Primary Ectopic Meningiomas: Report of 6 Cases with Emphasis on Atypical Morphology and Exploratory Immunohistochemistry

Overview

Journal Histol Histopathol

Specialties Anatomy & Histology
Pathology

Date 2022 Nov 11

PMID 36367373

Authors

Hao Ni

Qianqian Yang

Chenxi Shi

Peiyu Zhao

Shenghua Zhan

Lingchuan Guo

Affiliations

Soon will be listed here.

Abstract

Aims: To investigate the histological and immunohistochemical features of primary ectopic meningiomas (PEMs), especially those of primary ectopic atypical meningiomas (PEAMs).

Methods And Results: We examined 6 cases of PEM, including 2 PEAM cases, which occurred separately in left nasal cavity, left lower lung, right neck, left orbit, right upper lung, and left upper lung by histological and immunohistochemical analysis. In general, of the 6 PEM cases analyzed, 4 cases exhibited morphology of Grade Ⅰ, including 1 fibrous, 1 meningothelial, and 2 transitional variant. The remaining 2 cases shared similar atypical morphology of Grade Ⅱ. The tumors were distributed in sheet-like patterns with loss of architecture of classic meningiomas. Significant hypercellularity, multi-focal necrosis, and thin-walled blood vessels were identified. The mitotic figures were estimated at 6 per 10 high-power fields in one case, and 8 mitotic figures in another. Immunohistochemically, the 6 PEM cases were all positive for Vimentin and EMA, while none showed immunostaining for CKpan, S-100, CD34, STAT6, SMA, Syn or Bcl-2. 4 PEM cases of Grade Ⅰ were immunoreactive for PR but negative for P53, while the 2 PEAM cases displayed negative staining for PR but positivity for P53. As for Ki-67, the positive staining of 4 Grade Ⅰ cases was no greater than 2%, while the positive rates of the 2 PEAM cases were 10% and 20%.

Conclusions: Our study has expanded cases of PEMs, especially the 2 PEAM cases in rare sites. Our study has also further summarized the pathological features of PEMs, focusing on the histological features of PEAMs, and the immunohistochemical features worthy of further investigations.

References

Aiyer R, Prashanth V, Ambani K, Bhat V, Soni G . Primary extracranial meningioma of paranasal sinuses. Indian J Otolaryngol Head Neck Surg. 2014; 65(Suppl 2):384-7. PMC: 3738789. DOI: 10.1007/s12070-012-0565-y. View

Anderson J, Anderson J, Alhatem A, Walter A, Langston L . Type III cutaneous atypical meningioma of the scalp. J Cutan Pathol. 2022; 49(6):565-569. DOI: 10.1111/cup.14200. View

Barone F, Inserra F, Scalia G, Ippolito M, Cosentino S, Crea A . Ga-DOTATOC PET/CT Follow Up after Single or Hypofractionated Gamma Knife ICON Radiosurgery for Meningioma Patients. Brain Sci. 2021; 11(3). PMC: 8001061. DOI: 10.3390/brainsci11030375. View

Cimini A, Ricci F, Pugliese L, Chiaravalloti A, Schillaci O, Floris R . A Patient with a Benign and a Malignant Primary Pulmonary Meningioma: An Evaluation with 18F Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography and Computed Tomography with Iodinated Contrast. Indian J Nucl Med. 2019; 34(1):45-47. PMC: 6352649. DOI: 10.4103/ijnm.IJNM_101_18. View

Foda A, Rafi S, Ikram N, Alam M, Ayesha S . Spinal Versus Intracranial Meningioma: Aberrant Expression of CD10 and Inhibin with Relation to Clinicopathological Features and Prognosis. Pathol Oncol Res. 2019; 26(2):1313-1318. DOI: 10.1007/s12253-019-00704-2. View

Gomez-Aracil V, Mayayo E, Alvira R, Arraiza A, Cajal S . Fine needle aspiration cytology of primary pulmonary meningioma associated with minute meningotheliallike nodules. Report of a case with histologic, immunohistochemical and ultrastructural studies. Acta Cytol. 2002; 46(5):899-903. DOI: 10.1159/000327067. View

