Extracerebral Pterional Metastasis from Malignant Meningioma: A Case Report

Anaplastic or malignant meningiomas that are classified as World Health Organization (WHO) grade III account for less than 1% of all meningiomas diagnosed. Despite the aggressive course, distant metastases are a rarity, occurring in only 0.1% to 0.2% of cases. We report the case of a 56-year-old woman who presented with parasagittal benign meningioma that underwent malignant transformation along with metastasis into the right orbitosphenoid region. The clinical, radiological, and histopathological aspects are highlighted, with an emphasis on the natural history of meningiomas.

Lymphoplasmacyte-Rich Meningioma of the Third Ventricle: Case Report

Introduction Meningiomas are the most common primary intracranial tumors, accounting for up to 35% of the neoplasms in this category. Approximately 10­20% of these neoplasms are histologically atypical, and the lymphoplasmacyte-rich meningioma (LPM) corresponds to a very rare subtype of meningioma that is characterized histopathologically by massive infiltrates of inflammatory cells. The case described in the present study is the sixth case of an intraventricular LPM found in the literature and the first case considering the location in the third ventricle. Case Description A 21-year-old male without previous comorbidities sought medical attention due to visual impairment (complaining of intermittent visual blur) for 2 months. A magnetic resonance imaging of the brain confirmed the presence of a well-delimited solid mass in the third ventricle of 3.0 2.3 cmwith a cystic component that extended itself inferiorly and distorted the visual pathway anatomy. Neurosurgeons decided to access the lesion using an interhemispheric transcallosal approach with a transforaminal access, and the lesion was resected completely. The patient has an ambulatorial endocrinological follow-up and is neurologically stable 6 months after the procedure. No new visual deficits were noted. Conclusion Lymphoplasmacyte-rich meningioma is a very rare intracranial tumor, and the involvement of the third ventricle make this case unique.

Chordoid Meningioma: Literature Review

Chordoid meningiomas (CMs) are a rare subgroup of tumors, accounting for 0.5% of all meningiomas. Chordoid meningioma tumors correspond to World Health Organization (WHO) Grade II lesions and behave aggressively, with an increased likelihood of recurrence. There are few genetic studies about CMs, but we understand that there is deletion at many chromosomal loci. Histologically, CMs are characterized by strands and cords of meningothelial cells arranged in a mucinous stroma. Morphologically, it can mimic other chondroid and myxoid tumors within the brain and its vicinity, thus posing a diagnostic challenge. Chordoid meningiomas have an aggressive clinical course and a propensity to recur compared with classical meningiomas. The goal of the treatment is surgery, with total resection of the tumor; however, due to its high degree of recurrence, radiotherapy is often necessary as an adjuvant treatment.

Grade I meningiomas with atypical characteristics: a worse prognosis / Meningiomas grau I com características atípicas: um pior prognóstico

ABSTRACT The study reviewed the histology of cases of grade I meningiomas with spontaneous necrosis, grade I without necrosis and grade II meningiomas, to evaluate the histological and immunohistochemical factors of the patients' prognosis, while correlating the clinicopathological features with the clinical follow-up of the patients. A review of 47 cases from the Department of Pathology of UNIFESP was performed and the samples were submitted to immunohistochemical examination with the p53 protein, Ki-67 cell proliferation factor and progesterone receptor markers. A greater expression was found in the progression of several degrees of aggressiveness for p53 and Ki-67, and a higher frequency of progesterone receptors in the lower degrees. The group of grade I meningiomas with spontaneous necrosis showed histological and immunohistochemical indexes that approximate those of the grade II meningioma. This suggests a worse prognosis for grade I meningiomas with necrosis.

