Type III cutaneous atypical meningioma of the scalp

Area of Science:

• Dermatopathology
• Neurosurgery
• Oncology

Background:

• Meningiomas are tumors arising from the meninges.
• Extracranial meningiomas, particularly cutaneous ones, are rare and can mimic other spindle-cell tumors.
• Cutaneous meningiomas are classified into three types based on origin: congenital, ectopic, and direct extension.

Observation:

• A 71-year-old woman presented with a painful, enlarging lesion on her left central frontal scalp.
• Biopsy revealed a spindle cell neoplasm with whorled nests, increased mitotic activity, hypercellularity, and sheeted architecture.
• Magnetic resonance imaging showed a left frontal tumor eroding through the skull.

Findings:

• Histopathologic findings were consistent with an atypical meningioma (World Health Organization grade 2).
• Atypical meningiomas represent 5% to 15% of all meningiomas.
• The tumor involved both soft tissue and bone.

Implications:

• Cutaneous meningioma should be included in the differential diagnosis for spindle-cell neoplasms of the skin and subcutaneous tissue, especially in the head and neck region.
• Accurate diagnosis is crucial for appropriate management and patient outcomes.
• This case underscores the importance of recognizing rare tumor presentations.