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April 2001: a 70 year old woman with recurrent meningioma
L F Bleggi-Torres1, J S Reis-Filho, L N Faoro
1Department of Pathology (Neuropathology), University of Paraná, Curitiba, Brazil.
Abstract:
The April Case of the Month (COM). The contributors report a case of a 70 year-old woman with recurrent meningiomas, one of which showed rhabdoid and lipomatous differentiation. Histopathological study of the first and second previous resections showed only typical meningothelial meningioma. On the third craniotomy, a new tumor specimen showed an admixture of classic meningothelial meningioma with lipomatous and rhabdoid foci. Immunohistochemical studies showed diffuse reactivity for epithelial membrane antigen and vimentin, as well as focal positivity for desmin and smooth muscle actin in the areas with rhabdoid features and S100 protein in the lipomatous foci. The presence of these three different and concomitant histological patterns only in the third surgical resection might support a metaplastic origin and, also, corroborates the concept that rhabdoid features are suggestive of an aggressive behavior.
Insights
Recurrent meningiomas can develop aggressive rhabdoid and lipomatous features, suggesting metaplasia. This case highlights the importance of histopathological analysis for aggressive tumor behavior in meningioma patients.
Area of Science:
- Neuropathology
- Surgical Oncology
- Oncogenesis
Background:
- Meningiomas are typically benign tumors arising from the meninges.
- Recurrent meningiomas can exhibit varied histological patterns.
- Metaplasia, a change in cell type, is a recognized phenomenon in some tumors.
Observation:
- A 70-year-old woman presented with recurrent meningiomas.
- Subsequent tumor resections revealed a shift from typical meningothelial meningioma to an admixture of meningothelial, lipomatous, and rhabdoid components.
- Immunohistochemistry confirmed distinct markers for each histological subtype.
Findings:
- The third tumor resection demonstrated a unique combination of meningothelial, lipomatous, and rhabdoid differentiation.
- Rhabdoid areas showed positivity for desmin and smooth muscle actin.
- Lipomatous foci were positive for S100 protein.
Implications:
- The emergence of diverse histological patterns in a single recurrent tumor suggests a metaplastic origin.
- The presence of rhabdoid features in meningiomas may indicate aggressive behavior and a poorer prognosis.
- This case underscores the need for thorough histopathological evaluation of recurrent meningiomas to guide treatment strategies.