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Sclerosing meningioma: immunohistochemical analysis of five cases
1Department of Pathology, Gachon Medical School Gil Medical Centre, Incheon, Korea.
Abstract:
Sclerosing meningioma is a rare morphologic subtype of meningioma and may be mistaken for atypical or malignant meningioma and astrocytoma or schwannoma because of marked collagen deposits and a sparse population of cells with little resemblance to meningothelial cells. Authors describe the histopathologic and immunophenotypic features of five cases of sclerosing meningioma. Histologically, all the cases consisted of paucicellular collagenous tissue containing spindle cells with or without small foci of meningothelial cell proliferation. The morphology and immunohistochemical profile of the spindle cells were different from those of conventional meningothelial cells. The meningothelial cells showed a typical immunoreactivity of conventional meningiomas, while the spindle cells displayed a strong expression of vimentin. The Ki-67 labelling index was uniformly low in all cases, and none of cases expressed p53 protein. In summary, the recognition of meningothelial cells in massively sclerotic lesions is helpful for a correct diagnosis. In the cases with a total absence of meningothelial cells, however, the vague collagenous whorls are more diagnostic rather than immunohistochemistry. Considering association with clear cell meningioma, prospective and retrospective long-term follow-up is necessary for deciding whether reminiscent clear cell meningiomas should be separated from sclerosing meningioma or not.
Insights
Sclerosing meningioma, a rare subtype, can be misdiagnosed due to its collagenous nature. Recognizing meningothelial cells or collagenous whorls aids in accurate diagnosis of this brain tumor.
Area of Science:
- Neuropathology
- Surgical Pathology
- Oncology
Background:
- Sclerosing meningioma is a rare morphologic variant of meningioma.
- Its distinct histological features, marked by collagen deposition and sparse cells, can lead to misdiagnosis.
- Differential diagnosis includes atypical meningioma, malignant meningioma, astrocytoma, and schwannoma.
Observation:
- This study describes the histopathologic and immunophenotypic characteristics of five sclerosing meningioma cases.
- Histology revealed paucicellular collagenous tissue with spindle cells, occasionally with meningothelial cell foci.
- Spindle cells exhibited morphology and immunohistochemical profiles distinct from conventional meningothelial cells, showing strong vimentin expression.
Findings:
- Conventional meningothelial cells displayed typical immunoreactivity.
- Spindle cells showed strong vimentin expression.
- Low Ki-67 labeling index and absence of p53 protein expression were noted in all cases.
Implications:
- Recognition of meningothelial cells in sclerotic lesions is crucial for accurate sclerosing meningioma diagnosis.
- In cases lacking meningothelial cells, vague collagenous whorls are more diagnostic than immunohistochemistry.
- Further long-term follow-up is needed to determine if clear cell meningiomas should be classified separately from sclerosing meningioma.
