Difference between revisions of "Meningioma"

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====Grade I====
====Grade I====
=====Meningothelial=====
=====Meningothelial meningioma=====
*Most common.
*Most common.


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*Syncytial, nuclear clearing ([[pseudoinclusions]]).
*Syncytial, nuclear clearing ([[pseudoinclusions]]).


=====Fibrous=====  
=====Fibrous meningioma=====  
*AKA fibroblastic.
*AKA fibroblastic.
*Not collagen but looks like it. (It is really laminin or fibronectin).
*Not collagen but looks like it. (It is really laminin or fibronectin).


=====Transistional=====
=====Transistional meningioma=====
*Rare.
*Rare.


=====Psammomatous=====
=====Psammomatous meningioma=====
Microscopic:  
Microscopic:  
*[[Psammoma bodies]].
*[[Psammoma bodies]].


=====Angiomatous=====
=====Angiomatous meningioma=====
*AKA vascular.
*AKA vascular.
*May bleed like stink.
*May bleed like stink.


=====Microcystic=====
=====Microcystic meningioma=====
Microscopic:  
Microscopic:  
*Cystic appearance.
*Cystic appearance.


=====Secretory=====
=====Secretory meningioma=====
*Assoc. with brain edema; may have a worse outcome.
*Assoc. with brain edema; may have a worse outcome.


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*Metastatic mucinous adenocarcinoma.
*Metastatic mucinous adenocarcinoma.


=====Lymphoplasmacyte-rich=====
=====Lymphoplasmacyte-rich meningioma=====
Microscopic:
Microscopic:
*Lymphocytes.
*Lymphocytes.
*Plasma cells.
*Plasma cells.
=====Metaplastic=====
=====Metaplastic meningioma=====
*Much talked about... but very rare.
*Much talked about... but very rare.


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====Grade II====
====Grade II====
=====Invasive=====  
=====Invasive meningioma=====  
*Invades the brain.
*Invades the brain.


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*[http://moon.ouhsc.edu/kfung/jty1/Composites/FNA0IE18-Meningioma-Invasion.htm Meningioma with brain invasion (ouhsc.edu)].
*[http://moon.ouhsc.edu/kfung/jty1/Composites/FNA0IE18-Meningioma-Invasion.htm Meningioma with brain invasion (ouhsc.edu)].


=====Clear cell=====
=====Clear cell meningioma=====
Epidemiology:  
Epidemiology:  
*Usu. spinal cord.<ref>{{Ref PSNP|200}}</ref>
*Usu. spinal cord.<ref>{{Ref PSNP|200}}</ref>
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*[http://blog.lib.umn.edu/santa013/neuropathology/2009/10/meningioma-with-clear-cell-features.html Clear cell meningioma (umn.edu)].
*[http://blog.lib.umn.edu/santa013/neuropathology/2009/10/meningioma-with-clear-cell-features.html Clear cell meningioma (umn.edu)].


=====Chordoid=====  
=====Chordoid meningioma=====  
*Chordoma-like.
*Chordoma-like.


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====Grade III====
====Grade III====
=====Papillary=====
=====Papillary meningioma=====
Microscopic:  
Microscopic:  
*True papillae.
*True papillae.
=====Rhaboid=====
=====Rhabdoid meningioma=====
Microscopic:  
Microscopic:  
*Rhabdoid appearance (abundant cytoplasm).
*Rhabdoid appearance (abundant cytoplasm).

Revision as of 16:16, 3 January 2012

Meningioma a very common tumour in neuropathology.

General

Prevalence

  • Common.
  • May be caused by prior radiation.

Radiology

  • Extra-axial.

Prognosis

  • Most are benign.
    • May be malignant.

Genetics

Microscopic

Features (memory device WCN):

  • Whorled appearance - key feature.
  • Calcification, psammomatous (target-like appearance; (tight) onion skin).
  • +/-Nuclear pseudoinclusions - focal nuclear clearing with a sharp interface to unremarkable chromatin.

Images:

Notes:

  • May involute into benign sclerotic tissue.[2]
  • Thick-walled blood vessels = feature of schwannoma.

Morphologic subtypes

  • Many subtypes exist.[3]
  • The histologic subtypes generally don't have much prognostic significance.
    • Some subtypes are high grade by definition; also see histologic grading.

Grade I

Meningothelial meningioma
  • Most common.

