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Acta Cytologica 2014;58:1-8
(DOI:10.1159/000355284)

Cytopathology of Extracranial Ectopic and Metastatic Meningiomas

Ocque R.a · Khalbuss W.E.a · Monaco S.E.a · Michelow P.M.b · Pantanowitz L.a

Author affiliations

aDepartment of Pathology, University of Pittsburgh Medical Center, Shadyside Hospital, Pittsburgh, Pa., USA; bDepartment of Pathology, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa

Corresponding Author

Correspondence to: Dr. Liron Pantanowitz

Department of Pathology, UPMC Shadyside

Cancer Pavilion Suite PB201, 5120 Center Avenue

Pittsburg, PA 15232 (USA)

E-Mail pantanowitzl@upmc.edu

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Abstract

Introduction: Extracranial meningiomas may infrequently be encountered as ectopic or metastatic tumors. Their rarity and unique cytomorphology often pose significant diagnostic dilemmas. The aim of this study was to report our experience with a series of ectopic and metastatic meningiomas, characterizing their cytomorphology with histological correlation. Materials and Methods: A retrospective analysis involving 13 patients with cytological preparations from extracranial meningiomas was performed. Cytology cases were correlated with available surgical resection specimens. Data regarding clinical findings, tumor information, cytomorphology, follow-up histological features and immunohistochemistry were recorded and analyzed. Results: There were 5 cases with metastases and 8 ectopic meningiomas. Metastases occurred in the scalp/skull, lung, paraspinal soft tissue and liver. Primary ectopic meningiomas were located in the paranasal sinuses and ear, orbit and neck. Cytomorphological features characteristic of meningiomas were identified in the majority of samples including tightly cohesive clusters of spindled cells, whorls, intranuclear inclusions, nuclear grooves and psammomatous calcification. Unusual cytomorphological features identified in only a few cases included epithelioid cell predominance, abundant inflammatory cells, small-cell change, papillary structures and pseudoacinar growth. Metastatic tumors exhibited more nuclear atypia and occasionally mitoses or necrosis. Meningiomas were shown to be immunoreactive for epithelial membrane antigen, pancytokeratin and vimentin. Conclusion: Although rare, extracranial meningiomas can be encountered in cytologic specimens and should be included in the differential diagnosis when characteristic morphological features of meningiomas are seen. Cytopathologists should be aware that these lesions could be mistaken for other tumors, especially when confounded by atypia and unusual cytomorphological features.

