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Published on: January 14, 2014
A case of metaplastic meningioma with extensive xanthomatous change
Hayato Ikota1, Yoichi Nakazato
1Department of Diagnostic Pathology, Fukaya Red Cross Hospital, Fukaya, Saitama, Japan. hayato-ikota@umin.net
Abstract:
We report a case of metaplastic meningioma with extensive xanthomatous change occurring in a 61-year-old woman. Magnetic resonance imaging demonstrated a well-demarcated, dura-based mass measuring 7 cm in maximal diameter in the right occipital to parietal area. Under a clinical diagnosis of meningioma, right parietal craniotomy was performed. Histologically, the tumor showed extensive xanthomatous change together with the common features of meningothelial meningioma. Tumor cells showed diffuse xanthomatous change in various quantities, and xanthomatous tumor cells frequently showed a gradual transition to the non-xanthomatous counterpart. The xanthomatous tumor cells showed immunopositivity for epithelial membrane antigen (EMA), vimentin, fatty acid synthase and several histiocytic markers (CD68, Ki-M1p, MAC387, lysozyme, alpha 1-antitrypsin and alpha 1-antichymotrypsin). In addition, there was patchy infiltration of foamy macrophages. Since these histiocytes did not show immunopositivity for EMA, these cells were distinguished from the xanthomatous tumor cells. These two types of xanthomatous changes comprised approximately two-thirds of the whole tumor tissue. Any atypical features such as necrosis, frequent mitotic figures or brain parenchymal invasion were not observed. We diagnosed this case as xanthomatous meningioma, WHO grade I.
Insights
This study details a rare xanthomatous meningioma case in a 61-year-old woman. The benign tumor exhibited extensive xanthomatous changes and was successfully diagnosed and managed.
Area of Science:
- Neuropathology
- Oncology
Background:
- Metaplastic meningiomas are rare dural-based tumors.
- Xanthomatous change, characterized by lipid-laden cells, is an uncommon feature in meningiomas.
Observation:
- A 61-year-old woman presented with a large, well-demarcated, dura-based mass in the right occipital-parietal region.
- Magnetic resonance imaging revealed a 7 cm tumor.
- Histopathological examination showed a meningothelial meningioma with extensive xanthomatous changes.
Findings:
- Tumor cells displayed diffuse xanthomatous morphology with transitions to non-xanthomatous areas.
- Immunohistochemistry confirmed tumor cells positive for EMA, vimentin, fatty acid synthase, and histiocytic markers.
- Foamy macrophages, distinct from tumor cells, were also present, with xanthomatous changes comprising two-thirds of the tumor.
- No atypical features like necrosis, high mitotic activity, or brain invasion were observed, confirming WHO grade I.
Implications:
- This case expands the understanding of meningioma variants.
- Highlights the importance of immunohistochemistry in differentiating xanthomatous tumor cells from infiltrating macrophages.
- Contributes to the literature on benign meningiomas with unusual histological features.
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