bromochloroacetic-acid and Meningioma

Clear cell meningioma (CCM) is a rare variant of meningioma, which is important to distinguish because of its aggressive behaviour. Sixty-eight cases have been previously described in the literature. In this retrospective study, we report seven cases of CCM operated in our institution between 1994 and 2008.. Seven CCM cases were retrieved from the files of our pathology department. Clinical and radiological data were reviewed. A standard histological study was realized and immunohistochemistry was performed with epithelial membrane antigen (EMA), cytokeratin KL1, progesterone receptors, Ki-67 (MIB-1), S100 protein.. Patients' age ranged from 2 to 70 years (median age: 36 years), with a female predominance (5/7 patients). Three patients belonged to the same family, probably affected by neurofibromatosis type 2. CCM occurred in various locations: medullary region (two), sphenoid wing (two), ponto-cerebellar angle (two), tentorium (one). The tumour could be fully resected in three cases. Follow-up ranged from 3 months to 15 years: recurrence occurred in four patients, three of whom eventually died from the disease.. In our series, the frequency of CCM (0,6% of all meningiomas operated on in our institution) and its histological aspects are almost identical to those observed of the literature. We discuss the predictive value of proliferation index (MIB-1) and the role of patient status and quality of surgical resection in the evolution.. Our study supports the fact that MCC course is less favourable than meningioma WHO grade I, even in the absence of anaplastic area, high mitotic activity, or necrosis. In this series, MIB-1 index was of no interest identifying patients with or without recurrence.

Topics: Adult; Aged; Astrocytoma; Biomarkers, Tumor; Child, Preschool; Diagnostic Errors; Ependymoma; Female; Humans; Keratins; Ki-67 Antigen; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1; Neoplasm Proteins; Neurofibromatosis 2; Receptors, Progesterone; Retrospective Studies; S100 Proteins; Young Adult

Chordoid meningioma, World Health Organization grade II, is an uncommon variant of meningioma with a propensity for aggressive behavior and increased likelihood of recurrence. As such, recognition of this entity is important in cases that show similar morphologic overlap with other chondroid/myxoid neoplasms that can arise within or near the central nervous system. A formal comparison of the immunohistochemical features of chordoid meningioma versus tumors with significant histologic overlap has not been previously reported. In this study, immunohistochemical staining was performed with antibodies against D2-40, S100, pankeratin, epithelial membrane antigen (EMA), brachyury, and glial fibrillary acidic protein (GFAP) in 4 cases of chordoid glioma, 6 skeletal myxoid chondrosarcomas, 10 chordoid meningiomas, 16 extraskeletal myxoid chondrosarcoma, 18 chordomas, 22 low-grade chondrosarcomas, and 27 enchondromas. Staining extent and intensity were evaluated semiquantitatively and mean values for each parameter were calculated. Immunostaining with D2-40 showed positivity in 100% of skeletal myxoid chondrosarcomas, 96% of enchondromas, 95% of low-grade chondrosarcomas, 80% of chordoid meningiomas, and 75% of chordoid gliomas. Staining with S100 demonstrated diffuse, strong positivity in all (100%) chordoid gliomas, skeletal myxoid chondrosarcomas, low-grade chondrosarcomas, and enchondromas, 94% of chordomas, and 81% of extraskeletal myxoid chondrosarcomas, with focal, moderate staining in 40% of chordoid meningiomas. Pankeratin highlighted 100% of chordoid gliomas and chordomas, 38% of extraskeletal myxoid chondrosarcomas, and 20% of chordoid meningiomas. EMA staining was positive in 100% of chordoid gliomas, 94% of chordomas, 90% of chordoid meningiomas, and 25% of extraskeletal myxoid chondrosarcomas. Brachyury was positive only in the chordomas (100%), whereas GFAP was positive only in the chordoid gliomas (100%). EMA was the most effective antibody for differentiating chordoid meningioma from skeletal myxoid chondrosarcoma, low-grade chondrosarcoma, and enchondroma, whereas D2-40 was the most effective antibody for differentiating chordoid meningioma from extraskeletal myxoid chondrosarcoma and chordoma. Our findings demonstrate that in conjunction with clinical and radiographic findings, immunohistochemical evaluation with a panel of D2-40, EMA, brachyury, and GFAP is most useful in distinguishing chordoid meningioma from chordoid glioma, skeletal myxoid

Topics: Adolescent; Adult; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Biomarkers, Tumor; Child; Chondroma; Chondrosarcoma; Chordoma; Diagnosis, Differential; Female; Fetal Proteins; Glial Fibrillary Acidic Protein; Glioma; Humans; Immunohistochemistry; Keratins; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1; Predictive Value of Tests; S100 Proteins; T-Box Domain Proteins; Young Adult

A cutaneous meningioma of the external auditory canal occurred in a 48-year-old Filipino woman who had undergone subtotal resection of a dural-based intracranial meningioma at the ipsilateral cerebellopontine angle 36 months previously. Radiologic findings demonstrated a recurrence of intracranial meningioma with surface erosion and heterogeneous densities of the mastoid bone, without extension to the area of the external auditory canal. Meningioma in the external ear canal is extremely rare. To our knowledge, there have been only two previously reported cases, both without intracranial lesion. In this case, the auditory canal lesion may represent either an ectopic meningioma arising from an arachnoid cell rest or an occult direct extension from intracranial menigioma.

Topics: Actins; Brain Neoplasms; Chromogranins; Ear Canal; Female; Humans; Immunohistochemistry; Keratins; Meningioma; Middle Aged; Mucin-1; Neoplasms, Unknown Primary; Skin Neoplasms; Synaptophysin; Tomography, X-Ray Computed

Mass lesions of the central nervous system (CNS) that may assume a clear cell appearance are diverse in nature. Primary conditions in this category include oligodendroglioma, hemangioblastoma, germinoma (seminoma), clear cell and chordoid meningioma, pleomorphic xanthoastrocytoma, and lipid-rich glioblastoma. These proliferations usually can be identified by attention to clinical presentation, topographic location, radiographic details, and histological nuances. Occasionally, however, electron microscopy or immunohistological analysis may be necessary. A recommended panel of reagents for the evaluation of clear cell primary CNS lesions include antibodies to glial fibrillary acidic proteins, S-100 protein, epithelial membrane antigen, vimentin, keratins, placental-like alkaline phosphatase, and synaptophysin. This article reviews the salient clinicopathologic attributes of such proliferations, elaborates a practical approach to their diagnosis, and discusses important differential diagnostic considerations. The latter include malformative lesions, infarcts, inflammatory conditions, and secondary lymphomas, carcinomas, and melanomas.

Topics: Alkaline Phosphatase; Carcinoma, Renal Cell; Central Nervous System Neoplasms; Diagnosis, Differential; Germinoma; Glial Fibrillary Acidic Protein; Hemangioblastoma; Humans; Immunohistochemistry; Keratins; Meningioma; Mucin-1; Oligodendroglioma; S100 Proteins; Synaptophysin; Vimentin; Xanthomatosis

The tumor designated by Stout and Murray as "hemangiopericytoma" (HPC) more than 50 years ago continues to represent a source of uncertainty and disagreement among pathologists. In particular, questions exist regarding the synonymity of a hemangiopericytomatous growth pattern--defined by a monomorphic population of compact polygonal or bluntly fusiform cells and a branching stromal vascular pattern with a "staghorn" configuration--and the presence of a reproducible biological entity. It has been shown repeatedly that these same histologic features may be observed at least focally in a diversity of neoplasms, including "true" hemangiopericytomas, synovial sarcomas, mesenchymal chondrosarcomas, infantile fibrosarcomas, malignant fibrous histiocytomas, malignant peripheral nerve sheath tumors, leiomyosarcomas, endometrial stromal sarcomas, solitary fibrous tumors, myofibromas, malignant mesotheliomas, thymomas, sarcomatoid carcinomas, malignant melanomas, and "phosphaturic mesenchymal tumors." Despite their potential sharing of the microscopic attributes in question, such neoplasms have individualistic clinical features and can also be distinguished from one another by specialized pathologic analyses. HPC is "defined" in that context by reactivity for vimentin, with or without CD34 and CD57, but it lacks other immunodeterminants of epithelial, neural, and myogenous differentiation. Paradoxically, this phenotype is indeed associated with the presence of myogenous-type cytoplasmic filaments in ultrastructural evaluations of HPC. Other lesions that may resemble "true" HPC--but which possess dissimilar subcellular and clinical characteristics--include solitary fibrous tumors, hemangiopericytomalike tumors of the sinonasal tract, and "infantile (congenital) hemangiopericytomas." Such observations suggest that the hemangiopericytoma is both a pathologic entity and a morphological pattern, and they emphasize the utility of adjuvant pathologic studies in this diagnostic context.

