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Multiple meningiomas of different pathological features: case report
1Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Korea. heonyoo@thrunet.com
Abstract:
Meningioma is a common intracranial tumour and it may occur not infrequently as one of the multiple tumours, especially in patients with neurofibromatosis. The incidence of multiple meningiomas (MMs) without the stigmata of neurofibromatosis is rare, ranging from 1 to 9% of all meningiomas in the literature. Multiple meningiomas with different pathologic features are even rarer, and most of them are benign histologies. The authors report an extremely rare case of MMs which were presented with malignant and benign histological features simultaneously. The underlying mechanism of MM formation is still unclear, however, subarachnoid spread was thought to be the most likely mechanism. The findings of most of MMs showed identical histopathological features and several molecular biologic studies provided evidence for the monoclonal origin of MMs to back up the above hypothesis. However, different histological features among the reported multiple meningioma cases including our particular one, suggests their origin from multicentric neoplastic foci activated by a supposed tumour-producing factor. However, we cannot completely exclude the possibility of independent progression from monoclonal origin.
Insights
Multiple meningiomas (MMs) are rare, especially those with varying histological features. This case highlights MMs presenting with both malignant and benign characteristics, challenging current understanding of their origin.
Area of Science:
- Neuropathology
- Neurosurgery
- Oncology
Background:
- Meningiomas are common intracranial tumors, with multiple meningiomas (MMs) occurring in 1-9% of cases.
- MMs typically present with identical histopathological features, suggesting a monoclonal origin.
- The presence of MMs without neurofibromatosis is uncommon.
Observation:
- This report details an exceptionally rare instance of MMs exhibiting simultaneous malignant and benign histological features.
- The patient did not present with the typical stigmata of neurofibromatosis.
Findings:
- While subarachnoid spread is a hypothesized mechanism for MM formation, the differing histological features in this case challenge monoclonal origin theories.
- The findings suggest a potential multicentric origin activated by a tumor-producing factor, though independent progression from a monoclonal origin cannot be excluded.
Implications:
- This case underscores the complexity of meningioma development and the need for further research into the etiology of MMs with diverse histologies.
- Understanding the origins of such rare presentations is crucial for accurate diagnosis and treatment planning in neuro-oncology.