Microscopic:

Fibrous meningioma
  • AKA fibroblastic.
  • Not collagen but looks like it. (It is really laminin or fibronectin).
Transistional meningioma
  • Rare.
Psammomatous meningioma

Microscopic:

Angiomatous meningioma
  • AKA vascular.
  • May bleed like stink.
Microcystic meningioma

Microscopic:

  • Cystic appearance.
Secretory meningioma
  • Assoc. with brain edema; may have a worse outcome.

Microscopic:[4]

  • Eosinophilic intracytoplasmic inclusions that are CEA +ve and PAS +ve.

DDx:

  • Metastatic mucinous adenocarcinoma.
Lymphoplasmacyte-rich meningioma

Microscopic:

  • Lymphocytes.
  • Plasma cells.
Metaplastic meningioma
  • Much talked about... but very rare.

Microscopic:

  • Cartilage or bone formation.

Grade II

Invasive meningioma
  • Invades the brain.

Images:

Clear cell meningioma

Epidemiology:

  • Usu. spinal cord.[5]

Microscopic:

  • Clear cells - contain glycogen (PAS +ve).

Images:

Chordoid meningioma
  • Chordoma-like.

Microscopic:

  • Myxoid appearance.

Image:

Grade III

Papillary meningioma

Microscopic:

  • True papillae.
Rhabdoid meningioma

Microscopic:

  • Rhabdoid appearance (abundant cytoplasm).

Histologic grading

Grading:[3]

  • Grade 1:
    • Low mitotic rate (< 4 mitoses/10 HPF - for whatever HPF means, see HPFitis).
    • Excludes clear cell, chordoid, papillary, and rhabdoid subtypes.
  • Grade 2 (either #1, #2 or #3):
    1. Brain-invasive meningioma.
      • Protrusion of meningioma into brain.
        • Meninogioma with entraped GFAP +ve tissue.
    2. Atypical meningioma (by histomorphology) - either A or B.
      • A. Intermediate mitotic rate (>= 4 mitoses/10 HPF - for whatever HPF means, see HPFitis.)
      • B. Three of the following five features:
        1. Sheeting architecture.
        2. High NC ratio clusters; clusters of "lymphocyte-like" cells.
        3. Hypercellularity.
        4. Macronucleoli.
        5. Necrosis not caused by treatment, e.g. radiation or embolization.
    3. Clear cell or chordoid subtype.
  • Grade 3 (either of the following):
    • High mitotic rate (>=20 mitoses/10 HPF - for whatever HPF means, see HPFitis.)
    • "Frank anaplasia"; marked nuclear atypia.
    • Papillary or rhabdoid subtype.

Notes:

  • Grade II soft criteria memory device HMNs: hypercellular, macronucleoli, NC ratio increased, necrosis, sheeting.

IHC

  • EMA +ve.[6]
  • Other CKs usually -ve.

DDx of meningioma & IHC[7]

  • S-100 +ve - schwannoma.
    • +ve in ~80% of fibrous meningiomas.
  • CD34 +ve - solitary fibrous tumour.
    • +ve in ~60% of fibrous meningiomas.
  • EMA +ve in ~30% of hemangiopericytoma.
  • Claudin-1 - new kid on the block: +ve in meningioma, but low sensitivity.

Standard work-up (UHN)[8]

  • Ki-67 >5-10% - predicts re-occurrence.
  • PR (progesterone receptor) +ve in 2/3; -ve PR predicts re-occurrence.

See also

References

  1. ↑ URL: http://moon.ouhsc.edu/kfung/jty1/neurotest/Q13-Ans.htm. Accessed on: 26 October 2010.
  2. ↑ URL: http://radiographics.rsna.org/content/23/3/785.long. Accessed on: 3 November 2010.
  3. ↑ 3.0 3.1 Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 194. ISBN 978-0443069826.
  4. ↑ URL: http://moon.ouhsc.edu/kfung/jty1/Com04/Com405-1-Diss.htm. Accessed on: 12 October 2011.
  5. ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 200. ISBN 978-0443069826.
  6. ↑ Perry, Arie; Brat, Daniel J. (2010). Practical Surgical Neuropathology: A Diagnostic Approach: A Volume in the Pattern Recognition series (1st ed.). Churchill Livingstone. pp. 13. ISBN 978-0443069826.
  7. ↑ Hahn HP, Bundock EA, Hornick JL (February 2006). "Immunohistochemical staining for claudin-1 can help distinguish meningiomas from histologic mimics". Am. J. Clin. Pathol. 125 (2): 203–8. doi:10.1309/G659-FVVB-MG7U-4RPQ. PMID 16393681. http://ajcp.ascpjournals.org/content/125/2/203.full.pdf.
  8. ↑ Croul, SE. 8 November 2010.

External links

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