Topics: Actins; Bone Neoplasms; CD57 Antigens; Diagnosis, Differential; Hemangiopericytoma; Humans; Keratins; Meningioma; Myofibromatosis; Nasopharyngeal Neoplasms; Reticulin; Sarcoma, Synovial; Soft Tissue Neoplasms; Stromal Cells

Two cases of breast carcinoma metastatic to meningioma are described in patients 69 and 62 years old respectively.. Cases were documented by radiological, histological and immunohistochemical techniques.. Both meningiomas contained an invasive duct carcinoma of the breast, one of which was apocrine in nature.. It is suggested that metastasis to meningioma is not so rare as it appears from the literature.

Topics: Aged; Apolipoproteins; Apolipoproteins D; Biomarkers, Tumor; Breast Neoplasms; Carcinoma, Ductal, Breast; Carrier Proteins; Female; Glycoproteins; Humans; Keratins; Membrane Transport Proteins; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1; Neoplasm Proteins; Neoplasms, Second Primary; Receptors, Estrogen; Receptors, Progesterone

Thymomas are cytologically benign epithelial neoplasms of the thymus gland. They compose 10% of mediastinal tumors, and are most common in the anterosuperior compartment. Seven to 36% of thymomas are malignant, as determined by tissue invasion, yet they metastasize in less than 3% of cases. Distinguishing lymphoma from lymphocyte-predominant thymoma is imprecise due to their histologic similarities. We present a 45-year-old man with intracranial metastatic thymoma. The lesion was interpreted radiographically as meningioma, and as possible lymphoma by frozen section. Flow cytometry proved this neoplasma to be a metastatic thymoma. Sixteen monoclonal antibodies were used to immunophenotype the CD45+ component of this tumor. Coexpression of CD4 and CD8 along with CD1 demonstrated lymphocytes of late cortical thymocyte origin; a second component was cytokeratin positive. This is the first reported case of extrathoracic metastases of thymoma diagnosed using flow cytometry. We propose this method as an invaluable technique to diagnose these histologically difficult neoplasms.

Topics: Aneuploidy; Antibodies, Monoclonal; Antigens, CD; Antigens, Neoplasm; Biomarkers, Tumor; Brain Neoplasms; Combined Modality Therapy; Diagnosis, Differential; DNA, Neoplasm; Flow Cytometry; Frozen Sections; Humans; Immunophenotyping; Keratins; Lymphoma, Non-Hodgkin; Magnetic Resonance Imaging; Male; Meningioma; Middle Aged; Neoplasm Proteins; Neoplastic Stem Cells; Parietal Lobe; T-Lymphocyte Subsets; Thymectomy; Thymoma; Thymus Neoplasms

Topics: Adenocarcinoma; Adenoma, Islet Cell; Animals; Antibodies, Monoclonal; Breast Neoplasms; Carcinoma, Small Cell; Carcinoma, Squamous Cell; Cytoskeletal Proteins; Desmoplakins; Desmosomes; Electrophoresis, Polyacrylamide Gel; Granulosa Cell Tumor; Humans; Immunosorbent Techniques; Intermediate Filament Proteins; Intermediate Filaments; Keratins; Kidney Neoplasms; Lung Neoplasms; Melanoma; Membrane Proteins; Meningioma; Mesothelioma; Microscopy, Electron; Microscopy, Fluorescence; Neoplasms; Neurosecretory Systems; Skin Neoplasms

While meningiomas are known as slow-growing extracerebral neoplasms, the subgroup of secretory meningiomas with histologically benign characteristics tend to cause disproportional peritumoral edema, frequently leading to severe medical and neurological complications in postoperative management. Among 1,484 meningiomas that were resected at our institution between 1990 and 2007, 44 (3%) patients were found to have the histological diagnosis of a secretory meningioma. The clinical course, radiological appearance, and histopathological features were retrospectively analyzed to examine the specifics of these benign lesions. Meningiomas were located at the convexity (n = 14), the cranial base (18), and the sphenoid ridge (12). A severe, nearly hemispheric perifocal edema disproportional to tumor size was seen on preoperative MR imaging in 18 (41%) patients. Following surgical resection, the postoperative course was uneventful in 29 patients. In 15 patients, severe peritumoral edema continued or even increased on postoperative CT imaging. Six patients showed midline shift and clinical worsening necessitating respirator-assisted ventilation and intracranial pressure monitoring. An association between the extent of brain edema and number of periodic acid Schiff-positive pseudopsammomas was found (p < 0.02). Further, the size of the edema correlated with the number of immunohistochemically detected cells expressing carcinoembryonic antigen (CEA) and cytokeratin (CK) (p < 0.01). Mean MIB-1 (Ki-67 antigen) proliferation index was 3.0% (range, 0%-17%) and did not correlate with edema or tumor recurrence. Secretory meningiomas are frequently associated with severe peritumoral edema. The extent of edema correlates with immunohistochemically detected expression of CEA and CK. Extended perifocal edema in meningiomas is an unusual finding and should alert the neurosurgeon that surgery may aggravate edema excessively, leading to a life-threatening postoperative situation.

Topics: Adult; Aged; Biomarkers, Tumor; Brain Edema; Carcinoembryonic Antigen; Female; Follow-Up Studies; Humans; Immunoenzyme Techniques; Keratins; Ki-67 Antigen; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Retrospective Studies; Tomography, X-Ray Computed

Topics: Humans; Keratins; Meningeal Neoplasms; Meningioma; Spinal Cord

Granular cell tumors (GCTs) are characterized by abundant eosinophilic cytoplasmic granules. Based on the hypothesis that canine intracranial GCT is a subtype of meningioma and its cytoplasmic granules are formed through autophagy processes, histopathological and immunohistochemical examination were performed on biopsy samples from 7 cases of canine intracranial GCTs and 15 cases of conventional meningiomas. Histopathologically, 7/7 cases of GCTs involved the meninges; foci of meningothelial-like cells were observed in 3/7 cases; brain invasion was observed in 2/7 cases. Immunohistochemically, neoplastic cells of GCTs were positive for E-cadherin and negative for S100, cytokeratin, CD204, and β-catenin in 7/7 cases. Neoplastic cells of 15/15 cases of meningiomas were positive for E-cadherin, and negative for S100 and CD204. Immunoreactivity of meningiomas for cytokeratin and β-catenin was observed in 6/15 cases and 8/15 cases, respectively. Cytoplasmic granules of GCTs were positive for ubiquitin (5/7), p62 (5/7), and LC3 (7/7). Compared to GCTs, the ratios of ubiquitin (6/15) and p62 (3/15) positive cases were lower in meningiomas, and 15/15 cases were negative for LC3. These findings indicate that the biological natures of GCTs including anatomical location, histopathological features and immunoreactivity for E-cadherin are almost in conformity with those of meningiomas. The immunoreactivity for autophagy associated molecules may suggest the possible involvement of autophagy in cytoplasmic granule formation of canine intracranial GCTs.