© 2013 S. Karger AG, Basel


References

  1. Burger PC, Scheithauer BW: Tumors of the Central Nervous System: AFIP Atlas of Tumor Pathology. Silver Spring, ARP Press, 2007.
  2. Perry A, Louis DN, Scheithauer BW, Budka H, von Deimling A: Meningiomas; in Louis DN, Ohgaki H (eds): WHO Classification of Tumours of the Central Nervous System. New York, International Agency for Research on Cancer, 2007, pp 164-172.
  3. Whicker JH, Devine KD, MacCarty CS: Diagnostic and therapeutic problems in extracranial meningiomas. Am J Surg 1973;126:452-457.
  4. Gibson S, Prayson R: Primary ectopic meningiomas; in Lee JH (ed): Meningiomas: Diagnosis, Treatment, and Outcome. London, Springer, 2009, pp 573-584.
  5. Teague SD, Conces DJ Jr: Metastatic meningioma to the lungs. J Thorac Imaging 2005;20:58-60.
  6. Rushing EJ, Bouffard JP, McCall S, Olsen C, Mena H, Sandberg GD, et al: Primary extracranial meningiomas: an analysis of 146 cases. Head Neck Pathol 2009;3:116-130.
  7. Thomas HG, Dolman CL, Berry K: Malignant meningioma: clinical and pathological features. J Neurosurg 1981;55:929-934.
    External Resources
  8. Siddiqui MT, Mahon BM, Cochran E, Gattuso P: Cytologic features of meningiomas on crush preparations: a review. Diagn Cytopathol 2008;36:202-206.
  9. Deshmukh SD, Rokade VV, Pathak GS, Nemade SV, Ashturkar AV: Primary extra-cranial meningioma in the right submandibular region of an 18-year-old woman: a case report. J Med Case Rep 2011;5:271.
  10. Gupta N, Kaur J, Srinivasan R, Das A, Mohindra S, Rajwanshi A, et al: Fine needle aspiration cytology in lesions of the nose, nasal cavity and paranasal sinuses. Acta Cytol 2011;55:135-141.
  11. Hameed A, Gokden M, Hanna EY: Fine-needle aspiration cytology of a primary ectopic meningioma. Diagn Cytopathol 2002;26:297-300.
  12. Qutub MF, Haider A, Jawad HA, Khalbuss WE: Fine needle aspiration cytology of ectopic meningioma presenting as a neck mass: a case report and a review of the literature. Cytopathology 2012;23:61-64.
  13. Solares J, Lacruz C: Fine needle aspiration cytology diagnosis of an extracranial meningioma presenting as a cervical mass. Acta Cytol 1987;31:502-504.
    External Resources
  14. Joggerst KH, Langford LA, Williams MD: Aggressive meningiomas involving the parotid gland. Ann Diagn Pathol 2012;16:85-90.
  15. Das DK, Das J, Bhatt NC, Chachra KL, Natarajan R: Orbital lesions: diagnosis by fine needle aspiration cytology. Acta Cytol 1994;38:158-164.
    External Resources
  16. Munjal K, Pancholi V, Nandedkar S, Verma R: Fine needle aspiration cytology diagnosis of an extracranial meningioma presenting as a mass in the medial canthus. Acta Cytol 2006;50:706-709.
    External Resources
  17. Agrawal P, Dey P, Saikia UN, Gupta N, Radhika S, Nijhawan R, et al: Fine-needle aspiration cytology of orbital meningiomas. Diagn Cytopathol 2012;40:967-969.
  18. Islam MN, Amin MS, Dipi RM, Khan NA: Comparison of computed tomographic and cytopathological findings in the evaluation of adult orbital mass. Mymensingh Med J 2013;22:75-79.
    External Resources
  19. Gonzalez-Capora R, Otal-Salaverri C, Hevia-Vazquez A, Lerma-Puertas E, Murga-Sierra M, Galera-Davidson H: Fine needle aspiration cytology of recurrent ectopic meningioma. Acta Cytol 1989;33:85-88.
    External Resources
  20. Spitz DJ, Reddy V, Selvaggi SM, Kluskens L, Green L, Gattuso P: Fine-needle aspiration of scalp lesions. Diagn Cytopathol 2000;23:35-38.
  21. Kaleem Z, Fitzpatrick MM, Ritter JH: Primary pulmonary meningioma: report of a case and review of the literature. Arch Pathol Lab Med 1997;121:631-636.
    External Resources
  22. Ueno M, Fujiyama J, Yamazaki I, Uchiyama T, Ishikawa Y, Satoh Y: Cytology of primary pulmonary meningioma: report of the first multiple case. Acta Cytol 1998;42:1424-1430.
  23. Baisden BL, Hamper UM, Ali SZ: Metastatic meningioma in fine-needle aspiration (FNA) of the lung: cytomorphologic finding. Diagn Cytopathol 1999;20:291-294.
  24. Jha RC, Weisbrod GL, Dardick I, Herman SJ, Chamberlain D: Intracranial meningioma with pulmonary metastases: diagnosis by percutaneous fine-needle aspiration biopsy and electron microscopy. Can Assoc Radiol J 1991;42:287-290.
    External Resources
  25. Peck AG, Dedrick CG, Taft PD: Pulmonary metastases from intracerebral meningioma: diagnosis by percutaneous needle aspiration biopsy. AJR Am J Roentgenol 1976;126:419-422.
  26. Tworek JA, Mikhail AA, Blaivas M: Meningioma: local recurrence and pulmonary metastasis diagnosed by fine needle aspiration. Acta Cytol 1997;41:946-947.
    External Resources
  27. Khalbuss WE, Grigorian S, Bui MM, Elhosseiny A: Small-cell tumors of the liver: a cytological study of 91 cases and a review of the literature. Diagn Cytopathol 2005;33:8-14.
  28. Imlay SP, Snider TE, Raab SS: Clear-cell meningioma: diagnosis by fine-needle aspiration biopsy. Diagn Cytopathol 1998;18:131-136.
  29. Miedema JR, Zedek D: Cutaneous meningioma. Arch Pathol Lab Med 2012;136:208-211.
  30. Gomez-Aracil V, Mayayo E, Alvira R, Arraiza A, Ramon y Cajal S: Fine needle aspiration cytology of primary pulmonary meningioma associated with minute meningotheliallike nodules: report of a case with histologic, immunohistochemical and ultrastructural studies. Acta Cytol 2002;46:899-903.
    External Resources
  31. Joseph JT: Extra-axial tumors; in Joseph JT (ed): Diagnostic Neuropathology Smears. Philadelphia, Lippincott Williams & Wilkins, 2007, pp 165-180.
  32. Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC: ‘Malignancy' in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 1999;85:2046-2056.
  33. Moss TH, Nicoll JAR, Ironside JM: Meningeal tumours; in Intra-Operative Diagnosis of CNS Tumors. New York, Oxford University Press, 1997, pp 130-141.
  34. Tsonou A, Theofanopoulou A, Kefalaki A, Lambrinaki E, Polito D: Presentation of a case of metastatic malignant meningioma to the lung. Cytopathology 2011;22:88.
  35. Martinez-Saez E, Malik I, Connor S, King A: Combined rhabdoid, papillary and adenocarcinomatous-like elements in a malignant meningioma - a potential diagnostic problem. Clin Neuropathol 2012;31:51-53.
  36. Patil S, Scheithauer BW, Strom RG, Mafra M, Chicoine MR, Perry A: Malignant meningiomas with epithelial (adenocarcinoma-like) metaplasia: a study of 3 cases. Neurosurgery 2011;69:884-892.
  37. Rajaram V, Brat DJ, Perry A: Anaplastic meningioma versus meningeal hemangiopericytoma: immunohistochemical and genetic markers. Hum Pathol 2004;35:1413-1418.
  38. Thompson LD, Bouffard JP, Sandberg GD, Mena H: Primary ear and temporal bone meningiomas: a clinicopathologic study of 36 cases with a review of the literature. Mod Pathol 2003;16:236-245.
  39. Miettinen M, Paetau A: Mapping of the keratin polypeptides in meningiomas of different types: an immunohistochemical analysis of 463 cases. Hum Pathol 2002;33:590-598.
  40. Thompson LD, Gyure KA: Extracranial sinonasal tract meningiomas: a clinicopathologic study of 30 cases with a review of the literature. Am J Surg Pathol 2000;24:640-650.

Article / Publication Details

First-Page Preview
Abstract of Fine Needle Aspiration

Received: July 06, 2013
Accepted: August 22, 2013
Published online: November 01, 2013

Number of Print Pages: 8
Number of Figures: 6
Number of Tables: 3

ISSN: 0001-5547 (Print)
eISSN: 1938-2650 (Online)

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