Journal of Pathology and Translational Medicine

Case Study

Intraoperative frozen cytology of intraosseous cystic meningioma in the sphenoid bone: Na Rae Kim, Gie-Taek Yie; J Pathol Transl Med. 2020;54(6):508-512. Published online July 1, 2020; DOI: https://doi.org/10.4132/jptm.2020.05.21

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Meningiomas in bone are rarely subjected to fine-needle aspiration diagnosis, and those arising in the skull bone with a cystic presentation are rare. A 24-year-old woman presented with subdural hemorrhage, and subsequent radiology depicted an osteolytic mass-like lesion in the sphenoid bone. Intraoperatively, a solid and cystic hemorrhagic lesion mimicking an aneurysmal bone cyst was observed in the sphenoid bone with dural tearing. Frozen cytology showed singly scattered or epithelioid clusters of round to elongated cells intermixed with many neutrophils. Tumor cells had bland-looking round nuclei with rare prominent nucleoli and nuclear inclusions and eosinophilic granular to globoid cytoplasm in capillary-rich fragments. Histology revealed intraosseous meningothelial and microcystic meningioma (World Health Organization grade 1) in right lesser wing of the sphenoid bone. Considering its unusual location and cytologic findings, differential diagnoses included chordoma, chondroma, chondrosarcoma, and aneurysmal bone cyst. The present case posed a diagnostic challenge due to possible confusion with these entities.

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Review

Molecular characteristics of meningiomas: Young Suk Lee, Youn Soo Lee; J Pathol Transl Med. 2020;54(1):45-63. Published online January 15, 2020; DOI: https://doi.org/10.4132/jptm.2019.11.05

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Abstract PDF

Meningioma is the most common primary intracranial tumor in adults. The grading of meningioma is based on World Health Organization criteria, which rely on histopathological features alone. This grading system is unable to conclusively predict the clinical behavior of these tumors (i.e., recurrence or prognosis in benign or atypical grades). Advances in molecular techniques over the last decade that include genomic and epigenomic data associated with meningiomas have been used to identify genetic biomarkers that can predict tumor behavior. This review summarizes the molecular characteristics of meningioma using genetic and epigenetic biomarkers. Molecular alterations that can predict meningioma behavior may be integrated into the upcoming World Health Organization grading system.

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Original Article

Expression of c-MET in Invasive Meningioma: Sumi Yun, Jae Moon Koh, Kyu Sang Lee, An Na Seo, Kyung Han Nam, Gheeyoung Choe; J Pathol Transl Med. 2015;49(1):44-51. Published online January 15, 2015; DOI: https://doi.org/10.4132/jptm.2014.10.13

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Abstract PDF

Background
Meningiomas show high recurrence rates even after curative tumor removal. The invasiveness of meningiomas may contribute to their high recurrence rates. Recently, c-MET and hepatocyte growth factor (HGF) have been reported to be involved in cancer invasion. Methods: We examined the immunohistochemical expression of c-MET and HGF in 100 cases of patients with meningiomas who have undergone complete tumor removal. Results: c-MET^-High and HGFHigh were found in 17% and 13% of meningiomas, respectively. Brain invasion was observed in 17.6% of c-MET^-High meningiomas, but in only 2.4% of c-MET^-Low meningiomas (p=.033). Bone/ soft tissue invasion was observed in 23.5% of c-MET^-High meningiomas and in 9.6% of c-MET^-Low meningiomas (p=.119). HGF^-High did not show statistical association with brain invasion or bone/ soft tissue invasion. c-MET^-High demonstrated shorter recurrence-free survival (RFS, 93.5±8.2 months vs 96.1±1.9 months); however, this difference was not statistically significant (p=.139). There was no association of HGF^-High with RFS. Conclusions: This study demonstrates that c- MET^-High is associated with brain invasion of meningiomas, and that c-MET expression may be a useful predictive marker for meningioma recurrence. Patients with invasive meningiomas with high expressions of c-MET may be good candidates for targeted therapy using c-MET inhibitors.