Topics: Animals; Autophagy; beta Catenin; Cadherins; Cell Adhesion Molecules; Dog Diseases; Dogs; Granular Cell Tumor; Immunohistochemistry; Keratins; Meningeal Neoplasms; Meningioma; Ubiquitins

A 3.5-year-old Holstein cow presented with a 2-week history of weakness, ataxia and difficulty in rising, followed by recumbency. At necropsy, a 3 × 2.5 cm tumour mass was found in the subdural area of the left parietal lobe of the cerebrum. Histopathology revealed the tumour to be a variant of secretory meningeal tumour. Immunohistochemically, all of the neoplastic cells expressed vimentin and some were immunopositive for cytokeratin. There were variably sized, scattered pseudocysts containing eosinophilic material that stained positively with Alcian blue and periodic acid-Schiff stains. The marginal zone of the tumour exhibited regressive change characterized by lymphocytic infiltration and extensive fibrotic areas enclosing large numbers of tumour cell nests in which most tumour cells were apoptotic. This tumour was considered to be a secretory variant of cerebral meningioma with partial spontaneous regression.

Topics: Animals; Cattle; Cattle Diseases; Female; Keratins; Meningeal Neoplasms; Meningioma; Vimentin

Secretory meningioma (SM) is a rare histologic subtype known to cause disproportional peritumoral brain edema. Although meningiomas are defined by slow growth and mostly manifest with benign clinical symptoms, SMs can cause life-threatening deterioration. The aim of this study was to characterize the potential pitfalls in treatment of SMs by illustrating their characteristic clinical features.. We analyzed 69 patients with SM who underwent surgery at our institution and compared them with a matched nonsecretory meningioma cohort. Retrospective data were analyzed for frequency of seizures as the first presenting symptom, maximum corticosteroid use, intensive care unit stay, and hospital stay. In addition, histologic and radiographic data were evaluated for the extent of peritumoral brain edema formation, tumor location, and tumor size and correlated to clinical presentation.. Seizures were observed at a significantly higher rate as the first presenting symptom leading to clinical admission in patients with SM (33.3%) compared with the matched nonsecretory meningioma cohort (13%, P = 0.008). In patients with SM, seizures were associated with increased edema formation, whereas seizures in patients with nonsecretory meningioma correlated with tumor size (P = 0.007). The clinically more complicated course in patients with SM was reflected by increased demand for corticosteroids and a prolonged intensive care unit stay (P < 0.001). SM further showed a higher recurrence rate of 35.9% compared with a cohort of 320 World Health Organization grade I meningiomas resected at our institution (P < 0.001).. Our results illustrate the complicated clinical course of this rare histologic meningioma subtype. The increased frequency of seizures may enable raised awareness of clinicians for potential complications and treatment adjustments perioperatively early at clinical admission.

Topics: Adult; Aged; Aged, 80 and over; Brain; Brain Edema; Cohort Studies; Female; Humans; Image Processing, Computer-Assisted; Keratins; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1; Seizures; Stage-Specific Embryonic Antigens

Vulvar Paget's disease is sub-classified into three types based upon its origin. It might be a primary vulvar disease (type 1) or associated with a non-cutaneous adenocarcinoma-rectal, colonic, cervical (type 2) or linked with an urothelial neoplasia (type 3). Type 1lesions must be considered as potentially invasive. Their immunophenotype is CK7+/CK20-. Classically, in case of depth of invasion below 1mm, nodal metastases are exceptional. We report a case of type 1 Paget's disease in a postmenopausal woman with superficial invasion and multiple inguinal nodal metastases.

Topics: Aged; Biomarkers, Tumor; Female; Frontal Lobe; Humans; Keratins; Lymphatic Metastasis; Meningeal Neoplasms; Meningioma; Neoplasm Invasiveness; Neoplasms, Second Primary; Paget Disease, Extramammary; Peptidyl-Dipeptidase A; Postmenopause; Receptor, ErbB-2; Receptors, Estrogen; Vulvar Neoplasms

A 64-year-old male patient presented with generalized convulsions. Magnetic resonance imaging revealed a large meningeal tumor with some cysts in the right frontal region. Surgical resections were performed three times, and local radiation therapy was administered twice over a period of 8 years for the treatment of tumor recurrences. The tumor tended to recur in spite of the surgical and radiation therapies. The tumor was diagnosed as a chordoid meningioma, and the second surgical specimen showed increasing nuclear atypia and mitoses in tumor cells. An immunohistochemical study revealed the tumor cells were positive for vimentin, S-100 protein, and cytokeratin AE1/AE3. An electron microscopic study revealed intracytoplasmic vacuolar spaces, loosely connected interdigitating cell processes with intermediate junctions, and extracellular spaces which contained fluffy granular intercellular substances. The tumor cell surfaces displayed pseudopodia which extended into the intercellular spaces and the tumor cells had moderate quantities of cytoplasm containing abundant mitochondria and glycogen granules. According to the ultrastructural features in the past reports of chordoid meningiomas, these meningiomas are suspected to have a mixture of the characteristic ultrastructural features of meningothelial meningiomas and chordoid sarcomas.

Topics: Cell Nucleus; Cysts; Cytoplasmic Granules; Humans; Immunohistochemistry; Keratins; Magnetic Resonance Imaging; Male; Meningioma; Microscopy, Electron; Middle Aged; Mitochondria; Neoplasm Recurrence, Local; Neurosurgical Procedures; Reoperation; S100 Proteins; Tissue Fixation; Tomography, X-Ray Computed; Vimentin

Chordoma originates from embryonic notochordal remnants in the midline along the spinal axis and is characterized by cords and lobules of neoplastic cells arranged within myxoid matrix. Because of histologic similarities with myxoid matrix and overlapping immunohistochemical profile, chondrosarcoma, myxopapillary ependymoma, and chordoid meningioma enter in the histologic differential diagnosis at this site. Therefore, the judicious use of a panel of selected immunostains is unquestionably helpful in diagnostically challenging cases. To find useful immunohistochemical markers for assisting in differential diagnosis between chordoma and other tumors with chordoid morphology, an immunohistochemical study using D2-40, epithelial membrane antigen (EMA), pan-cytokeratin (panCK), glial fibrillary acidic protein (GFAP), S-100 protein, galectin-3, neural cell adhesion molecule (NCAM), beta-catenin, E-cadherin, and carcinoembryonic antigen was performed on 14 chordomas, 7 chondrosarcomas, 9 myxopapillary ependymomas, and 4 chordoid meningiomas. Chordoma typically showed positive for EMA and panCK and negative for D2-40 and GFAP; whereas chondrosarcoma revealed positive for D2-40, and negative for EMA, panCK, and GFAP; myxopapillary ependymoma positive for GFAP and negative for EMA; and chordoid meningioma positive for EMA, and negative for panCK and GFAP. On the basis of our immunohistochemical study, a panel of D2-40, EMA, panCK, and GFAP allowed the correct recognition of all tumors examined. Other immunohistochemical markers including S-100 protein, galectin-3, NCAM, beta-catenin, E-cadherin, and carcinoembryonic antigen were of little value in differential diagnosis. In summary, the best immunohistochemical markers useful for the evaluation of tumors with chordoid morphology were D2-40, EMA, cytokeratin, and GFAP. D2-40 was a true chondroid marker to be useful for the differential diagnosis with chordoma.

Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Biomarkers, Tumor; Chondrosarcoma; Chordoma; Diagnosis, Differential; Ependymoma; Glial Fibrillary Acidic Protein; Humans; Immunohistochemistry; Keratins; Meningioma; Mucin-1

Meningiomas and breast cancers are common tumors among women in the fifth to seventh decade. However, metastasis from breast cancer to an intracranial meningioma is rare. A 63-year-old woman presented with headache, nausea and vomiting, and progressive right hemiparesis for one month. She had undergone a right modified radical mastectomy in another hospital 10 years prior. At that time, the pathological diagnosis was infiltrating ductal carcinoma. She required adjuvant radiotherapy and chemotherapy for a local recurrence 7 years later. On admission to our hospital, cranial CT scans showed a brightly enhancing, irregularly shaped lesion over the left high parietal lobe with surrounding parenchymal edema. Histopathological examination of the lesion revealed two distinct tumor types, meningioma and metastatic carcinoma of breast tissue origin. Although meningiomas have well-known radiological features, other tumors, including metastases from breast cancers may simulate them. In the clinical setting of previously diagnosed breast cancer, prompt craniotomy for removal of meningioma-like intracranial lesions is recommended to avoid missing the diagnosis of breast cancer metastasis which carries a poorer prognosis than meningioma and requires a different treatment strategy.

