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Anaplastic meningioma with papillary, rhabdoid, and epithelial features: a case report
A Saito1, Y Nakazato, Y Yoshii
1Department of Neurosurgery, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan.
Abstract:
A 74-year-old man manifested disturbed consciousness and right hemiparesis. Computed tomography revealed a left frontal parasagittal meningeal tumor with extensive peritumoral brain edema and skull invasion. Subtotal removal was performed. Five years later, he underwent two more operations of massive recurrences. Pathological studies revealed anaplastic meningioma with two different histological areas. One was an epithelial and meningothelial area, and the other was a papillary and rhabdoid area. In the papillary and rhabdoid area, small tumor cells with a high nucleus/cytoplasm ratio proliferated densely around the dilated central capillaries with a pseudopapillary pattern. Many rhabdoid cells (vimentin ++, cytokeratin AE1/AE3 +, epithelial membrane antigen [EMA] + +) tended to be distributed far from the central capillaries. There were many mitotic figures near the central vessels. Dense MIB1-positive nuclei were also observed near the central vessels. The trabecular pattern of the tumor cells in the epithelial area was quite different from the histological features of chordoid meningioma.
Insights
This study details a rare anaplastic meningioma case with distinct histological areas. The aggressive tumor recurred multiple times, highlighting the need for effective treatment strategies for complex meningiomas.
Area of Science:
- Neuro-oncology
- Surgical Pathology
Background:
- Anaplastic meningiomas are rare, aggressive tumors with a high recurrence rate.
- Accurate histological classification is crucial for predicting prognosis and guiding treatment.
Observation:
- A 74-year-old male presented with altered consciousness and hemiparesis due to a left frontal parasagittal meningeal tumor.
- Initial computed tomography (CT) showed a large tumor with brain edema and skull invasion, requiring subtotal removal.
- The tumor recurred massively over five years, necessitating two additional surgeries.
Findings:
- Pathological examination revealed an anaplastic meningioma with two distinct areas: epithelial/meningothelial and papillary/rhabdoid.
- The papillary/rhabdoid area exhibited pseudopapillary patterns with high-grade features, including numerous mitotic figures and MIB1-positive cells near capillaries.
- Immunohistochemistry confirmed rhabdoid cells positive for vimentin, cytokeratin AE1/AE3, and epithelial membrane antigen (EMA).
Implications:
- This case highlights the complex histopathology of anaplastic meningiomas and their aggressive behavior.
- The distinct histological patterns may influence treatment response and patient outcomes.
- Further research into targeted therapies for specific meningioma subtypes is warranted.