RESUMO O objetivo do estudo foi realizar a revisão histológica de casos de meningiomas grau I com necrose espontânea, grau I sem necrose e grau II para avaliar os fatores histológicos e imunohistoquímicos de prognóstico dos pacientes, correlacionando informações no âmbito clínico-patológico com o seguimento clínico dos pacientes. Foi realizada revisão de 47 casos do Departamento de Patologia da UNIFESP e as amostras foram submetidas a exame imunohistoquímico com os marcadores proteína p53, fator de proliferação celular Ki-67 e receptor de progesterona. Verificou-se maior expressão na progressão dos diversos graus de agressividade para p53 e Ki-67 e maior frequência de receptores de progesterona nos menores graus. O grupo dos meningiomas grau I com necrose espontânea apresentou índices histológicos e imuno-histoquímicos que se aproximam dos meningiomas grau II. Isto sugere um pior prognóstico dos meningiomas grau I com necrose.

Expression of merlin, NDRG2, ERBB2, and c-MYC in meningiomas: relationship with tumor grade and recurrence

Meningiomas are common, usually benign tumors of the central nervous system that have a high rate of post-surgical recurrence or regrowth. We determined expression of the proteins merlin, NDRG2, ERBB2, and c-MYC in meningiomas using immunohistochemistry and assessed relationships between protein expression and gender, age, tumor grade, and recurrence or regrowth. The study sample comprised 60 patients, (44 women and 16 men) with a mean age of 53.2±12.7 years. Tumors were classified as grade I (n=48) or grades II and III (n=12). Expression of merlin, NDRG2, ERBB2, and c-MYC was not significantly different statistically with relation to gender, age, or meningioma recurrence or regrowth. Merlin was expressed in 100% of the cases. No statistically significant difference between tumor grade and recurrence or regrowth was identified. Statistically significant differences were identified between the mean age of patients with grade I (54.83±11.60) and grades II and III (46.58±15.08) meningiomas (P=0.043), between strong c-MYC expression and grades II and III (P<0.001), and between partial surgical resection and tumor recurrence or regrowth (P<0.001). These findings reveal the lower mean age among grades II and III meningioma patients than grade I patients, the influence of the protein merlin on tumorigenesis, the association of c-MYC with aggressive meningiomas, and that partial surgical resection is associated with tumor recurrence or regrowth.

Liver metastasis of meningeal hemangiopericytoma: a study of 5 cases

Mesenchymal tumors in the liver, whether primary or metastatic, are rare. Meningeal hemangiopericytoma (HPC) is characteristically associated with delayed metastasis and the liver is one of the most common sites. Despite its consistent histological features, a pathological diagnosis of HPC in the liver is sometimes not straightforward due to its rarity and usually remote medical history of the primary meningeal tumor. In this report, the clinicopathological features of 5 cases of metastatic HPC to the liver were reviewed and described.

Surgical Treatment for Falcotentorial Meningiomas

Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomas and provide a review of our experience.

Foramen magnum meningiomas: surgical treatment in a single public institution in a developing country / Meningiomas do forame magno: tratamento cirúrgico em uma instituição pública em um país em desenvolvimento

Objective: To analyze the clinical outcome of patients with foramen magnum (FM) meningiomas. Method: Thirteen patients (11 Feminine / 2 Masculine with FM meningiomas operated on through lateral suboccipital approach were studied. Clinical outcome were analyzed using survival (SC) and recurrence-free survival curves (RFSC). Results: All tumors were World Health Organization grade I. Total, subtotal and partial resections were acchieved in 69.2%, 23.1% and 7.7%, respectively, and SC was better for males and RFSC for females. Tumor location, extent of resection and involvement of vertebral artery/lower cranial nerves did not influence SC and RFSC. Recurrence rate was 7.7%. Operative mortality was 0. Main complications were transient (38.5%) and permanent (7.7%) lower cranial nerve deficits, cerebrospinal fluid fistula (30.8%), and transient and permanent respiratory difficulties in 7.7% each. Conclusions: FM meningiomas can be adequately treated in public hospitals in developing countries if a multidisciplinary team is available for managing postoperative lower cranial nerve deficits. .