Topics: Aged, 80 and over; Breast Neoplasms; Carcinoma; Female; Humans; Keratins; Meningeal Neoplasms; Meningioma; Tomography, X-Ray Computed

Tumor-to-tumor metastasis is a very rare event. We report three cases of tumor metastasizing in another tumor: a clear cell renal cell carcinoma in a vesicular thyroid adenoma, a lung carcinoma in a meningioma and a neuroendocrine lung carcinoma in a clear cell renal cell carcinoma. According to the literature, clear cell renal cell carcinoma is the most common tumor recipient of metastasis while lung carcinoma is the most common donor tumor. Several physiopathological mechanisms can explain this phenomenon, but many of them are still unknown.

Topics: Adenocarcinoma, Clear Cell; Aged; Biopsy; Carcinoma, Large Cell; Cell Division; Female; Hemoptysis; Humans; Immunohistochemistry; Keratins; Kidney Neoplasms; Lung Neoplasms; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Metastasis; Nephrectomy; Thyroid Neoplasms

Secretory meningiomas constitute a relatively rare subtype of meningiomas, accounting for only 1.1% at our institution, with a 6:1 predominance of female patients. This study aimed to obtain more information about the immunohistochemical characteristics of this histological entity, and to analyse the effects of histological factors such as the presence of mast cells on the radiological evidence of surrounding tumour oedema that frequently occurred in this subtype of meningioma. Fourteen cases of secretory meningioma were examined. Relevant clinical information was obtained from the patient files. Peritumoural oedema was determined either by CT or MRI scans and graded as small, moderate and severe. In order to perform the quantitative evaluation of mast cells in secretory meningiomas in a comparison with other meningiomas, 14 non-secretory meningiomas were randomly selected and used as a control group. The immunohistochemical staining of carcinoembryonic antigen was positive within the secretory droplets and the cells surrounding them in all cases. Ki 67 (MIB 1) proliferative index mean values were 2.4%, indicating low expression in all secretory meningiomas. Moreover, from our statistical analysis, there is no clear-cut pattern of various types of cytokeratins emerging in secretory meningiomas. The secretory meningiomas were characterized by a significantly increased number of mast cells as compared with non-secretory meningiomas of different grades. As the present clinical findings and laboratory results could not confirm a correlation between mast cell density and radiological evidence of oedema, further studies of mediators are warranted.

Topics: Actins; Adult; Aged; Brain Edema; Carcinoembryonic Antigen; Cell Movement; Cell Proliferation; Female; Humans; Immunohistochemistry; Incidence; Keratins; Ki-67 Antigen; Male; Mast Cells; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1; Pericytes; Vimentin

Metastasis from extracranial tumor into an intracranial primary tumor is an uncommon event. A predominant tendency of meningioma to be the host tumor for breast carcinoma has been found. In the current report, three cases of breast carcinoma metastatic to intracranial meningiomas are described. In our cases, metastasis in meningioma was the first clinical manifestation of the occult primitive breast carcinoma. We review widely the literature concerning such rare occurrences and discuss all the postulated pathogenetic mechanisms. There are few cases reported in the literature on resonance magnetic imaging of metastatic carcinoma in meningioma. Two of our patients have been studied by MRI, but we do not find predictive radiological finding of this particular association.

Topics: Adenocarcinoma; Adult; Aged; Breast Neoplasms; Female; Humans; Immunohistochemistry; Keratins; Magnetic Resonance Imaging; Male; Mammography; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasms, Multiple Primary; Receptors, Estrogen; Receptors, Progesterone; Vimentin

Topics: Aged; Brain Neoplasms; Humans; Immunohistochemistry; Keratins; Male; Meningioma; Mucin-1; Neoplasm Metastasis; Prostate-Specific Antigen; Prostatic Neoplasms; Telencephalon

To investigate the clinicopathologic and immunohistochemical features of secretory meningiomas.. Nine secretory meningiomas were examined. From each specimen, sections were cut and stained with hematoxylin-eosin, periodic acid-Schiff (PAS) stain, and periodic acid-Schiff stain with diatase(PAS-D ). Immunohistochemical markers including oestrogen receptor (ER), progesterone receptor (PR), carcinoembryonic antigen (CEA), cytokeratin (CK), epithelial membrane antigen (EMA), and MIB-1 were detected with streptavidin peroxidase (SP) immunohistochemical staining methods. One case was observed by electron microscopy (EM).. The 9 secretory meningiomas were located at sphenoid ridge, left parietal lobe or frontal lobe. Severe peritumoral edema was observed in 5 cases. Seven cases were followed up for 6 to 88 months; none of them showed evidence of recurrence. Histologically, the conspicuous feature was the eosinophilic inclusions. The finding of pericytic proliferation on examination was helpful to making a diagnosis. In all 9 cases, the tumor cells were positive for PR, but in 6 cases the inclusions were negative. ER was negative in 8 cases. CEA,CK, EMA expressed in the inclusions and the surrounding cells in 7 cases. In 1 case the positive rate for MIB-1 was 5%, but in the other 8 cases the positive rates were not more than 2%. The intercellular lumens and intracellular mucosa were observed under EM.. Secretory meningioma is a rare subtype of meningioma that shows glandular epithelium differentiation. It is a meningioma of the low-risk type in terms of incidence, recurrence and prognosis.

Topics: Adult; Aged; Carcinoembryonic Antigen; Female; Humans; Keratins; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Receptors, Progesterone

Secretory meningiomas are rare histological subtypes of meningiomas with benign biological behaviour. In this study, the authors describe the first case of secretory meningioma with many mitotic figures and brain invasion, and discuss the clinicopathologic features including immunohistochemical staining profile and ultrastructural appearance of this tumour. A case of a 54-year-old man diagnosed with an intracranial tumour located in the left frontal lobe is presented. On pre-contrast CT scans, the tumour was hypodense and the contrast enhancement was marked in the pseudo membrane. The tumour was partially removed. The histological diagnosis was secretory meningioma with many mitotic figures, a high MIB-1 labeling index and a brain invasion.

Topics: Carcinoembryonic Antigen; Combined Modality Therapy; Cranial Irradiation; Frontal Lobe; Humans; Keratins; Ki-67 Antigen; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Mitotic Index; Mucin-1; Neoplasm Invasiveness; Neoplasm Proteins; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant

Based on clinical and histologic features, differentiating metastatic carcinomas from benign or malignant meningiomas usually is not difficult. Occasionally, however, in some patients without a clinical history of carcinoma, malignant meningiomas can morphologically simulate metastatic carcinoma, necessitating an immunohistochemical study for cytokeratin to make a correct diagnosis. However, the utility of immunohistochemical markers to separate malignant meningioma from metastatic carcinoma has not been investigated. The immunoperoxidase method with antigen retrieval was used to characterize the expression of three cytokeratins (AE1/AE3, CAM 5.2, and Pan cytokeratin), EMA, CEA, Ber-EP4, CD 15, and B72.3 in 12 previously diagnosed malignant meningiomas, 20 benign meningiomas, and 20 metastatic carcinomas. Cytokeratin expression was detected in 75% of malignant meningiomas, 0% of benign meningiomas, and 100% of metastatic carcinomas. While epithelial markers of Ber-EP4, CEA, B72.3 and CD-15 were positive in 90, 80, 70 and 65% of the metastatic carcinoma, respectively, they were negative in all 12 malignant meningioma examined. Vimentin immunoreactivity was seen in all benign and malignant meningiomas, and in 20% of metastatic carcinomas. Our results indicated that cytokeratin is not a reliable immunohistochemical marker to separate a malignant meningioma from metastatic carcinoma. A panel of epithelial markers including Ber-EP4, CEA, B72.3 and CD-15, and vimentin may be needed to separate malignant meningioma from metastatic carcinoma. Cytokeratin expression can be a potential pitfall for confusing a malignant meningioma with a metastatic carcinoma.

