LGCmain
Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 1585
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size
IJPM is coming out with a Special issue on "Genitourinary & Gynecological pathology including Breast". Please submit your articles for these issues


 
  Table of Contents    
LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 410-411
Papillary meningioma: A rare malignant variant


Institute of Pathology, ICMR, New Delhi, India

Click here for correspondence address and email

Date of Web Publication27-May-2011
 

How to cite this article:
Jairajpuri Z, Jain I, Singh A. Papillary meningioma: A rare malignant variant. Indian J Pathol Microbiol 2011;54:410-1

How to cite this URL:
Jairajpuri Z, Jain I, Singh A. Papillary meningioma: A rare malignant variant. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Dec 15];54:410-1. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/410/81595


Sir,

The histopathological spectrum of meningiomas is broad with several variants. Papillary meningioma (PM) is a rare, distinctive malignant histological variant of meningioma with a highly aggressive clinical course and grim prognosis. It is important to recognize this variant in view of its implications for management as well as prognostication in order to reduce the morbidity and mortality. We report a case of papillary meningioma in a female patient presenting with a history of intermittent headache and loss of vision.

A 45-year-old woman presented with complaints of intermittent headache for twenty days and loss of vision for five days. Ophthalmic examination revealed papilloedema while on CT scan, a contrast enhancing hypodense mass in the left frontoparietal area was seen.

Microscopy of sections from the lesion showed tumor tissue composed of sheets of cells arranged in a predominantly papillary pattern with perivascular pseudorosettes. Tumor cells displayed moderate eosinophilic cytoplasm and vesicular nuclei and few mitoses [Figure 1]. Microscopic foci of necrosis were also seen. Immunohistochemical staining revealed positivity for epithelial membrane antigen (EMA) [Figure 2]b and vimentin [Figure 2]a, while it was non-reactive for glial fibrillary acidic protein (GFAP). All these findings led to a diagnosis of PM.
Figure 1: Photomicrograph H and E ×100 showing tumor tissue composed of sheets of cells arranged in a predominantly papillary pattern; cells show moderate eosinophilic cytoplasm and vesicular nuclei

Click here to view
Figure 2: (a) Immunohistochemistry showing vimentin positivity; (b) Immunohistochemistry showing epithelial membrane antigen ×400 positivity

Click here to view


Meningiomas are among the most common brain neoplasms accounting for approximately 13-19% of all primary intracranial tumors, they represent wide biological and histological spectrum. [1] PM are a malignant variant and are designated grade 3 by classification of WHO. [2] They are histologically characterized exclusively or in part by papillary structures and are often intermixed with more classic meningothelial morphology. Knowledge of this variant is of clinical significance, as a variety of tumors can exhibit papillary features and are very pertinent to the differential diagnosis of an intracranial mass such as metastatic adenocarcinoma EMA and cytokeratin (CK) positive and vimentin negative, chemodectoma, papillary ependymoma and astroblastoma (GFAP positive). [3],[4]

Recognition of the lesion, as a distinct subtype, has been slow. Cushing and Eisenhardt were the first to describe papillary meningiomas as malignant variant with intracerebral recurrence. [5] The age at presentation has been variably reported by different authors; however, an age range of 3 to 69 years with no gender predominance has been seen. They are frequently seen in the supratentorial compartment and rarely reported in the posterior fossa, jugular foramen [3] and oculomotor nerve. [4]

Papillary meningioma are known to metastasize, with both local as well as distant metastasis. [3],[6] Local recurrences are more common with the tumor seen in cerebrospinal pathways also. [3] Distant metastasis is seen to occur in the lungs and liver. Tumor is known to recapitulate the original lesion at the metastatic site also. Lesions with papillary patterns are known to have an aggressive character with typical and atypical mitoses, necrosis, pleomorphism and recurrences associated with metastasis. The aggressive behavior of papillary meningioma associated with morbidity and mortality warrants a timely recognition of the diagnosis.

The standard treatment of PM is surgical resection, ranging from debulking to radical removal. Median survival has been noted to be eight years, illustrating the malignant propensity of these tumors. [7] Aggressive surgery followed by adjuvant radiotherapy is advocated in cases of malignant meningiomas. However, effectiveness of radiotherapy is disputed.

To conclude, PM is a rare variant of meningioma and its early diagnosis and management is important because of its propensity for recurrence and poor clinical outcome.

 
   References Top

1.Avninder S, Vermani S, Sharma S, Chand K. Papillary meningioma: A rare but distinct variant of malignant meningioma. Diagn Pathol 2007;2:3.  Back to cited text no. 1
    
2.Perry A. Meningiomas. In: McLendon RE, Rosenblum MK, Bigner DD, editors. Russell and Rubinstein's Pathology of Tumors of the Nervous System. 7 th ed. 2006. p. 427-74.  Back to cited text no. 2
    
3.Ludwin SK, Rubinstein LJ, Russell DS. Papillary meningioma: A malignant variant of meningioma. Cancer 1975;36:1363-73.  Back to cited text no. 3
[PUBMED]    
4.Piatt JH Jr, Campbell GA, Oakes WJ. Papillary meningioma involving the occulomotor nerve in an infant. Case report. J Neurosurg 1986;64:808-12.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Cushing H, Eisenhardt L. Meningiomas: Their classification, regional behavior, life history and surgical end results. monograph on Meningiomas after In: Thomas CC, editor. Ill, Baltimore, Springfield; 1938. p. 692-717.  Back to cited text no. 5
    
6.Kepes JJ, MacGee EE, Vergara G, Sil R. A case report: Malignant meningioma with extensive pulmonary metastases. J Kans Med Soc 1971;72:312-6.  Back to cited text no. 6
[PUBMED]    
7.Kross JM, Cella F, Bakker SL, Paz Y Geuze D, Egeler RM. Papillary meningioma with pleural metastasis: Case report and literature review. Acta Neurol Scand 2000;102:200-2.  Back to cited text no. 7
    

Top
Correspondence Address:
Ila Jain
SFS Flats B-3, Sheikh Sarai-1, New Delhi - 110 017
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.81595

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]

This article has been cited by
1 Papillary meningioma: an aggressive variant meningioma with clinical features and treatment: a retrospective study of 10 cases
Bin Li,Bangbao Tao,Hongmin Bai,Jun Zhong,Xiangru Wu,Juanhong Shi,Hui Sun,Shiting Li
International Journal of Neuroscience. 2016; 126(10): 878
[Pubmed] | [DOI]
2 Papillary meningioma of the jugular foramen: A case report
YING YU,HAIYANG XU,YUBO WANG,GANG ZHAO
Oncology Letters. 2015; 10(6): 3655
[Pubmed] | [DOI]
3 Magnetic resonance imaging findings of intracranial papillary meningioma: A study on eight cases
Xiang-Rong Yu,Xiang-Rong Jun-Zhang,Bi-Yun Zhang,Wei-Yuan Huang,Wei-Yuan Bo-Yin,Wen-Li Tan,Hai-Qing Li,Dao-Ying Geng
Clinical Imaging. 2014;
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures

 Article Access Statistics
    Viewed2839    
    Printed68    
    Emailed1    
    PDF Downloaded96    
    Comments [Add]    
    Cited by others 3    

Recommend this journal