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Rare Intracranial Recurrent Meningioma with Unique Coexisting Atypical, Papillary and Lipomatous Component: Case
Niamathullah Sadiya1, Swatee Halbe2, Mitra Ghosh1
1Department of Histopathology, Apollo Speciality Hospital, Vanagaram, Chennai, India.
Background:
Meningiomas are common central nervous system tumors with a wide range of morphologic variants, the pathogenesis being their complex embryogenesis. Intracranial meningiomas with heterogenous histopathology in the same lesion are common in low-grade meningiomas but less frequent in recurrent and high-grade variants.
Case Description:
A 75-year-old male presented elsewhere a year ago with complaints of slurred speech. Magnetic resonance imaging revealed a left frontotemporal, dural-based, extraaxial, solid cystic lesion with doubtful infiltration into the adjacent brain parenchyma. A subtotal excision was done. A diagnosis of meningioma with an aggressive biological behavior was rendered on histology, but the grade was deferred, in view of a single focus of small cell formation and no adjacent brain parenchyma to comment on invasion. The patient presented here with recurrence of his original symptoms. Magnetic resonance imaging of the brain with contrast revealed 2 dural-based, solid cystic enhancing lesions of sizes 29 mm × 25 mm × 24 mm and 25 mm × 16 mm seen at the left frontal region, indenting the adjacent brain parenchyma with diffuse meningeal thickening in the postoperative bed. Microscopy revealed a hypercellular meningeal neoplasm with increased mitosis and a pseudopapillary pattern with lipomatous changes.
Conclusions:
To date there are no case reports in current literature with such rare combinations in a recurrent meningioma. This highlights the multipotency of phenotypic transformation of primary meningothelial cells. The presence of papillary features, even if focal, should be quantified in the diagnosis. This is of importance because the most current literature suggests that meningioma harboring a papillary component has an increased risk of recurrence and progression to aggressive behavior.
Insights
This case report details a rare recurrent meningioma with aggressive features and mixed histopathology. Early identification of papillary components is crucial for predicting meningioma recurrence and aggressive behavior.
Area of Science:
- Neuro-oncology
- Pathology
- Neurosurgery
Background:
- Meningiomas are common central nervous system tumors with diverse morphologic variants.
- Heterogeneous histopathology within a single lesion is typical of low-grade meningiomas but less common in recurrent or high-grade variants.
Observation:
- A 75-year-old male presented with recurrent symptoms due to two dural-based, solid cystic enhancing lesions in the left frontal region.
- Initial diagnosis was meningioma with aggressive biological behavior, but grading was deferred due to limited tissue and focal small cell formation.
- Microscopy of the recurrent tumor revealed a hypercellular neoplasm with increased mitosis, pseudopapillary pattern, and lipomatous changes.
Findings:
- The recurrent meningioma exhibited a rare combination of histopathological features, including papillary and lipomatous changes.
- The presence of papillary features, even focally, was noted in the recurrent tumor.
- The tumor demonstrated aggressive characteristics with increased mitosis and infiltration into adjacent brain parenchyma.
Implications:
- This case highlights the potential for phenotypic transformation in primary meningothelial cells, leading to complex recurrent meningiomas.
- Quantifying papillary features in meningioma diagnosis is critical due to their association with increased recurrence risk and aggressive behavior.
- Accurate histopathological grading and recognition of specific features like papillary components are essential for predicting meningioma prognosis and guiding treatment strategies.
