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:
- Cerebral convexities (cerebral surfaces)
- Parasagittal (falx, parafalcine)
- Sphenoid ridge
- 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
- Noncontrast Head CT: Hyperdense
- MRI, T1: Isointense (to gray matter)
- MRI, T2: Isointense (to gray matter)
- MRI, T1 with contrast: Intense, homogenous contrast enhancement
- Dural tail is present in ~ 50% of cases
Prognosis
- Generally, meningiomas are benign tumors but there is tremendous variability in their degree of malignancy:
- Meningioma, G1
- Atypical meningioma, G2
- Anaplastic (malignant) meningioma, G3
- 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
- Psammoma body
- 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.
- Whorl formations
- 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.