Citations

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Drug target therapy and emerging clinical relevance of exosomes in meningeal tumors
Swati Sharma, Rashmi Rana, Prem Prakash, Nirmal Kumar Ganguly
Molecular and Cellular Biochemistry.2024; 479(1): 127. CrossRef
The efficacy of preoperative MRI features in the diagnosis of meningioma WHO grade and brain invasion
Jun Jiang, Juan Yu, Xiajing Liu, Kan Deng, Kaichao Zhuang, Fan Lin, Liangping Luo
Frontiers in Oncology.2023;[Epub] CrossRef
The Role of Pharmacotherapy in Treatment of Meningioma: A Systematic Review
Ataollah Shahbandi, Darsh S. Shah, Caroline C. Hadley, Akash J. Patel
Cancers.2023; 15(2): 483. CrossRef
Advances in the systemic therapy for recurrent meningiomas and the challenges ahead
Yi Li, Jan Drappatz
Expert Review of Neurotherapeutics.2023; 23(11): 995. CrossRef
Clinical and pathological impact of an optimal assessment of brain invasion for grade 2 meningioma diagnosis: lessons from a series of 291 cases
Thiébaud Picart, Chloé Dumot, Jacques Guyotat, Vladislav Pavlov, Nathalie Streichenberger, Alexandre Vasiljevic, Tanguy Fenouil, Anne Durand, Emmanuel Jouanneau, François Ducray, Timothée Jacquesson, Moncef Berhouma, David Meyronet
Neurosurgical Review.2022; 45(4): 2797. CrossRef
Nomogram based on MRI can preoperatively predict brain invasion in meningioma
Jing Zhang, Yuntai Cao, Guojin Zhang, Zhiyong Zhao, Jianqing Sun, Wenyi Li, Jialiang Ren, Tao Han, Junlin Zhou, Kuntao Chen
Neurosurgical Review.2022; 45(6): 3729. CrossRef
Overexpression of Hepatocyte growth factor and its soluble receptor (s-cMet) in the serum of patients with different grades of meningioma
Farhad Mashayekhi, Soheila Talesh Sasani, Alia Saberi, Zivar Salehi
Journal of Clinical Neuroscience.2021; 93: 1. CrossRef
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Curcumin Inhibits HGF-Induced EMT by Regulating c-MET-Dependent PI3K/Akt/mTOR Signaling Pathways in Meningioma
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Letter: Brain Invasion in Meningiomas—Sex-Associated Differences are not Related to Estrogen- and Progesterone Receptor Expression
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Brain Invasion in Meningiomas: Incidence and Correlations with Clinical Variables and Prognosis
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Case Report

Diffuse Pulmonary Meningotheliomatosis: A Case Report.: Jungsuk An, Heejung Park, Joungho Han, Tae Sung Kim, Yong Soo Choi, Moon Seok Choi, Sang Won Um; Korean J Pathol. 2011;45:S32-S35.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S32

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Abstract PDF

Diffuse pulmonary meningotheliomatosis (DPM) is an extremely rare condition. We herein report a unique case of DPM in a 54-year-old woman with a previous history of hepatocellular carcinoma. A chest computed tomography showed diffuse bilateral nodular infiltration, suggesting miliary spread of metastatic hepatocellular carcinoma. The patient underwent a video-assisted thoracoscopic surgery for diagnostic purposes. The cut surface of the lung specimen showed multiple dispersed small nodules, consisting of variably sized nests or whorls of bland epithelioid cells often along the walls of alveolar septa or in a perivascular network within the alveolar interstitium. The tumor cells showed immunoreactivity for epithelial membrane antigen, vimentin, and progesterone receptor. DPM should be included in the differential diagnosis of diffuse multiple small nodules or a reticular pattern in the radiologic studies.

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Minute Pulmonary Meningothelial-Like Nodules Simulating Hematogenous Lung Metastasis: A Case Report
Sang Kook Lee, Gi Jeong Kim, Young Jae Kim, Ah Young Leem, Eu Dong Hwang, Se Kyu Kim, Joon Chang, Young Ae Kang, Song Yee Kim
Tuberculosis and Respiratory Diseases.2013; 75(2): 67. CrossRef

Original Article

Expression of Hepatocyte Growth Factor/c-met by RT-PCR in Meningiomas.: Na Rae Kim, Yang Seok Chae, Weon Jeong Lim, Seong Jin Cho; Korean J Pathol. 2011;45(5):463-468.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.5.463

