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Primary mediastinal atypical meningioma: report of a case and literature review.

Mogi A, Hirato J, Kosaka T, Yamaki E, Kuwano H - World J Surg Oncol (2012)

Bottom Line: On the other hand, primary ectopic meningiomas are extremely rare and usually limited to the head and neck region or to the paravertebral soft tissues.Their occurrence in the mediastinum is even rarer.The clinical features, treatment, pathological findings, and prognosis are analyzed, and the literature on ectopic meningioma is reviewed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. akmogi@showa.gunma-u.ac.jp

ABSTRACT
Meningiomas are common neoplasms arising from the central nervous system meninges. On the other hand, primary ectopic meningiomas are extremely rare and usually limited to the head and neck region or to the paravertebral soft tissues. Their occurrence in the mediastinum is even rarer. Until now, only 4 cases of primary mediastinal meningioma have been reported in the literature searched on Medline. Because of its rarity and intriguing pathogenesis, we report here a case of primary mediastinal meningioma that was treated by surgical resection. The clinical features, treatment, pathological findings, and prognosis are analyzed, and the literature on ectopic meningioma is reviewed.

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Numerous typical whorl formations (A) and small cells with a high nuclear/cytoplasmic ratio (B) were observed in the tumor. Spontaneous necrosis was occasionally seen (C). The tumor was partially involved in the adjacent pulmonary parenchyma (D). There were some mitotic figures, and the Ki-67/MIB-1 labeling index was approximately 7% in relatively higher positive-rate fields (E). Marked immunoreactivity for epithelial membrane antigen (EMA) was seen (F).
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Figure 3: Numerous typical whorl formations (A) and small cells with a high nuclear/cytoplasmic ratio (B) were observed in the tumor. Spontaneous necrosis was occasionally seen (C). The tumor was partially involved in the adjacent pulmonary parenchyma (D). There were some mitotic figures, and the Ki-67/MIB-1 labeling index was approximately 7% in relatively higher positive-rate fields (E). Marked immunoreactivity for epithelial membrane antigen (EMA) was seen (F).

Mentions: Microscopically, the tumor was partially encapsulated and composed of bundles of spindle-shaped cells with elongated nuclei and syncytial nets of tumor cells with oval nuclei. A few tumor cells had an intracellular cytoplasmic inclusion. In some areas, many typical whorl formations for fibrous meningioma were observed (Figure 3A). There were several foci of small cells with a high nuclear/cytoplasmic ratio (Figure 3B). Spontaneous and zonal necroses were occasionally seen (Figure 3C). In addition, the tumor involved adjacent pulmonary parenchyma (Figure 3D). The mitotic index was four per 10 high-power fields (hpf) at the areas where the mitotic figures were most frequently observed, and the Ki-67/MIB-1 labeling index was approximately 7% in relatively higher positive-rate fields (Figure 3E). Immunohistochemical examinations showed positivity to EMA (Figure 3F) and vimentin, focal positivity to S-100, CD34, and D2-40, and negativity to αSMA and desmin. Some oval tumor cells containing large cell bodies were stained for synaptophysin and neurofilament.


Primary mediastinal atypical meningioma: report of a case and literature review.

Mogi A, Hirato J, Kosaka T, Yamaki E, Kuwano H - World J Surg Oncol (2012)

Numerous typical whorl formations (A) and small cells with a high nuclear/cytoplasmic ratio (B) were observed in the tumor. Spontaneous necrosis was occasionally seen (C). The tumor was partially involved in the adjacent pulmonary parenchyma (D). There were some mitotic figures, and the Ki-67/MIB-1 labeling index was approximately 7% in relatively higher positive-rate fields (E). Marked immunoreactivity for epithelial membrane antigen (EMA) was seen (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3278378&req=5

Figure 3: Numerous typical whorl formations (A) and small cells with a high nuclear/cytoplasmic ratio (B) were observed in the tumor. Spontaneous necrosis was occasionally seen (C). The tumor was partially involved in the adjacent pulmonary parenchyma (D). There were some mitotic figures, and the Ki-67/MIB-1 labeling index was approximately 7% in relatively higher positive-rate fields (E). Marked immunoreactivity for epithelial membrane antigen (EMA) was seen (F).
Mentions: Microscopically, the tumor was partially encapsulated and composed of bundles of spindle-shaped cells with elongated nuclei and syncytial nets of tumor cells with oval nuclei. A few tumor cells had an intracellular cytoplasmic inclusion. In some areas, many typical whorl formations for fibrous meningioma were observed (Figure 3A). There were several foci of small cells with a high nuclear/cytoplasmic ratio (Figure 3B). Spontaneous and zonal necroses were occasionally seen (Figure 3C). In addition, the tumor involved adjacent pulmonary parenchyma (Figure 3D). The mitotic index was four per 10 high-power fields (hpf) at the areas where the mitotic figures were most frequently observed, and the Ki-67/MIB-1 labeling index was approximately 7% in relatively higher positive-rate fields (Figure 3E). Immunohistochemical examinations showed positivity to EMA (Figure 3F) and vimentin, focal positivity to S-100, CD34, and D2-40, and negativity to αSMA and desmin. Some oval tumor cells containing large cell bodies were stained for synaptophysin and neurofilament.

Bottom Line: On the other hand, primary ectopic meningiomas are extremely rare and usually limited to the head and neck region or to the paravertebral soft tissues.Their occurrence in the mediastinum is even rarer.The clinical features, treatment, pathological findings, and prognosis are analyzed, and the literature on ectopic meningioma is reviewed.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. akmogi@showa.gunma-u.ac.jp

ABSTRACT
Meningiomas are common neoplasms arising from the central nervous system meninges. On the other hand, primary ectopic meningiomas are extremely rare and usually limited to the head and neck region or to the paravertebral soft tissues. Their occurrence in the mediastinum is even rarer. Until now, only 4 cases of primary mediastinal meningioma have been reported in the literature searched on Medline. Because of its rarity and intriguing pathogenesis, we report here a case of primary mediastinal meningioma that was treated by surgical resection. The clinical features, treatment, pathological findings, and prognosis are analyzed, and the literature on ectopic meningioma is reviewed.

Show MeSH
Related in: MedlinePlus