Topics: Antibodies, Neoplasm; Biomarkers, Tumor; Carcinoembryonic Antigen; Carcinoma; Diagnosis, Differential; Humans; Immunohistochemistry; Keratins; Lewis X Antigen; Meningeal Neoplasms; Meningioma; Mucin-1; Predictive Value of Tests; Vimentin

Keratins are known to be expressed in some meningiomas, and they have been consistently reported in secretory meningiomas. However, the expression of individual keratin polypeptides has not yet been systematically explored, and such a study could provide important information for the differential diagnosis of meningioma and other tumors, particularly metastatic carcinomas. In this study we analyzed the keratin polypeptide patterns of 463 meningiomas of different types using well-characterized monoclonal antibodies specific to 11 individual keratins and 3 additional antibodies that recognize more than 1 keratin. Archnoid tissues from autopsies were examined for comparison. Secretory meningiomas showed consistent positivity for all simple epithelial keratins K7, K8, K18, and K19, usually limited to the slender spindle cells lining the gland-like lumina. Other keratins variably detected in a minority of gland-like structures were K5/6, K14, K16, and K17. Among other meningiomas, keratin 18 was commonly present in a significant number of tumor cells in different subtypes (30% to 80% of cases), often extensively. The K18 positivity of meningiomas paralleled that observed in normal arachnoids, which were negative for K7, K8, K19, and AE1. Only rare meningiomas, other than the secretory ones, had significant positivity for K7, K8, K19, and other keratins than K18. The concentric spindle cells around psammoma bodies and few other spindle cell foci were often focally positive for K7 and to lesser degree for K8, K14, and K19. The complex pattern of keratins in meningiomas has to be considered in the differential diagnosis of meningioma and metastatic carcinoma. In this context, antibodies to K7, K8, and K19 and the antibodies AE1 and AE3 are useful, because they only rarely label significant numbers of meningioma cells but are positive in a great majority of carcinomas. Careful histologic analysis is necessary to differentiate anaplastic meningiomas and metastatic carcinomas, which have overlapping patterns of several keratins except K20, which was never present in any type of meningioma.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Keratins; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Metastasis; Peptide Mapping

Paranasal meningioma was diagnosed in a 5-year-old Appaloosa gelding. The mass occupied the right maxillary, frontal, and sphenopalatine sinuses but did not invade the calvarium. The diagnosis was based on histologic evaluation, positive immunohistochemical staining for vimentin and cytokeratin, and ultrastructural features including the presence of interdigitating spindle cells with numerous desmosomes.

Topics: Animals; Horse Diseases; Horses; Immunohistochemistry; Keratins; Male; Meningioma; Paranasal Sinus Neoplasms; Vimentin

This study examined immunohistochemical staining patterns for several meningioma variants involving either the brain or spinal cord of dogs. Formalin-fixed, paraffin-embedded tissue from 15 tumors was obtained. The selected tumor group included seven meningothelial, three transitional, two malignant (anaplastic), one myxoid, one papillary, and one osteomatous meningiomas. Tumors were evaluated for reactivity to the following six immunohistochemical markers: vimentin, pancytokeratin, glial fibrillary acidic protein (GFAP), S100, neuron-specific enolase (NSE), and synaptophysin. Vimentin expression was detected in all meningiomas, and 14 of 15 tumors demonstrated intense vimentin staining in more than 50% of the neoplastic cells. Pancytokeratin expression was present in 11 of 15 neoplasms; however, positive staining frequently was focal and often involved a small percentage of the neoplastic cells. GFAP expression was detected in a single, anaplastic meningioma. Although expression of NSE and S100 was detected in 12 of 25 meningiomas, the intensity of the staining and the percentage of positive neoplastic cells was highly variable. Synaptophysin was uniformly negative. These results will help to establish immunohistochemical profiles for meningiomas that will improve our ability to correctly differentiate these neoplasms of meningeal origin from central nervous system tumors originating from other sites.

Topics: Animals; Brain Neoplasms; Central Nervous System Neoplasms; Dog Diseases; Dogs; Female; Glial Fibrillary Acidic Protein; Immunohistochemistry; Immunophenotyping; Keratins; Male; Meningioma; Phosphopyruvate Hydratase; S100 Proteins; Synaptophysin; Vimentin

A 74-year-old man manifested disturbed consciousness and right hemiparesis. Computed tomography revealed a left frontal parasagittal meningeal tumor with extensive peritumoral brain edema and skull invasion. Subtotal removal was performed. Five years later, he underwent two more operations of massive recurrences. Pathological studies revealed anaplastic meningioma with two different histological areas. One was an epithelial and meningothelial area, and the other was a papillary and rhabdoid area. In the papillary and rhabdoid area, small tumor cells with a high nucleus/cytoplasm ratio proliferated densely around the dilated central capillaries with a pseudopapillary pattern. Many rhabdoid cells (vimentin ++, cytokeratin AE1/AE3 +, epithelial membrane antigen [EMA] + +) tended to be distributed far from the central capillaries. There were many mitotic figures near the central vessels. Dense MIB1-positive nuclei were also observed near the central vessels. The trabecular pattern of the tumor cells in the epithelial area was quite different from the histological features of chordoid meningioma.

Topics: Aged; Biomarkers, Tumor; Cell Differentiation; Humans; Keratins; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Neoplasm Proteins; Neoplasm Recurrence, Local; Neoplastic Stem Cells; Nerve Tissue Proteins; Vimentin

We present a rare case of primary extracranial meningioma in a 36-year-old man, who had a solitary multinodular mass located in the plantar muscle of the foot. The histology of specimens from simple excision was typical of meningioma, showing bland spindle cell proliferation with a whorl pattern. Immunohistochemical analysis demonstrated that the tumor cells showed diffuse and strong positivity for epithelial membrane antigen as well as moderate reactivity for cytokeratin and vimentin. Ultrastructurally, the tumor cells were characterized by thin bipolar cytoplasmic processes and joined by multiple small desmosomes. There were frequent pinocytotic vesicles and a distinct external lamina on the cell surface. These findings suggest that this primary ectopic meningioma, arising in the soft tissue, may have been derived from perineurial cells of the peripheral nerve, but was morphologically distinguishable from perineurioma. Primary extracranial meningioma should be included in the differential diagnosis of soft-tissue spindle cell tumors, especially those of peripheral nerve origin.

Topics: Adult; Diagnosis, Differential; Foot Diseases; Humans; Immunohistochemistry; Keratins; Male; Meningioma; Nerve Sheath Neoplasms; Soft Tissue Neoplasms; Vimentin

Tumor-to-tumor metastasis is rare. We report a case of metastatic renal cell carcinoma in meningioma. A 67-year-old woman presented a two-week history of motor dysphagia and decreased short-term memory. She had undergone a left radical nephrectomy for a renal cell carcinoma 7 years ago, and had not received any adjuvant therapy. MRI disclosed a 3.0 x 3.0 x 3.0-cm sized round tentorial-based extraaxial mass with peritumoral edema in the left posterior temporal lobe. During operation, the tumor was found to be an encapsulated mass firmly attached to the tentorium. Histologically, the tumor was a meningotheliomatous meningioma extensively infiltrated by metastatic renal cell carcinoma, accompanying widespread coagulative necrosis. Immunohistochemical staining for cytokeratin revealed strong positivity only in the renal cell carcinoma component. The patient's postoperative course was uneventful. Post-operative radiation therapy was applied to the whole brain. Three months after operation, the patient developed right hemiparesis and dysphagia. Brain MRI at that time did not reveal recurrence or any other causative lesions, although the whole body scan disclosed uptake at the second lumbar vertebra and rib. The patient refused further treatment.

