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Meningeal meningiomatosis in a child: case report
A M Avellino1, L S Hair, W F Symmans
1Department of Pathology (Division of Neuropathology), Columbia Presbyterian Hospital, College of Physicians and Surgeons, New York, NY.
Abstract:
We report a child with multifocal meningeal lesions demonstrating mixed meningiomatous histologic features. This lesion appears to have evolved over seven years, starting with a brief episode of garbled speech, nausea, and headache at 4.5 years of age. The child was then asymptomatic until 9 when she presented with bilateral leg weakness, in addition to her prior presenting symptoms and communicating hydrocephalus. Meningeal biopsies of two lesions were performed 18 months later. Immunohistochemistry and electron microscopy were needed to substantiate the histologic diagnosis. Radiation therapy to the craniospinal axis and corticosteroids were of some benefit, but more aggressive therapeutic modalities became necessary. The nosology of this lesion is discussed.
Insights
This case study details a rare pediatric multifocal meningioma evolving over seven years. Aggressive treatment was necessary for this complex central nervous system lesion.
Area of Science:
- Pediatric Neurology
- Neuro-oncology
- Histopathology
Background:
- Meningiomas are typically benign tumors arising from meningeal tissues.
- Multifocal meningiomas are rare, especially in pediatric populations.
- Understanding the evolution and behavior of rare CNS tumors is crucial for effective management.
Observation:
- A child presented with initial symptoms of garbled speech, nausea, and headache at 4.5 years old.
- The patient later developed bilateral leg weakness, communicating hydrocephalus, and persistent headaches at age 9.
- Multifocal meningeal lesions with mixed meningiomatous features were identified.
Findings:
- Histologic examination of meningeal biopsies revealed mixed meningiomatous features.
- Immunohistochemistry and electron microscopy were essential for definitive diagnosis.
- The lesion demonstrated a progressive, evolving nature over a seven-year period.
Implications:
- This case highlights the diagnostic challenges and prolonged clinical course of rare pediatric multifocal meningiomas.
- Effective management required a combination of radiation therapy, corticosteroids, and more aggressive therapeutic modalities.
- Further research into the nosology and treatment strategies for such rare CNS tumors is warranted.