Objetivo: Analisar as evoluções clínicas de 13 pacientes com meningiomas do forame magno (FM). Método: Foram estudados 13 pacientes com meningiomas do FM (11 Feminino / 2 Masculino) operados por abordagem suboccipital lateral. As evoluções clínicas foram analisadas usando curvas de sobrevida (SC) e de sobrevida livre de doença (RFSC). Resultados: Os 13 tumores eram Grau I da Organização Mundial de Saúde. Ressecções total, subtotal and parcial foram obtidas em 69,2%, 23,1 e 7,7%, respectivamente. A SC foi melhor para homens e a RFSC foi melhor para mulheres. Localização/ extensão da ressecção/envolvimento da artéria vertebral/nervos cranianos baixos não influenciaram a SC/RFSC. A taxa de recorrência foi 7,7%. A mortalidade operatória foi zero. As principais complicações foram déficits de nervos cranianos baixos transitórios (38,5%) e permanentes (7,7%); fístula de líquido cefalorraquidiano (30,8%) e dificuldades respiratórias transitórias e permanentes em 7,7% cada. Conclusões: Meningiomas do FM podem ser adequadamente tratados em hospitais públicos em países em desenvolvimento se houver uma equipe multidisciplinar para cuidar de déficits de nervos cranianos baixos pós-operatórios. .

Spinal Meningeal Melanocytoma with Benign Histology Showing Leptomeningeal Spread: Case Report

Meningeal melanocytoma is a rare benign tumor with relatively good prognosis. However, local aggressive behavior of meningeal melanocytoma has been reported, especially in cases of incomplete surgical resection. Malignant transformation was raised as possible cause by prior reports to explain this phenomenon. We present an unusual case of meningeal melanocytoma associated with histologically benign leptomeningeal spread and its subsequent aggressive clinical course, and describe its radiological findings.

Peritumoral brain edema in intracranial meningiomas / Edema peritumoral em meningiomas intracranianos

Occurrence of peritumoral brain edema (PBE) in meningiomas has been associated with several factors in recent years, although its pathophysiological mechanism has not yet been fully elucidated. The aim of this study was to analyze the correlation between the presence / degree of PBE and factors such as gender, age, size and histological subtype of tumor. We analyzed the MRI images of 74 patients operated on Hospital Beneficência Portuguesa de Porto Alegre for the presence / degree of PBE and data was statistically correlated with the parameters of the patient. PBE was present in 70.1 percent of patients. Tumors with higher volume had more PBE. Tumors of the olfactory groove showed more PBE than sphenoid wing and parassagittal tumors. Transitional subtype showed more PBE than fibroblastic and meningothelial subtypes.

A presença de edema cerebral peritumoral (ECP) em meningiomas tem sido associada a diversos fatores nos últimos anos, embora o seu mecanismo fisiopatológico ainda não tenha sido inteiramente elucidado. O objetivo desse estudo foi analisar a correlação entre a presença/grau de ECP e fatores como sexo, idade, volume e subtipo histológico do tumor. Foram analisadas imagens de RM de 74 pacientes operados no Hospital Beneficência Portuguesa de Porto Alegre quanto à presença/grau de ECP e os dados correlacionados estatisticamente com os parâmetros do paciente. ECP estava presente em 70,1 por cento dos pacientes. Tumores com maior volume apresentaram mais ECP. Tumores da goteira olfatória apresentaram mais ECP que os da asa do esfenóide e que os parassagitais. Meningiomas transicionais apresentaram mais ECP que os fibroblásticos e que os meningoteliais.

