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Sclerosing Meningioma: Clinicopathological Study of Four Cases
So-Hyang Im,
Chun K. Chung,
Byung-Kyu Cho,
Min-Kyung Kim,
Je G. Chi
Department of Neurosurgery, Seoul National University College of Medicine,
Clinical Research Institute, Seoul National University Hospital (S.-H.I.,
C.K.C., B.-K.C.); Department of Pathology, Ilsan Paik Hospital, Inje University College of
Medicine (M.-K.K.); Department of Pathology, Neuroscience Research Institute, Seoul National
University Medical Research Center (J.G.C.), Seoul, Korea
Sclerosing meningioma is a distinct histologic subtype of meningioma,
however, it is often confused with other tumors, especially malignant tumors.
To
widen our knowledge of sclerosing meningioma and to help neurosurgeons and
neuropathologists diagnose this clinically and pathologically unfamiliar disease
entity, we reviewed four such cases, which were originally misdiagnosed.
Sclerosing meningiomas were assessed for cellularity, cellular pleomorphism,
mitotic activity, brain invasion, and necrosis.
Immunohistochemical staining was
performed on paraffin-embedded sections using the avidin–biotin–peroxidase
complex method.
The histologic appearance of the underlying cerebral parenchyma
invasion by tumor cells led to a diagnosis of malignant meningioma or to the
completely erroneous diagnosis of ganglioglioma.
The most conspicuous histologic
finding of these four sclerosing meningiomas was extensive collagen deposition,
so called `sclerosis' and an intermingled small population of spindle or round
cells with clear cytoplasmic halos, giving a 'fried egg' appearance.
However, a
typical meningothelial whorl pattern was identified in all cases.
Tumor cells
exhibited positive immunoreactivity for epithelial membrane antigen and
vimentin, but were negative for glial fibrillary acidic protein, p53, S-100, and
neuronal markers.
Proliferative indices, using Ki-67, ranged from 0% to 4%, and
brain invasion was present in three of four tumors.
All four patients are doing
well with no evidence of tumor recurrence (follow-up duration of 25 months to 12
years).
Brain invasion needs to be re-evaluated as a criterion of malignancy in
meningioma.
Special attention should be paid to the diagnosis of this subtype of
meningioma to prevent unnecessary postoperative radiotherapy and to ensure
correct therapeutic decision.
Keywords: immunohistochemical study, meningioma, pathology, sclerosing
Copyright
©
2004 Kluwer Academic Publishers.
All rights reserved
Source: http://journals.kluweronline.com/article.asp?PIPS=5270378
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