Topics: Aged; Carcinoma, Renal Cell; Female; Humans; Keratins; Kidney Neoplasms; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma

A case of meningioma coexisting with both lipomatous and secretory components, the latter characterized by hyaline inclusion bodies, is reported. The neuroradiological features of lipomeningioma are reevaluated, and the possible pathogenetic mechanisms of this unique combination in the present case are discussed.

Topics: Adipose Tissue; Adult; Carcinoembryonic Antigen; Cerebral Angiography; Female; Humans; Hyalin; Inclusion Bodies; Keratins; Lipoma; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Mucin-1; Neoplasm Proteins; Periodic Acid-Schiff Reaction; Seizures; Tomography, X-Ray Computed

We describe a case of meningothelial meningioma with a large number of intranuclear inclusions. Morphologically, these are divided into cytoplasmic inclusions and nuclear vacuoles. The cytoplasmic inclusion has a limiting membrane with cell organelles and filaments. Inclusions of this type are generally eosinophilic, like the cytoplasm. However, there are many inclusions that are more eosinophilic than the cytoplasm or that have a ground-glass appearance. Some of them may contain fine or coarse granules. On the other hand, the nuclear vacuole lacks a limiting membrane and appears empty. In most of the inclusions of this type, there is a faintly basophilic substance in the margin. Generally, the cytoplasmic inclusions are as immunopositive as cytoplasm with vimentin, but some of these cytoplasmic inclusions are more reactive. Under the electron microscope, abnormal aggregation of intermediate filaments is recognized in the cytoplasmic inclusions. It is considered that a strong reaction of cytoplasmic inclusions with vimentin immunostaining is due to abnormal aggregation of intermediate filaments. The present study distinctly demonstrates abnormal localization of intermediate filaments in the cytoplasmic inclusions, and it is suggested that the cytoskeleton participates in the evolution of the cytoplasmic inclusions.

Topics: Aged; Biomarkers, Tumor; Cell Nucleus; Cytoplasm; Cytoskeletal Proteins; Desmin; Gene Expression Regulation, Neoplastic; Humans; Immunoenzyme Techniques; Inclusion Bodies; Intracellular Membranes; Keratins; Male; Meningeal Neoplasms; Meningioma; Microscopy, Electron; Mucin-1; Neoplasm Proteins; Nerve Tissue Proteins; Vacuoles; Vimentin

Topics: Adult; Biopsy; Brain Edema; Chordoma; Diagnosis, Differential; Female; Humans; Immunohistochemistry; Keratins; Lymphocytes; Meningeal Neoplasms; Meningioma; Notochord; Plasma Cells

To investigate the epithelial features of intraspinal meningiomas, 25 intraspinal meningiomas and 25 intracranial meningiomas were examined for the presence of pseudopsammoma bodies with hematoxylin-eosin and periodic acid-Schiff staining. In addition, we investigated the expression of keratin and epithelial membrane antigen (EMA) by immunohistochemical methods. Pseudopsammoma bodies were found in 3 of 25 cases of intracranial meningiomas (12%), but no definitive pseudopsammoma bodies were observed the intraspinal meningiomas. Three cases (12%) of intraspinal meningiomas and 9 cases (36%) of intracranial meningiomas, including 3 cases with pseudopsammoma bodies, were immunoreactive for keratin. All 25 (100%) intracranial meningiomas and 20 of 25 (84%) intraspinal meningiomas were reactive for EMA. In the intraspinal meningiomas, 4 of 25 cases (16%) showed no reactivity for EMA. These findings suggest that the origin of certain cell components of meningiomas may be different according to the site of the tumor or that the nature of meningioma may be modified by the local environment.

Topics: Aged; Aged, 80 and over; Brain Neoplasms; Cell Differentiation; Eosine Yellowish-(YS); Epithelium; Female; Hematoxylin; Humans; Immunohistochemistry; Keratins; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1; Periodic Acid-Schiff Reaction; Spinal Cord Neoplasms; Staining and Labeling

Secretory meningioma is a rare histologic variant characterized by a unique epithelial differentiation of meningothelial cells resulting in the production of hyaline inclusions. Most previous reports have presented single case observations. The authors selected 31 cases for a clinicopathologic study to characterize this type of tumor further.. Clinical data were compiled and the extent of peritumoral edema was assessed from preoperative computed tomography or magnetic resonance imaging scans. Preparations of surgical specimens of all tumors were studied after both conventional histologic and immunohistochemical preparations were made. Immunostaining was performed by either the avidin-biotin complex method or the alkaline phosphatase-antialkaline phosphatase method using 22 primary antibodies.. In the tumor collection used in this study, secretory meningiomas represented 3% of meningiomas. The female-to-male ratio was 9:1. Most tumors were located at the sphenoid ridge or at the frontal convexity, and recurrences were not observed. Eighty-four percent of tumors presented with slight to marked peritumoral edema. The MIB-1 staining index showed a mean of 3.8%. Inclusions and surrounding cells consistently expressed epithelial membrane antigen, cytokeratins, carcinoembryonic antigen, and carbohydrate antigen 19-9. In decreasing frequency, they also contained alpha1-antitrypsin, immunoglobulin (Ig)A, alpha1-antichymotrypsin, IgM, and IgG. Cells positive for vimentin and S-100 did not contain inclusions. All tumors were positive for progesterone receptors. Macrophages were stained with antibodies to factor XIIIa, human leukocyte antigen-DR, and alpha1-antitrypsin. In 64% of cases, tumor vessels lacked expression of glucose transporter protein 1.. The classification of secretory meningioma as a distinct variant has been justified on clinical, histologic, and immunohistochemical grounds. The unique epithelial features call attention to the broad spectrum of differentiation properties found in meningiomas.

Topics: Adult; Aged; Aged, 80 and over; alpha 1-Antichymotrypsin; alpha 1-Antitrypsin; CA-19-9 Antigen; Carcinoembryonic Antigen; Cell Differentiation; Coloring Agents; Edema; Epithelium; Female; Humans; Hyalin; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunohistochemistry; Inclusion Bodies; Keratins; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1; Receptors, Estrogen; Tomography, X-Ray Computed

Despite controversy regarding its histogenesis, meningeal hemangiopericytoma (HPC) is a well-defined clinicopathologic entity exhibiting high rates of recurrence and late extracranial metastasis. It must be distinguished from several benign neoplasms, particularly fibrous meningioma (FM) and solitary fibrous tumor (SFT). To determine the immunoprofile of HPC, we studied 27 meningeal examples, including 13 low-grade and 14 high-grade tumors. For comparison, 20 FMs and eight SFTs of the meninges were also evaluated. The immunotype of HPC included vimentin (85%), factor XIIIa (78%) in individual scattered cells, Leu-7 (70%), and CD34 (33%) in a weak, patchy pattern. Focal desmin and cytokeratin positivity was only occasionally encountered (20% each). The SFT shared a similar immunophenotype, except that CD34 expression (100%) was characteristically strong and diffuse. The FM characteristically expressed epithelial membrane antibody (EMA) (80%) and S-100 protein (80%); CD34 reactivity (60%) was patchy and weak. Both within and among all three tumor types, MIB-1 labeling indices varied widely. Specifically, they were unrelated to tumor grade in HPC. Significant reactivity for p53 protein was detected in 52% of HPCs, 17% of SFTs, and 5% of FMs. Meningeal HPC exhibits a distinct antigenic profile, one enabling the exclusion of other entities in nearly all cases. The rare expression of desmin or cytokeratin in HPC suggests either the occurrence of divergent differentiation or, less likely, the possibility that its distinctive morphology is but a phenotype shared by several types of meningeal sarcoma.