Cirugía de los meningiomas intracraneales en el Servicio de Neurocirugía del Hospital Provincial Docente "Manuel Ascunce Domenech" / Intracraneal meningiona surgery at the Neurosurgery Service of Provincial Academic Hospital Manuel Ascunce Domenech

Se realizó un estudio descriptivo observacional de todos los pacientes diagnosticados de meningiomas Intracraneales en el Servicio de Neurocirugía del Hospital provincial Docente "Manuel Ascunce Domenech". Se determinó que los meningiomas Intracraneales resultaron más frecuentes en mujeres de la cuarta y quinta décadas de la vida, la cefalea, el déficit motor y las alteraciones mentales fueron los signos y síntomas neurológicos de mayor incidencia. La localización más frecuente de la lesión fue la de la convexidad frontal y resultó ser la de mejor grado de resección quirúrgica. El meningioma meningotelial, seguido del psamomatoso fueron los tipos histológicos predominante y las complicaciones respiratorias, la fístula de LCR y la sepsis quirúrgica ocuparon el primer lugar en cuanto a complicaciones. Se discuten y comparan estos resultados con la literatura nacional e internacional.

A descriptive observational study was run on all patients with intracranial meningiomas diagnosis at the Neurosurgery Department of the Academic Hospital "Manuel Ascunce Domenech". The result was that intracranial meningiomas are more frequent in women in their forties and fifties, migraine, motor deficit and mental disturbances were the neurological signs and symptoms of main incidence. The most frequent location of the lesion was the frontal convexity and proved to be of the best level of surgical resection. The meningiothelial meningioma followed by the psammomatous were the predominant histological types as well as the respiratory complications. As for complications the CSV fistula and surgical sepsis were on the first place. These results are discussed and compared with national and international literature.

Multiple intracranial meningiomas: diagnosis, biological behavior and treatment / Meningiomas intracranianos múltiplos: diagnóstico, comportamento biológico e tratamento

Multiple intracranial meningiomas (MIM) are a rare pathology when not associated with neurofibromatosis. The prevalence rate of those tumors varied from 2.3 to 8.9 percent of all intracranial meningiomas. OBJECTIVE: To present, analyze and discuss the cases of seven patients diagnosed with multiple intracranial meningiomas, describing their clinical and histological characteristics, as well as their biological behavior. METHOD: The patients records, surgical descriptions, imaging studies and the histopathological exams were retrospectively reviewed. This is the largest series of MIM publisted in Brazil. RESULTS: This sample consists of five women and two men. The age varied from 42 to 84 (average 53.8). Twenty-two meningiomas were identified and varied from 1.5 to 192 cm³, with an 62.8 cm³ average volume. The number of procedures varied from 1 to 5 per patient. No surgical death occurred in this series. CONCLUSION: Despite the multiplicity of tumors, number of recurrences, the new tumors, repeated operations and re-operations, radiotherapy and a number of postoperative complications, the patients experienced a long survival in conjunction with a fairly good quality of life.

Os meningiomas intracranianos múltiplos são tumores raros quando não associados a neurofibromatose, correspondem de 2,3 a 8,9 por cento de todos os meningiomas intracranianos. OBJETIVO: Apresentar, analisar e discutir 7 pacientes com diagnóstico de meningioma intracraniano múltiplo, descrevendo as características clínicas, histológicas e o comportamento biológico desses tumores. MÉTODO: Trata-se de revisão retrospectiva incluindo a análise dos prontuários, das descrições cirúrgicas, dos estudos de imagem e do material histopatológico. Esta série é a maior série de meningiomas intracranianos múltiplos publicada no Brasil. RESULTADOS: A casuística é composta de 5 mulheres e 2 homens. A idade oscilou entre 42 e 84 anos, com média de 53,8 anos. Identificamos 22 meningiomas que variaram de 1,5 a 192 cm³, com volume médio de 62,8 cm³. O número de procedimentos oscilou de 1 a 5 por paciente. Não ocorreu mortalidade cirúrgica. CONCLUSÃO: Apesar de vários tumores, de recorrências, do surgimento de novas neoplasias, de várias cirurgias, re-operações, do tratamento com radioterapia e de inúmeras complicações pós-operatórias, esses pacientes obtiveram uma longa sobrevida com boa qualidade de vida.