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Histiocytic meningioma: A distinctive subtype of meningioma?
Liqiong Liu1, Jonathan Stone2, Joan T Hoffpauir3
1Louisiana State University Health Science Center, New Orleans, USA;
Abstract:
Meningioma with extensive histiocytic changes is rare. We describe a case of histiocytic meningioma which occurred in a 55-year-old woman. The patient had a progressive headache and a decline in fine motor coordination and memory for the past four years. Magnetic resonance imaging demonstrated a well-demarcated, dura-based and contrast-enhancing mass lesion in the right superior frontoparietal region. Histopathologically, the tumor showed neoplastic meningothelial proliferation with extensive and multifocal histiocytic infiltration. The histiocytic component constituted approximately half of the entire tumor. Immunohistochemically, both meningothelial and histiocytic cells showed immunoreactivity for epithelial membrane antigen (EMA), while the histiocytic cells were also positive for CD4 and CD68. In addition, there were scattered S100-positive histiocytes throughout the tumor. Proliferative index highlighted by Ki67 immunostain was 1.6%. There were no high-grade changes such as frequent mitoses, necrosis, or brain parenchymal invasion in the specimen. With review of the literature, we propose that this type of meningioma should be considered as a separate subtype of meningioma. The biological basis and differential diagnosis are discussed.
Insights
This study details a rare case of histiocytic meningioma in a 55-year-old woman, characterized by significant histiocytic infiltration. Researchers propose classifying this distinct meningioma subtype based on its unique pathological features.
Area of Science:
- Neuropathology
- Oncology
- Histopathology
Background:
- Meningiomas are typically slow-growing tumors arising from the meninges.
- Histiocytic changes within meningiomas are exceptionally uncommon, presenting diagnostic challenges.
Observation:
- A 55-year-old female presented with a four-year history of progressive headache and cognitive decline.
- MRI revealed a well-defined, contrast-enhancing lesion in the right superior frontoparietal region.
- Histopathological analysis showed a meningioma with approximately 50% histiocytic infiltration.
Findings:
- Immunohistochemistry confirmed neoplastic meningothelial cells and histiocytic cells expressing epithelial membrane antigen (EMA).
- Histiocytic cells were positive for CD4 and CD68, with scattered S100-positive cells.
- The Ki67 proliferation index was low (1.6%), with no signs of high-grade malignancy or invasion.
Implications:
- The findings suggest that histiocytic meningioma may represent a distinct subtype requiring specific diagnostic criteria.
- Further research into the biological basis and differential diagnosis of this rare entity is warranted.
- Accurate classification is crucial for appropriate patient management and prognosis.