Topics: Adult; Aged; Antigens, CD34; Biomarkers, Tumor; Female; Fibroma; Hemangiopericytoma; Humans; Immunohistochemistry; Immunophenotyping; Keratins; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Transglutaminases

We studied a recurrent meningioma located in the right frontal lobe. The tumor showed high cellularity and the cells had plump, hyalinous cytoplasm. Immunohistochemically, almost all the tumor cells were positive for epithelial membrane antigen and vimentin, and unexpectedly, glial fibrillary acidic protein (GFAP). Ultrastructural investigation revealed abundant 8- to 10-nm filaments in the cytoplasm. Conspicuous interdigitations with numerous desmosomes were present. Frequently, intracellular and intercellular lumina lined by microvilli were also found. We considered the present case to be an unusual variant of meningioma with GFAP expression. A few cases of meningioma with triple expression of GFAP, vimentin and cytokeratin have been reported previously. However, the present case showed obvious pathological differences from these, and had no immunoreactivity for cytokeratin.

Topics: Frontal Lobe; Glial Fibrillary Acidic Protein; Humans; Immunohistochemistry; Keratins; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Recurrence; Vimentin

Topics: Adolescent; Histocytochemistry; Humans; Immunohistochemistry; Keratins; Male; Meningioma; Skin Neoplasms; Vimentin

Psammoma bodies and small calcifications are frequently seen in a wide variety of tissues. These deposits of calcium salts render tissues difficult to section. Conventional decalcification alters the tissues; consequently it is not advisable to decalcify tissues containing only small calcium deposits. A simple and rapid method to remove small amounts of calcium salts using citric acid alone is described. This method does not alter the antigenic properties of the substances studied.

Topics: Antigens; Calcium; Carcinoma, Papillary; Citrates; Citric Acid; Decalcification Technique; Humans; Keratins; Meningioma; Staining and Labeling; Thyroglobulin; Thyroid Neoplasms

In an attempt to characterize the dual mesenchymal and epithelial differentiating potential of meningiomas, cryostat sections from 50 meningiomas of diverse histological subtypes were examined immunohistochemically with a panel of markers for epithelial and mesenchymal differentiation. The overall positivities were: keratins 50%, epithelial membrane antigen 94%, human milk fat globules 38%, carcinoembryonic antigen 4% (secretory meningiomas only), desmoplakins 64%, collagen I 82%, procollagen I 96%, collagen III 74%, collagen IV 60%, laminin 54%, fibronectin 98% and vimentin 98%. Such production of keratins was not found in many previous immunohistochemical analyses of meningiomas with paraffin sections. The extracellular matrix proteins were present in a pericellular distribution suggestive of their being produced by the tumour cells. The potential of dual epithelial and mesenchymal differentiation in meningiomas was further examined in seven cases established on short-term cultures. Morphologically, subcultured tumour cells resembled fibroblasts and in five cases revealed similar epithelial and mesenchymal immunohistochemical profiles as for direct tumour immunostaining. In two cases, cells from the primary cultures revealed a fine skeleton of intercellular matrix proteins stainable by immunohistochemical methods, providing further proof that meningioma cells possess the capability to elaborate extracellular matrix proteins, a major mesenchymal function akin to that of fibroblasts.

Topics: Adult; Aged; Biomarkers; Cell Differentiation; Culture Techniques; Epithelium; Extracellular Matrix Proteins; Female; Humans; Immunohistochemistry; Keratins; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Proteins

Three unusual cutaneous tumors are described along with ultrastructural and immunohistochemical studies. All lesions were asymptomatic red-brown papulonodules. Light microscopic examination revealed a whorled configuration of spindle-shaped cells, some concentrically arranged around blood vessels. Immunohistochemical panels exhibited positive staining only with antibody to vimentin and negative staining with antibodies against S-100 protein, muscle markers, cytokeratin, epithelial membrane antigen, Leu 7, type IV collagen, and factor XIIIa, ruling out obvious nevomelanocytic, nerve sheath, meningothelial, smooth muscle, and perithelial differentiation. Electron microscopic examination demonstrated cells producing poorly formed collagen fibrils, sparse collagen fibers, and possessing occasional ill-defined intercellular junctions between their elongated cell processes. This rare tumor is considered to be either an immature fibrohistiocytic or possibly a nerve sheath neoplasm with striking similarities to so-called canine hemangiopericytoma. Because the prominent whorled pattern was reminiscent of meningioma, the lesion was referred to as meningioma-like tumor of the skin.

Topics: Actins; Adult; Antigens, CD; Antigens, Differentiation, T-Lymphocyte; CD57 Antigens; Collagen; Desmin; Female; Hemangiopericytoma; Humans; Immunohistochemistry; Keratins; Male; Membrane Glycoproteins; Meningioma; Microscopy, Electron; Middle Aged; Mucin-1; S100 Proteins; Skin Neoplasms; Vimentin

Eighteen cases of anaplastic meningioma were studied by LM, EM and immunohistochemistry for vimentin, EMA, keratin, GFAP and S-100. Microscopically, there were four histologic types, i.e. fibrosarcoma-like, angiosarcoma-like, polymorphic giant cell sarcoma-like and angiopapillary structure. By EM, four kinds of cells: undifferentiated cell, intermediate transitional cell, spindle-shaped cell, and giant cell, were found and variant transitions from undifferentiated or poorly, differentiated to meningioma cells were observed. Their ultrastructures and immunohistochemical features are similar to those of malignant mesothelioma. Since these two kinds of neoplasm showed both mesenchymal and epithelial cells in the features, the authors consider that their histogenesis may also be similar.

Topics: Adolescent; Adult; Child; Female; Humans; Immunohistochemistry; Keratins; Male; Meningeal Neoplasms; Meningioma; Microscopy, Electron; Middle Aged; Vimentin

Two intraparenchymal lung tumors exhibiting the histopathologic and immunophenotypic characteristics of an intracranial meningioma are presented. The meningiomas presented as solitary asymptomatic nodules in elderly individuals. Both patients survived longer than 3 years following resection, and neither displayed clinical or radiographic evidence of a central nervous system tumor, suggesting that these are primary lung tumors. Review of the literature and discussion of other lesions in the differential diagnosis of this rare intrapulmonary neoplasm are presented.

Topics: Aged; Female; Humans; Immunoenzyme Techniques; Immunophenotyping; Keratins; Lung Neoplasms; Membrane Glycoproteins; Meningioma; Middle Aged; Mucin-1; S100 Proteins; Vimentin

An autopsy case of recurrent and malignant meningioma is reported. This case was originally typical benign transitional meningioma of the falx, however, the histology of the tumor changed to show malignant features during successive recurrences. At autopsy, the tumor revealed findings consistent with malignant meningioma. One of the most interesting features was the presence of cartilage and giant cells in some parts. Immunohistochemistry showed positive immunoreactivity for S-100 protein in some cartilage and giant cells and for cytokeratin in some giant cells. Multidifferential potential of the meningioma cells was suggested in this case.

Topics: Cartilage; Cerebral Ventricle Neoplasms; Female; Giant Cells; Humans; Immunohistochemistry; Keratins; Meningioma; Middle Aged; S100 Proteins

Seventy-seven cases of meningioma (15 with single or multiple recurrences), selected on the basis of their histologic subtypes, and nine cases of neurilemoma were analyzed immunohistochemically for the presence of the five classes of intermediate filament proteins, neuron-specific enolase (NSE), protein S-100, epithelial membrane antigen (EMA), and HNK-1 (Leu-7). Most antibodies were studied with the alkaline phosphatase-antialkaline phosphatase method. The peroxidase-anti-peroxidase and avidin-biotin-complex methods were used for Leu-7 and NSE, respectively. Meningiomas were subdivided into groups showing cytokeratin or protein S-100 positivity. Coexpression of these two markers was rare (5%) and occurred in meningotheliomatous meningiomas only. Only in these cases was cytokeratin expression more frequent than in meningiomas taken together (33% versus 20%). In contrast, protein S-100 expression was less frequent (46% versus 60% on average). In fibrous meningiomas, both cytokeratins and NSE were expressed less frequently than on average (11% versus 20%, 67% versus 88%, respectively). Protein S-100 occurred in a higher percentage of cases. Transitional meningiomas did not show cytokeratin expression. Protein S-100 occurred in a higher percentage of cases. Transitional meningiomas did not show cytokeratin expression. Protein S-100 was expressed slightly more often than in the other subtypes. Psam-momatous meningiomas coexpressed more markers than any other subtype. Hemangioblastic and hemangiopericytic forms did not stain for EMA, but otherwise showed a staining profile similar to that of meningiomas. HNK-1 was expressed in 29% of meningiomas, particularly among tumors with anaplastic histologic features. There was no marker that retrospectively indicated impending recurrences.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antigens, Differentiation; CD57 Antigens; Child; Child, Preschool; Female; Glial Fibrillary Acidic Protein; Humans; Intermediate Filament Proteins; Keratins; Male; Membrane Glycoproteins; Meningioma; Middle Aged; Mucin-1; Nervous System Neoplasms; Neurilemmoma; Neurofilament Proteins; Phosphopyruvate Hydratase; S100 Proteins; Vimentin

