- Department of Neurosurgery, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
- Department of Pathology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
Department of Pathology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
DOI:10.4103/2152-7806.97007Copyright: © 2012 Kashimura H. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Kashimura H, Mase T, Ogasawara K, Kurose A. Unusual growth pattern of a meningioma. Surg Neurol Int 09-Jun-2012;3:63
How to cite this URL: Kashimura H, Mase T, Ogasawara K, Kurose A. Unusual growth pattern of a meningioma. Surg Neurol Int 09-Jun-2012;3:63. Available from: http://sni.wpengine.com/surgicalint_articles/unusual-growth-pattern-of-a-meningioma/
Background:Rhabdoid meningioma exhibits high mitotic activity, anaplasia, and increased markers of cell proliferation. Here we describe a rhabdoid meningioma with a pattern of growth extending into the subarachnoid space and filled the cortical sulci.
Case Description:A 72-year-old woman presented with headache and was admitted to our hospital. Neurologic and physical examinations revealed no abnormalities. Contrast-enhanced axial T1-weighted images showed a well-enhanced, dural-based mass compressing the right temporal and frontal lobes, and extending into the sylvian cistern and filling the cortical sulci. The patient underwent partial resection and the histologic findings demonstrated rhabdoid meningioma.
Conclusion:Although this type of tumor is known to be aggressive in its growth, extension into the adjacent cisternal space and the filling of the cortical sulci are rare. The combination of histologic anaplasia with the highest reported proliferation rate, loss of cohesion of neoplastic cells, and the location of the tumor led to the unique growth pattern.
Keywords: Magnetic resonance imaging, meningioma, rhabdoid
Meningiomas arise from meningothelial cells on the arachnoidal membrane, grow slowly, and then finally compress the adjacent brain. Most meningiomas grow inward toward the brain as discrete well-defined, dural-based masses and are spherical or lobulated. The borders between the tumor and the brain are usually round and clear because they preserve the histologic structures, such as the tumor capsule, cerebrospinal fluid, arachnoid mater, and pia mater.[
Here we describe a case of rhabdoid meningioma that showed a unique growth pattern. The tumor extended into the subdural space and filled the cortical sulci.
A 72-year-old woman presented with headache and was admitted to our hospital. Neurologic and physical examinations demonstrated no abnormality. Computed tomography scans showed an abnormal mass lesion in the right frontotemporal convexity region. The lesion was surrounded by marked cerebral edema. Mass effect was noted on the midbrain. Magnetic resonance (MR) imaging showed a mass with a similar signal intensity on the T1-weighted image and high signal intensity on the T2-weighted image [
Axial T2-weighted magnetic resonance image showing significant perilesional edema (a). Axial enhanced T1-weighted magnetic resonance images (b) showing a well-enhanced, dural-based mass compressing the right temporal and frontal lobes, extending into the sylvian cistern (arrows) and filling the cortical sulci (arrow heads). It is specifically these subarachnoid components of the tumor in the sulci that showed relatively little mass effect. Coronal and sagittal enhanced T1-weighted images also showed unusual enhancement patterns (c, d)
The patient underwent a right frontotemporal craniotomy, and the tumor was partially resected. The removed specimens consisted of the tumor tissues only, and did not include the surrounding brain tissues. Microscopically, dyscohesiveness of tumor cells was observed. The tumor was globally composed of rhabdoid cells showing large eosinophilic cytoplasm and eccentrically placed, medium-sized round nuclei with prominent nucleoli [
Rhabdoid meningioma is a relatively rare tumor. It was classified as a WHO grade III tumor in 2000, along with papillary and anaplastic meningioma. It is a pathologic diagnosis with the presence of loosely cohesive cells with eccentric nuclei and hyaline, paranuclear inclusions being characteristic.[
Many radiographic patterns of meningioma have been reported, but the present case is quite rare. Several patients have presented with tumors that showed a unique infiltrating morphology. The borders between the tumor and the brain were unclear but seemed to be fused together, which resulted in a brush-like appearance on MR images. Investigators have speculated that the tumor infiltrate into the Virchow–Robin spaces might serve as a conduit for the spread of the tumor process.[
The management of malignant meningioma has included maximal surgical debulking followed by radiation therapy with or without systemic chemotherapy. We suggest that it would be difficult to completely resect such a tumor without causing additional neurologic disabilities. Thus, we resected the temporal mass lesion, and fractional radiation was targeted to the residual tumor. We continue to monitor the patient closely with surveillance imaging and clinical examination.
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