Meningioma

Overview

Common, typically benign (Grade 1) brain tumor that originates from arachnoid-type cells from the dura.
It derives from dural sites, the most common being:

Neurofibromatosis Type 2 (NF-2), breast cancer, and prior radiation are all conditions that are associated with development of meningioma.

In NF-2, patients can have multiple meningiomas, which is an important diagnostic clue to the diagnosis.

Chromosome 22 deletion (partial or total) is the most common genetic association with meningioma (which is c/w with the association of meningioma and NF-2).
Meningiomas are most prevalent in their 60s to 70s.

Histopathology

Psammoma bodies: microscopic calcific collections
Whorls: Spindle-shaped tumor cells that are concentrically arranged in a "whorled pattern".
Synctyial clusters: arrays of cells with invisible cell borders (cytoplasmic continuity). They typically have oval nuclei.
Numerous histological variants: all three contain whorls and psammoma bodies.

The most common variants are:

Meningothelial: Synctial cell clusters of arachnoidal epithelioid cells in lobules. Minimal whorls or psamomma bodies.
Fibrous: Fibroblast-like spindle cells in a collagenous matrix (like dense connective tissue) interposed between strands of meningothelial tissue.
Transitional (Mixed): Mixture of meningothelial and fibrous variants. Prominent whorls.
Psammomatous meningiomas: Prominent numbers of psammoma bodies.

Typical Radiographic Findings

Prognosis

Generally, meningiomas are benign tumors but there is tremendous variability in their degree of malignancy:

Pediatric meningiomas, on the whole, are more aggressive than adult meningiomas.

References

Adesina, Adekunle M., Tarik Tihan, Christine E. Fuller, and Tina Young Poussaint. Atlas of Pediatric Brain Tumors. Springer, 2016.

Buhl, Ralf M., H. Maximilian Mehdorn, and Peter A. Winkler. “NF2/Multiple Meningiomas.” In Meningiomas, 555–64. Springer, London, 2009. https://doi.org/10.1007/978-1-84628-784-8_59.

Daroff, Robert B., Joseph Jankovic, John C. Mazziotta, and Scott L. Pomeroy. Bradley’s Neurology in Clinical Practice E-Book. Elsevier Health Sciences, 2015.

Gaillard, Frank. “Meningioma | Radiology Reference Article | Radiopaedia.Org.” Radiopaedia. Accessed July 1, 2018. https://radiopaedia.org/articles/meningioma.

Gray, Frangoise, Charles Duyckaerts, and Umberto De Girolami. Escourolle and Poirier’s Manual of Basic Neuropathology. OUP USA, 2013.

Hanna, Ehab Y., and Franco DeMonte. Comprehensive Management of Skull Base Tumors. CRC Press, 2008.

Molavi, Diana Weedman. The Practice of Surgical Pathology: A Beginner’s Guide to the Diagnostic Process. Springer Science & Business Media, 2008.

Orkin, Stuart H., David E. Fisher, A. Thomas Look, Samuel Lux, David Ginsburg, and David G. Nathan. Oncology of Infancy and Childhood E-Book. Elsevier Health Sciences, 2009.

Image References

College, Department of Pathology, Calicut Medical. English: Concentrically Calcified Basophilic Structure in the Centre of the Field in a Meningioma. [H & E, 40X]. October 21, 2014. Calicut Medical College Native name ?????????? ???????? ??????, ?????????? Location Kozhikode, India Coordinates 11° 16? 15.71? N, 75° 50? 15.07? E Established 1957 Web page http://calicutmedicalcollege.ac.in/ Authority control?: Q5019886 ISNI:?0000 0001 0705 6304. https://commons.wikimedia.org/wiki/File:Meningioma_showing_Psammoma_body.jpg.

Jensflorian. English: Histopathology Specimen (HE Stain) of a Meningeotheliomatous Meingioma with Typical Whorl Formations. July 24, 2015. Own work. https://commons.wikimedia.org/wiki/File:Meningeotheliomatous_meningeoma_whorl_formations.jpg.