Hu X, Jiang M, Feng Z, Wang J, Wang P, Cai J . Primary Heterotopic Meningioma of Nasal Cavity: Case Report and Literature Review. Ear Nose Throat J. 2020; 101(9):NP383-NP388. DOI: 10.1177/0145561320974863. View

Huang X, Wang D, Lin J, Tang D, Sun F . [Clinical analysis of orbital ectopic meningiomas]. Zhonghua Yan Ke Za Zhi. 2018; 54(9):665-670. DOI: 10.3760/cma.j.issn.0412-4081.2018.09.006. View

Huang X, Tang D, Wu T, Jian T, Sun F . Ectopic orbital meningioma: a retrospective case series. BMC Ophthalmol. 2018; 18(1):296. PMC: 6233548. DOI: 10.1186/s12886-018-0959-z. View

10.

Inserra F, Barone F, Palmisciano P, Scalia G, Da Ros V, Abdelsalam A . Hypofractionated Gamma Knife Radiosurgery: Institutional Experience on Benign and Malignant Intracranial Tumors. Anticancer Res. 2022; 42(4):1851-1858. DOI: 10.21873/anticanres.15661. View

11.

Kishore M, Kaushal M, Bhardwaj M, Sharma N . Cutaneous Meningioma: A Cytomorphological Diagnosis. Indian Dermatol Online J. 2017; 8(3):201-204. PMC: 5447342. DOI: 10.4103/idoj.IDOJ_169_16. View

12.

Kucukosmanoglu I, Karanis M, Unlu Y, Coven I . Evaluation of P57, P53 and Ki67 Expression in Meningiomas. J Korean Neurosurg Soc. 2022; 65(4):499-506. PMC: 9271805. DOI: 10.3340/jkns.2021.0197. View

13.

Lu C, Hu X, Xu M, Mao W, Yang H, Wang Z . Posterior mediastinal ectopic meningioma: a case report. World J Surg Oncol. 2015; 13:156. PMC: 4417514. DOI: 10.1186/s12957-015-0581-y. View

14.

Maiuri F, Mariniello G, de Divitiis O, Esposito F, Guadagno E, Teodonno G . Progesterone Receptor Expression in Meningiomas: Pathological and Prognostic Implications. Front Oncol. 2021; 11:611218. PMC: 8320886. DOI: 10.3389/fonc.2021.611218. View

15.

Marcos D, Paiva Neto M, Goes P, Oshima C, Silva M, Stavale J . Grade I meningiomas with atypical characteristics: a worse prognosis. Arq Neuropsiquiatr. 2018; 76(11):756-759. DOI: 10.1590/0004-282X20180121. View

16.

Mogi A, Hirato J, Kosaka T, Yamaki E, Kuwano H . Primary mediastinal atypical meningioma: report of a case and literature review. World J Surg Oncol. 2012; 10:17. PMC: 3278378. DOI: 10.1186/1477-7819-10-17. View

17.

Murakami K, Takahashi H, Omori T, Uchida O, Hirano H, Kawate N . A case report of resected ectopic malignant meningioma with lung metastasis. Medicine (Baltimore). 2019; 98(23):e15853. PMC: 6571432. DOI: 10.1097/MD.0000000000015853. View

18.

Ohashi-Nakatani K, Shibuki Y, Fujima M, Watanabe R, Yoshida A, Yoshida H . Primary pulmonary meningioma: A rare case report of aspiration cytological features and immunohistochemical assessment. Diagn Cytopathol. 2018; 47(4):330-333. PMC: 6587802. DOI: 10.1002/dc.24126. View

19.

Pepe F, Pisapia P, De Caro M, Conticelli F, Malapelle U, Troncone G . Next generation sequencing identifies novel potential actionable mutations for grade I meningioma treatment. Histol Histopathol. 2019; 35(7):741-749. DOI: 10.14670/HH-18-195. View

20.

Ruiz J, Martinez A, Hernandez S, Zimman H, Ferrer M, Fernandez C . Clinicopathological variables, immunophenotype, chromosome 1p36 loss and tumour recurrence of 247 meningiomas grade I and II. Histol Histopathol. 2010; 25(3):341-9. DOI: 10.14670/HH-25.341. View