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Histopathological study of five cases with sporadic meningioangiomatosis
Yin Wang1, Xiang Gao, Zhen-Wei Yao
1Department of Neuropathology, Institute of Neurology, Huashan Hospital, Fudan University, 12 Wu Lu Mu Qi Zhong Road, Shanghai 200040, China. yinwang88@hotmail.com
Abstract:
We report five cases of sporadic meningioangiomatosis, three males and two females, ranging in age from 12 to 36 years at diagnosis. The lesion was found incidentally by MRI after a head trauma in one case; the other four subjects had a seizure disorders, which improved following surgical resection of the cortical lesions. Grossly, the lesionectomy specimens were of a whitish color and firm consistency. Histological examination revealed that the lesions were confined to the cortex with focal involvement of the overlying leptomeninges, and revealed unifying features of meningioangiomatosis, such as proliferating microvessels with perivascular cuffs of spindle-cell proliferation within the cortex. Two cases had numerous calcifications; one was associated with a prominent fibrocalcifying component. Immunostaining results were variable among the cases. Only vimentin was consistently positive. Some of the spindle cells were weak positive for EMA in two cases. Immunoreactions with anti-CD34 detected within the cytoplasm of the spindle cells were observed in three of the five cases. The Ki-67 proliferation index of all the cases was very low, less than 0.1%. Neurofibrillary tangles were identified in only one of the five cases using the Bodian and immunostaining methods. These findings indicate that meningioangiomatosis lesions show a wide range of clinicopathological features, making diagnosis difficult. A histopathological spectrum and differential diagnoses were discussed with a review of the literature. Since this lesion is a distinct clinicopathological entity and hamartomatous in nature, it is important to make a correct diagnosis in order to avoid further aggressive treatment.
Insights
This study details five cases of meningioangiomatosis, a rare brain lesion. Early diagnosis and surgical removal can improve seizure disorders, highlighting its hamartomatous nature.
Area of Science:
- Neuropathology
- Neuro-oncology
- Vascular Malformations
Background:
- Meningioangiomatosis is a rare, benign vascular lesion of the central nervous system.
- Sporadic cases present a diagnostic challenge due to variable clinicopathological features.
Observation:
- Five cases (3 males, 2 females, ages 12-36) of sporadic meningioangiomatosis are presented.
- Lesions were incidentally found via MRI or presented as seizure disorders that improved post-surgery.
- Histopathology revealed cortical lesions with microvessel proliferation and spindle-cell cuffs, sometimes with calcifications.
Findings:
- Immunostaining showed variable results, with vimentin consistently positive.
- Low Ki-67 proliferation index (<0.1%) and rare neurofibrillary tangles were noted.
- Clinicopathological features varied, complicating diagnosis.
Implications:
- Accurate histopathological diagnosis is crucial for appropriate patient management.
- Recognizing meningioangiomatosis as a distinct hamartomatous entity avoids unnecessary aggressive treatments.
- Understanding the spectrum of features aids differential diagnosis in neurosurgical pathology.
