution (0.9x2 microm, axialxlateral) is achieved in biological tissue by interfacing a state-of-the-art Ti:Al2O3 laser (lambda(c)=800 nm, delta lambda=260 nm, and P(out)=120 mW exfiber) to a free-space OCT system utilizing dynamic focusing. UHR OCT images are acquired from both healthy brain tissue and various types of brain tumors including fibrous, athypical, and transitional meningioma and ganglioglioma. A comparison of the tomograms with standard hematoxylin and eosin (H&E) stained histological sections of the imaged biopsies demonstrates the ability of UHR OCT to visualize and identify morphological features such as microcalcifications (>20 microm), enlarged nuclei of tumor cells (approximately 8 to 15 microm), small cysts, and blood vessels, which are characteristic of neuropathologies and normally absent in healthy brain tissue.

Coexistencia de siringomielia y meningioma intradural extramedular

The coexistence of non-communicating syringomyelia with extramedullary intradural tumours in surgical series is extremely rare. We report the case of a 68-year-old female who had been suffering from predominantly proximal asymmetrical progressive paraparesis, with no involvement of the sphincters; the clinical exploration revealed a band of thermal hypaesthesia D7-D8. Magnetic resonance imaging (MRI), following the administration of gadolinium, confirmed the coexistence of an extramedullary intradural expansive lesion, which had features suggesting it could be a meningioma, and a dorsal syringomyelia. The cavity involved two medullary segments situated above the tumour and there were no associated anomalies at the junction of the medulla and upper spinal cord. Following complete resection of the tumour, which was diagnosed histologically as being a transitional meningioma with abundant psammoma bodies, the patient recovered the ability to walk independently. MRI with contrast is the best diagnostic means available for the detection and delimitation of the two components in this rare association, although its capacity to detect signs suggesting turbulences in the intracavity fluid, especially in small cavities, has still to be confirmed. The variations in the size and situation of the cavity with respect to the seat of the tumour, and the fact that progress is seldom monitored with MRI in the cases published to date, do not allow us to identify the pathogenic mechanism responsible for this association or to suggest the best type of shunt to prevent a possible expansion of the syringomyelic cavity.

Molecular evidence of apoptotic death in malignant brain tumors including glioblastoma multiforme: upregulation of calpain and caspase-3.

Cell death in the core of human brain tumors is triggered by hypoxia and lack of nutrients, but the mode of cell death whether necrosis or apoptosis is not clearly defined. To identify the role of apoptosis in brain tumor cell death, we investigated macromolecular (RNA and protein) synthesis and activity in the central to peripheral region of benign [desmoplastic infantile ganglioglioma (DIG) and transitional meningioma (TMG)] and malignant [ependymoma (END), anaplastic astrocytoma (APA), and glioblastoma multiforme (GBM)] brain tumors derived from five patients who had not received previously radiotherapy or chemotherapy. Normal brain tissue (NBT) served as control. RT-PCR analysis of tumor tissues covering central to peripheral regions detected mRNA overexpression of pro-apoptotic gene bax in malignant tumors, indicating a commitment to apoptosis. The mRNA expression of calpain (a Ca(2+)-dependent cysteine protease) and calpastatin (endogenous calpain inhibitor) was altered resulting in an elevated calpain/calpastatin ratio. Calpain content and activity were increased, suggesting a role for calpain in cell death. In the mitochondria-dependent death pathway, caspase-9 and caspase-3 were also overexpressed in tumors. The increased caspase-3 activity cleaved poly(ADP-ribose) polymerase (PARP). Agarose gel electrophoresis detected a mixture of random and internucleosomal DNA fragmentation in malignant brain tumors. Overexpression of pro-apoptotic bax, upregulation of calpain and caspase-3, and occurrence of internucleosomal DNA fragmentation are now presented indicating that one mechanism of cell death in malignant brain tumors is apoptosis, and that enhancement of this process therapeutically may promote decreased tumor growth.

Ossified thoracic spinal meningioma in childhood: A case report and review of the literature

Spinal ossified meningiomas are extremely rare. This is a report of a study on a 15-year-old boy with thoracic spinal ossified meningioma. The meningioma was resected totally. Histopathological examination revealed a transitional meningioma (psammomatous+meningothelial). Immunohistochemically, Ki 67 antibody was applied but no positive staining was present. The surgical and pathological aspects of spinal ossified meningiomas were reviewed.

Intraparenchymal meningioma originating from underlying meningioangiomatosis

The authors present the case of a 20-year-old woman with right-sided temporal intraparenchymal meningioma originating from underlying meningioangiomatosis. The patient manifested temporal-type seizures as the initial symptom. She had no stigmata of neurofibromatosis Type 2. Neuroradiological studies revealed an intraaxial, contrast-enhancing lesion in the right temporal lobe. After gross-total removal of the tumor, histological examination revealed a transitional meningioma with surrounding neural parenchyma and features of meningioangiomatosis. Although there were no signs of anaplasia, necrosis, or increased mitosis, tumor islands were observed in the adjacent neuropil. The rare association of meningioangiomatosis and meningioma is discussed, along with radiological and surgical findings.

