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Published on: January 9, 2019
Meningeal Hemangiopericytomas and Meningomas: a Comparative Immunohistochemical and Genetic Study
Saoussen Trabelsi1, Nadia Mama, Maroua Chourabi
1Department of Cytogenetics, Molecular Genetics and Reproductive Biology, Farhat Hached University Hospital, Sousse, Tunisia
Background:
The meningeal hemangiopericytoma (MHPC) is a vascular tumor arising from pericytes. Most intracranial MHPCs resemble meningiomas (MNGs) in their clinical presentation and histological features and may therefore be misdiagnosed, despite important differences in prognosis.
Materials And Methods:
We report 8 cases of MHPC and 5 cases of MNG collected from 2007 to 2011 from the Neuro-Surgery and Histopathology departments. All 13 samples were re reviewed by two independent pathologists and investigated by immunohistochemistry (IHC) using mesenchymal, epithelial and neuro-glial markers. Additionally, we screened all tumors for a large panel of chromosomal alterations using multiplex ligation probe amplification (MLPA). Presence of the NAB2-STAT6 fusion gene was inferred by immunohistochemical staining for STAT6.
Results:
Compared with MNG, MHPCs showed strong VIM (100% of cases), CD99 (62%), bcl-2 (87%), and p16 (75%) staining but only focal positivity with EMA (33%) and NSE (37%). The p21 antibody was positive in 62% of MHPC and less than 1% in all MNGs. MLPA data did not distinguish HPC from MNG, with PTEN loss and ERBB2 gain found in both. By contrast, STAT6 nuclear staining was observed in 3 MHPC cases and was absent from MNG.
Conclusions:
MNG and MHPC comprise a spectrum of tumors that cannot be easily differentiated based on histopathology. The presence of STAT6 nuclear positivity may however be a useful diagnostic marker.
Insights
Meningeal hemangiopericytoma (MHPC) and meningioma (MNG) are difficult to distinguish. STAT6 nuclear positivity may serve as a key diagnostic marker for MHPC, aiding in accurate diagnosis and prognosis.
Area of Science:
- Neuro-oncology
- Pathology
- Genetics
Background:
- Meningeal hemangiopericytoma (MHPC) and meningioma (MNG) share clinical and histological similarities, leading to potential misdiagnosis.
- MHPC and MNG have distinct prognoses, highlighting the need for accurate differentiation.
Purpose of the Study:
- To investigate the diagnostic utility of immunohistochemical markers and chromosomal alterations in differentiating MHPC from MNG.
- To identify reliable markers for distinguishing between these two challenging tumor types.
Main Methods:
- Retrospective analysis of 8 MHPC and 5 MNG cases.
- Immunohistochemistry (IHC) using various markers (mesenchymal, epithelial, neuro-glial).
- Multiplex ligation probe amplification (MLPA) for chromosomal alterations and STAT6 nuclear staining for NAB2-STAT6 fusion gene inference.
Main Results:
- MHPCs showed distinct IHC profiles compared to MNGs, with strong VIM, CD99, bcl-2, and p16 positivity.
- The p21 antibody was significantly more positive in MHPC (62%) than in MNG (<1%).
- STAT6 nuclear staining was observed in MHPC cases but absent in MNG, suggesting its potential as a diagnostic marker.
Conclusions:
- Histopathological differentiation between MNG and MHPC can be challenging.
- STAT6 nuclear positivity emerges as a potentially valuable diagnostic marker for MHPC, aiding in accurate diagnosis.