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Abstract PDF: BACKGROUND
Hepatocyte growth factor (HGF) is a potent mitogenic cytokine. C-met protein, which is known to be the HGF receptor has transmembrane tyrosine kinase activity and is encoded by the c-met oncogene. The HGF/c-met signaling pathway may play various roles in the carcinogenesis of various organs.
METHODS
We examined HGF and c-met mRNA expression by utilizing reverse transcription polymerase chain reaction on 40 surgically resected intracranial meningiomas (25 benign, 10 atypical, and 5 anaplastic cases).
RESULTS
An HGF overexpression was detected in 28%, 50%, and 80% of the benign, atypical and anaplastic meningiomas, respectively; a high expression of HGF or the coexpression of HGF/c-met was detected in the high grade meningiomas (the atypical and anaplastic cases, p=0.046, p=0.014). An HGF expression was statistically significant in the recurrent meningiomas (p=0.003), and HGF expression was significantly lower than c-met mRNA expression in benign meningiomas (p=0.034).
CONCLUSIONS
There was no correlation between histologic subtypes and HGF/c-met expression. Determination of HGF expression can be used as a molecular predictor for recurrence of meningioimas. These results suggest that HGF and c-met expression in meningiomas may be associated with anaplastic progression.

Case Reports

"Chordoid" Meningioma with Systemic Manifestations of Castleman Syndrome: A case report.: Hwa Sun Lee, Hweon Ok Kim, Do Youn Park, Mee Yeong Sol, Kang Suek Suh, Sun Kyung Lee; Korean J Pathol. 1996;30(3):255-260.

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Abstract PDF: Chordoid meningioma is a recently established meningeal tumor and is characterized by a chordoma like histologic appearance, peritumoral lymphoplasma cell infiltrates causing systemic manifestations similar to Castleman syndrome and having a good prognosis. We experienced a case of chordoid meningioma in a 25 year-old woman. The patient preoperatively manifested iron-resistant hypochromic microcytic anemia, polyclonal gammopathy with beta-gamma bridging and detected a huge mass in the right temporo-parietal convexity of the brain. Microscopically, the mass was composed of nests and cords of cuboid, partly vacuolated cells in a mucoid matrix, simulating chordoma. The tumor was surrounded by masses of lymphoplasma cells around vessels, many of the plasma cells contained Russell bodies. Ultrastructural findings showed intranuclear cytoplasmic invaginations, microvilli protruding from cytoplasmic surfaces and well formed desmosomes. Some portions of tumor cell surface were covered by stretches of basal lamina.

Clear Cell Meningioma.: Hee Jeung Cha, Soo Kee Min, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 1997;31(8):782-787.

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Abstract PDF: Clear cell meningioma is a recently recognized morphologically unique entity. It shows no sex predilection, affects primarily the lumbar region, and the cerebellopontine angle. Despite its benign appearance, it may be aggressive, particularly in intracranial cases. All lesions are moderately cellular, with the exception of stromal hyalinization. The tumor consists largely of a sheet- like or somewhat lobular pattern of polygonal cells, the cytoplasm of which is clear. No close association is noted between the recurrence or the clinical outcome and factors such as mitotic activity, the PCNA index, and the DNA ploidy status. But the MIB-1 proliferation index is appreciably higher in recurrent tumors. We experienced a case of clear-cell meningioma showing a characteristic histologic finding. A 39-year-old man was admitted due to the recent onset of right-sided, facial-nerve palsy, left hemiparesis and general weakness. A CT scan of the head showed a well defined mass in the petroclival area. After surgical resection, the patient was in good condition, but 1 year later symptoms recurred. A CT scan of the head showed a huge, recurrent petroclival tumor with adhesion to the surrounding brain parenchyme.

Original Articles

Meningioma with Multiple Recurrences and Malignant Transformation Differences in expression of MIB1, p53 and progesterone receptor.: Eun Joo Seo, Hi Jeong Kwon; Korean J Pathol. 1997;31(12):1314-1316.

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Abstract PDF: We describe herein a case of meningioma showing three recurrences and in the end malignant transformation. To compare the differences of MIB1, p53 and progesterone receptor expressions in benign, recurrent and malignant meningiomas of the same patient, we performed immunohistochemical stainings for those markers. MIB1 and p53 reactivities were increased in proportion to histologic aggressiveness. By contrast, the progesterone receptor expression was noted in benign meningioma but not in malignant meningioma.

The Diagnostic Significance of AgNORs and MIB-1 Labelling Index in Atypical Meningioma.: Dae Hong Suh, Dong Sug Kim, Oh Lyong Kim; Korean J Pathol. 1998;32(11):1008-1014.

