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[Atypical meningioma with xanthogranulomatous stromal reaction]
Abstract:
A case of atypical meningioma with xanthogranulomatous stromal reaction was described in a 37 year-old man. At the age of 18, the patient started to have seizures. He became aware of disturbances in gait since 27 years of age. At the age of 37 he came to the hospital for detailed examinations and adequate treatment. EEG showed focal spikes at right temporal area and the CT scan disclosed abnormalities indicating the presence of a right posterior temporal mass. At craniotomy, a tumor was found located over the surface of right temporal lobe. It was well-circumscribed, firm in consistency and was attached to the dura, measuring 3cm in its greatest diameter. Gross total removal was accomplished. On cut section, the tumor was greyish in color mottled variously with yellow or rustbrown tint. It contained a cyst. Microscopically, the tumor was made up of compact masses of spindle-shaped or polygonal cells. The cells were arranged in areas in interlacing fascicles or forming whorles. In many places the tumor showed pleomorphic cytology. Mitotic figures were found few in number. The cytoplasm of the neoplastic cells appeared groundglass-like. Some of them contained hyaline globules. The globules were found to react positive with P.A.S. technique, and this procedure was resistant against diastase digestion. They were also stained positive with P.T.A.H. stain. In some areas foamy xanthomatous cells were found in groups. A large number of lymphocytes, plasma cells, eosinophiles and macrophages ingesting brownish pigments were found infiltrating around vascular vessels.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
This case study describes an atypical meningioma with a rare xanthogranulomatous stromal reaction in a 37-year-old male. Surgical removal was successful, highlighting a unique presentation of this brain tumor.
Area of Science:
- Neuropathology
- Neurosurgery
- Oncology
Background:
- Meningiomas are tumors that arise from the meninges, the membranes that surround the brain and spinal cord.
- Atypical meningiomas represent a distinct subtype with a higher potential for recurrence compared to typical meningiomas.
- Xanthogranulomatous stromal reaction is an uncommon finding in meningiomas, characterized by the presence of lipid-laden macrophages.
Observation:
- A 37-year-old male presented with a history of seizures and gait disturbances.
- Diagnostic imaging revealed a right posterior temporal mass, confirmed as an atypical meningioma during surgery.
- Microscopic examination showed neoplastic cells with pleomorphic cytology, groundglass-like cytoplasm, and hyaline globules, alongside foamy xanthomatous cells and inflammatory infiltrates.
Findings:
- The atypical meningioma exhibited a significant xanthogranulomatous stromal reaction.
- Hyaline globules within neoplastic cells stained positive with Periodic acid–Schiff (P.A.S.) and PTAH, resistant to diastase.
- The tumor was successfully and completely removed via craniotomy.
Implications:
- This case expands the understanding of meningioma histopathology, particularly the xanthogranulomatous variant.
- Accurate diagnosis and complete surgical resection are crucial for managing atypical meningiomas.
- Further research may elucidate the role of xanthogranulomatous changes in meningioma behavior and prognosis.