Falx meningioma presenting as acute subdural hematoma: case report

BACKGROUND Acute subdural hematomas caused by meningiomas have been rarely encountered. Pathophysiologic mechanisms and clinical considerations in these patients have not been sufficiently explored. We addressed the possible mechanism of spontaneous hemorrhage in our case and briefly discuss the optimal treatment. CASE DESCRIPTION This case of falx meningioma presenting as an acute subdural hematoma in a 78-year-old woman is described. On initial computed tomography (CT), an enhancing tumor of the falx appeared to be the cause of hemorrhage. Only faint contrast staining in the periphery of the tumor was seen on right external carotid arteriograms, with no evidence of other vascular supply. Extravasation of contrast material during the procedure occurred suddenly and was successfully treated by endovascular embolization using a microcatheter. The hematoma was emergently evacuated with gross total removal of the tumor. Pathologic examination confirmed a transitional meningioma with abundant hyalinized structures. Disruption of a thin-walled vessel adjacent to the tumor capsule was assumed to be the site of hemorrhage. CONcLUSIONS The longstanding ischemia of the tumor was considered to have produced the deposition of hyalin in the tissue, which changed the hemodynamics within the tumor, producing vascular stress leading to rupture. The prognosis of patients with meningiomas complicated by acute subdural hematoma is generally poor, with mortality reported in approximately one-half of such patients. Surgical exploration is the most effective treatment and should be conducted before irreversible brain damage has occurred.

Lung Carcinoma Presenting as Metastasis to Intracranial Meningioma

Tumor-to-tumor metastasis is rare. The authors report a case of a 52-year-old man with a 1-year history of a right parasaggital meningioma, whose clinical signs were consistent with enlarging meningioma. In preparation for surgery, the routine preoperative chest radiograph revealed a lung mass. Fine-needle aspiration of the mass revealed adenocarcinoma. The patient underwent surgical excision of the intracranial mass, which was thought to be a meningioma. However, pathologic examination revealed a transitional meningioma extensively infiltrated with deposits of metastatic carcinoma from the patient's primary lung tumor. Metastasis to meningioma was therefore responsible for the rapid enlargement of the long-standing meningioma, and caused the first clinical manifestation of primary lung carcinoma. Recurrent metastasis developed at the surgical site 5 weeks later, requiring surgical excision and postoperative radiation to prevent further recurrence. This is a highly unusual presentation for lung carcinoma and, to the authors' best knowledge, is the first such case reported. A review of the published literature revealed 20 other cases of lung carcinoma metastatic to meningioma, which were incidentally discovered on surgery or autopsy.

Abstract

We report a patient with a spheno-orbital meningioma having unusual clinical and radiological features. Eight days before consultation, this 66-year-old female developed right exophthalmos associated with periorbital pain. Neuroradiological features included, (1) multilocular intratumoral cyst on enhanced CT, (2) preferential extradural growth with prominent bony destruction and intratumoral hemorrhage on MRI, and (3) early venous draining on CAG. Histopathology including immunohistochemistry and electron microscopy revealed typical transitional meningioma. The only uncommon pathological feature was that the attachment consisted of the outer (periosteal) layer of the dura, and the microscopic structure of the inner (meningeal) layer was normal.

Spheno-orbital meningioma with unusual radiological features

We report a patient with a spheno-orbital meningioma having unusual clinical and radiological features. Eight days before consultation, this 66-year-old female developed right exophthalmos associated with periorbital pain. Neuroradiological features included, (1) multilocular intratumoral cyst on enhanced CT, (2) preferential extradural growth with prominent bony destruction and intratumoral hemorrhage on MRI, and (3) early venous draining on CAG. Histopathology including immunohistochemistry and electron microscopy revealed typical transitional meningioma. The only uncommon pathological feature was that the attachment consisted of the outer (periosteal) layer of the dura, and the microscopic structure of the inner (meningeal) layer was normal.

Malignant Transformation of Meningioma

A 51-year-old woman underwent resection of a parasagittal mass. Histology revealed a transitional meningioma graded as atypical on the basis of a mitotie index of up to found mitoscs per 10 high-power fields. A recurrence 20 months later displayed focal rhabdoid morphology, an increased mitotic index, and brain invasion. Despite surgery and adjuvant radiation therapy, a second recurrence necessitated resection 3 months later. Histologically the rhabdoid component had become more prominent and features of frank anaplasia were seen. Despite the surgeon's impression that a gross total resection was achieved, a third recurrence was detected after only 3 months. The recently recognized rhabdoid meningloma variant and histologic features of prognostic significance in meningioma grading are discussed.