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Abstract: There is no definite histological criteria which can predict the biologic behavior of meningiomas, although resectability is the most important factor in terms of recurrence. For grading meningiomas, various factors have been studied, such as hypercellularity, nuclear pleomorphism, small cells with high N/C ratio, prominent nucleoli (PN), frequent mitosis, loss of architecture, focal necrosis (FN). We investigated 116 meningiomas to evaluate the correlation between the factors and the proliferative activity using AgNORs and MIB-1 labelling index (LI). They were divided into 3 groups: Group A includes meningiomas with none of the factors; group B with one of the factors; group C with two or more factors. MIB-1 LI was correlated with each factor, but AgNORs was not. There was a statistical difference among group A (<1.28%), B (2.7%) and C (5.1%) (p<0.05) using MIB-1 LI. FN was the most frequently associated with other factors, and it had the highest MIB-1 LI (6.31%). MIB-1 LI of group B was 5.1 2.3%. In group B, the most frequent combination was FN and PN, and it showed the highest MIB-1 LI (5.74%). This study indicates that FN and PN are important for diagnosis of atypical meningioma, and MIB-1 LI appears to be a useful method for estimating the proliferative activity of meningiomas, and 5% or more of MIB-1 LI could help in making a diagnosis of atypical meningioma.

Correlation between Expression of p53 Protein and Prognostic Factors in Meningiomas.: Kyeong Mee Park, Jin Ye Yoo, Hye Jae Cho; Korean J Pathol. 1999;33(4):274-280.

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Abstract PDF: Mutation of p53 tumor suppressor gene is now recognized as the most frequent genetic alteration in human neoplasms. Although meningiomas are common intracranial tumors, little is known about the clinical significance of p53 abnormalities in meningiomas. We studied 31 cases of meningioma to investigate the significance of p53 protein expression in meningiomas and its relationships with histological and clinical parameters and proliferative activity. Classical and atypical meningiomas were 16 (51.6%) and 15 cases (43.4%), respectively. p53 protein expression was detected in 4 (25.0%) of 16 classical, and 12 (80.0%) of 15 atypical meningiomas. p53 protein expression was correlated with Ki-67 staining index, atypical type, high histologic score, sheet pattern of the neoplastic cells, vascular proliferation, and male patient (p<0.05). In conclusion, immunohistochemical evaluation of p53 protein and histologic score of meningiomas are useful in assessing the prognosis.

A Case of Orbital Meningioma Diagnosed by Fine Needle Aspiration Biopsy.: Ji Shin Lee, Kyung Soo Kim, Min Cheol Lee, Chang Soo Park, Sang Woo Juhng; Korean J Cytopathol. 1994;5(2):176-179.

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Abstract PDF: Orbital meningioma is a rare neoplasm that, even when suspected by CT or echographic examination, requires careful histologic study for precise identification. Fine needle aspiration(FNA) biopsy has become the diagnostic technique of choice in recent years for investigating orbital masses. There have been a few previous reports on FNA biopsy of orbital menigioma. We experienced a case of orbital meningioma in a 11-yr-old boy, diagnosed by FNA biopsy. The cytohistologic features of aspirated material(intranuclear inclusions. psammoma bodies, and cells arranged in whorls) made it easy to diagnose a meningioma.

Crush Cytology Features and Differential Diagnosis of Meningiomas and Schwannomas in Central Nervous System.: Young Ju Kim, Mi Yeong Jeon, Young Il Yang, Chan Hwan Kim, Hae Kyoung Yoon, Shin Kwang Khang; Korean J Cytopathol. 1996;7(2):169-176.

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Abstract PDF: This study was performed in order to evaluate the usefulness of the crush cytologic features and differential diagnosis between meningiomas and schwannomas in the central nervous system. Deeply seated and unusually located meningiomas and schwannomas with equivocal or erroneous frozen section diagnosis can be correctly diagnosed cytologically in crush preparations. Twenty-four meningiomas and nine schwannomas were studied by frozen section and crush preparation technique. These tumors displayed distinctive cytologic features. In meningiomas, the tumor tissue fragments were easy to crush, and the tumor cells were arranged in small clusters, flat sheets, papilla-like, whorling pattern or singly. Individual tumor cells displayed round or oval nuclei with finely granular chromatin pattern and inconspicuous small nucleoli. Occasionally psammoma bodies, nuclear pseudoinclusion or nuclear grooves were found. In schwannomas, tissue fragments were hard in consistency and difficult to crush. The crushed tissue presented as thick, irregular fragments with sharp borders. The cells showed ill-defined cytoplasm and round, oval, cigar-shaped or curved nuclei. It is important to emphasize that the smear pattern under low-power view and cytologic features are helpful in discriminating between these two tumors.

Case Reports

Cytologic Features of Secretory Meningioma in Squash Preparation: A Case Report.: Se Hoon Kim, Kwang Gil Lee, Tai Seung Kim; Korean J Cytopathol. 2004;15(1):52-55.

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Abstract PDF: Secretory meningioma is a distinct subtype of meningioma. We describe the cytologic features of a secretory meningioma on squash preparations, in comparision with other cytologic mimickers. A 54-year-old woman presented with hearing loss, vertigo, tinnitus, and headache for seven years. A brain MRI study revealed a 4.5 cm sized mass in the cerebellopontine angle, which showed homogenous signal intensity in T2-weighted image. The intraoperative squash smear showed some well-defined, thin rimmed intracytoplasmic inclusions, containing a finely granular eosinophilic core among less cohesive meningiomatous cells. Histologic sections revealed a meningothelial meningioma with scattered inclusions, with periodic acid-Schiff, carcinoembryonic antigen, and cytokeratin positivity. Identification of characteristic intracytoplasmic inclusions is helpful for diagnosing secretory meningiomas. On squash preparations, differential diagnoses included tumors with inclusions or cytoplasmic vacuolizations, such as metastatic mammary infiltrating ductal carcinoma, gastric adenocarcinoma, hepatocellular carcinoma, and clear cell ependymoma, oligodendroglioma, hemangioblastoma, chordoma, and other variants of meningiomas (clear cell, xanthomatous, microcytic, and chordoid variants). In addition, the possibilities of glioma with eosinophilic granular body, and metastatic tumors from mammary infiltrating ductal carcinoma, gastric adenocarcinoma, and hepatocellular carcinoma in meningioma should be considered.

Meningioma Arising from Meningioangiomatosis Without Neurofibromatosis: A Case Report.: Jae Hong Park, Seung Yeon Ha, Na Rae Kim; Korean J Pathol. 2007;41(4):263-265.

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Abstract PDF: We report a rare case of meningioma associated with meningioangiomatosis in a 9-year-old male patient who showed none of the stigmata of neurofibromatosis 2. Brain magnetic resonance images showed marked cortical calcification with slight contrast-enhancement in the parieto-occipital lobe. The resected mass showed that the lesion was mainly composed of meningioangiomatosis and a small focus was transformed into meningioma. To date, only 17 cases of such combined lesions have been reported in English medical literature. We report a rare case of meningioma that arose from meningioangiomatosis.

Secretory Meningioma: Report of 2 cases.: Dong Sug Kim, Eun Hi Lee, Young Ran Shim, Sang Pyo Kim, Oh Ryong Kim; Korean J Pathol. 1995;29(3):361-367.

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Abstract PDF: The secretary meningioma is a distinct variant of meningioma that revealed characteristic light microscopic, immunohistochemical and ultrastructural features of epithelial and secretary differentiation, which was named as a distinct subtype of meningioma by Alguacil-Garcia et al in 1986. We experienced 2 cases of secretary meningioma. One was a 53-year-old female who had suffered from sudden onset of dizziness for I day. The computerized tomography revealed a sharply marginated well enhanced mass in temporal lobe. The other was a 59-year-old female who had suffered from dizziness for 8 years. The computerized tomography revealed a well demarcated lobulated mass in petrosal ridge. In both cases, multiple hyaline inclusions were scattered in the background of meningothelial meningioma. They were PAS positive, diastase resistant, stained yellow with van Gieson, and did not stain with reticulin in contrast to Psammoma bodies. The immunohistochemistry revealed positive reaction for EMA, CEA, a-FP and cytokeratin. T'he electron microscopic study revealed interdigitation with desmosomes and abundant intracellular lumina. They were lined by numerous microvilli and filled with granular material which was composed of electron dense homogenous material, me branous material, and small membrane-bound vesicles. Microvilli were filled with electron dense material identical to the material in the lumina, and some of them were interconnected with electron dense material in the lumina. It was concluded that secretary activity of the meningothelial cells and degenerated microvilli were involved in the pathogenesis of hyaline inclusions.

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