The Cavitron ultrasonic surgical aspirator (CUSA) is a dissecting system that allows quick and effective removal of CNS tumors without traction or excessive manipulation of normal tissue. In this article, the immunoperoxidase staining patterns of cytology specimens obtained with the CUSA are compared with those from their corresponding resected surgical specimens employing a battery of monoclonal and polyclonal antibodies. Eleven cases of meningioma, three cases of glioblastoma multiforme, one astrocytoma, and two schwannomas were evaluated. In both CUSA cytologic biopsies and surgical biopsies, all the meningiomas showed strong staining for vimentin and epithelial membrane antigen, while two showed focal staining for cytokeratins. The glioblastoma multiforme and astrocytoma cases showed positivity for vimentin, S-100 protein, and glial fibrillary acidic protein, while the schwannomas stained positively for vimentin and S-100 protein. With only rare exceptions, the immunocytochemistry of the CUSA and surgical specimens correlated well in all of these cases in terms of strength of reaction and localization. There were no false-positive staining reactions in the CUSA material. This study suggests that reliable morphologic and immunoperoxidase studies can be performed on cytologic material obtained by the CUSA, which could aid in making an accurate and specific diagnosis of a variety of CNS tumors.

Topics: Astrocytoma; Biopsy; Cytodiagnosis; Glial Fibrillary Acidic Protein; Glioblastoma; Humans; Immunoenzyme Techniques; Keratins; Meningioma; Neoplasms, Nerve Tissue; Neurilemmoma; Neurosurgery; S100 Proteins; Suction; Ultrasonic Therapy; Vimentin

We studied 5 primary cutaneous meningiomas. All were congenital. Four were nodules or plaques on the scalp, and one was a lumbar polyp. Two were alopecic. A skull defect was present deep to one lesion, and the lumbar polyp was attached to dura. The tumors were concentrated in the subcutis, where strands of meningocytes were embedded in dense collageous tissue. Meningocytes wrapped around collagenous fibers, producing "collagen bodies". These formed the nidus for calcification that included psammoma bodies. Meningocytes also dissected between collagenous fibers, creating anastomosing spaces that mimicked a vascular tumor. Meningothelial-lined clefts, several milimeters in length, were present in 4 cases. Two lesions extended through dermal defects into the superficial dermis, where adnexa were reduced or absent. The meningocytes contained vimentin and epithelial membrane antigen. They lacked cytokeratin, S100 protein, and endothelial markers. The meningothelial lesions described herein lack the nodular and sheet-like growth patterns that typify meningiomas of the central nervous system and most primary ectopic meningiomas, including some that develop within the skin. They appear closely related to meningoceles and should be viewed as developmental abnormalities rather than neoplasms. The term "rudimentary meningocele" seems appropriate for these lesions.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Genetic Variation; Humans; Immunohistochemistry; Infant; Keratins; Male; Membrane Glycoproteins; Meningioma; Meningocele; Mucin-1; S100 Proteins; Skin Neoplasms; Vimentin

Meningiomas possess features indicative of epithelial differentiation. The present study further documents this finding by a multimodality approach on serial sections from 25 meningiomas of all histologic and clinical categories. Standard light microscopic examination, immunohistochemical staining with a variety of epithelial and nonepithelial markers, and histochemical staining for mucin were performed on each case. Directed electron microscopic examination was performed on selected examples of epithelial feature-positive and -negative cases. All cases were immunoreactive for vimentin and epithelial membrane antigen. Thirty-two percent were reactive for cytokeratin and 39% for S-100. Twenty percent showed mucin positivity by histochemistry. Electron microscopic examination of cytokeratin-positive cases showed either intracellular lumina (secretory areas) or cytoplasmic tonofibrils, whereas cytokeratin-negative tumors lacked lumina and tonofibrils. Previous studies showing epithelial features in meningiomas are reviewed with emphasis on the studies using immunohistochemistry. These histochemical, immunohistochemical, and ultrastructural characteristics are of utility in the examination of tumors of suspected meningeal origin, particularly when dealing with atypical presentations or histomorphologic features.

Topics: Antigens, Neoplasm; Epithelium; Histocytochemistry; Humans; Immunohistochemistry; Keratins; Membrane Glycoproteins; Meningeal Neoplasms; Meningioma; Microscopy, Electron; Mucin-1; S100 Proteins; Staining and Labeling; Vimentin

Topics: Aged; Carcinoembryonic Antigen; Female; Humans; Immunoglobulin A; Immunoglobulin M; Immunohistochemistry; Keratins; Membrane Glycoproteins; Meningioma; Mucin-1; S100 Proteins; Vimentin

A parasagittal meningioma of an eighty year old female patient showed by light and electron microscopy cystic architecture (forme humide) as well as nuclear vacuoles (indentations) and cytoplasmic inclusions. The latter are the known pseudopsammoma bodies or hyaline inclusions as demonstrated by light and electron microscopy. Light microcopy on paraffin sections and cytological smear preparations revealed, in addition to the cells of endotheliomatous meningioma and those containing the inclusions a third type with small granular cytoplasmic content. Electron microscopy showed characteristic features of meningioma such as folded double membranes, desmosomes and filaments and thus gave evidence of the meningiomatous nature of the tumor. By immunohistochemistry tumor cells in slightly focal distribution contained vimentin, whereas small clusters of cells with hyaline inclusions were strongly positive for cytokeratin. The dispersed cells of granular cytoplasmic content were positive for fibronectin. These findings, especially of the inclusion containing cytokeratin positive cell clusters may shed new light upon the concept of histogenesis and classification.

Topics: Aged; Aged, 80 and over; Biomarkers, Tumor; Cell Transformation, Neoplastic; Female; Fibronectins; Humans; Immunohistochemistry; Keratins; Meningeal Neoplasms; Meningioma; Microscopy, Electron; Vimentin

The successful application of immunostaining on smear preparations from 34 tumours of the central nervous system using the peroxidase-antiperoxidase technique and the avidin-biotin-peroxidase complex technique with commercially available antibodies is described. When combined with conventional smear preparations, the technique contributed to a rapid and accurate diagnosis in 79% of cases and is advocated to be a useful adjunct in neurosurgical diagnosis.

Topics: Antigens; Astrocytoma; Biopsy; Brain Neoplasms; Glial Fibrillary Acidic Protein; Humans; Immunohistochemistry; In Vitro Techniques; Keratins; Membrane Glycoproteins; Meningioma; Mucin-1; S100 Proteins; Spinal Cord Neoplasms

Three surgically removed meningotheliomatous meningiomas with hyaline inclusions or pseudopsammoma bodies were studied. Ultrastructurally, the lumina seemed to be predominantly intracytoplasmic, defined by a systemic unit membrane; they displayed abundant microvilli and contained granular or filamentous material, vacuoles, vesicular bodies, and lamellar structure. The cytoplasm surrounding the intracytoplasmic lumina was electron-dense and contained tonofilaments and desmosomal junctions. All three meningiomas showed expression of carcinoembryonic antigen, cytokeratin, and epithelial membrane antigen in the cells surrounding the hyaline bodies. Keratin, alpha-1-antitrypsin, and immunoglobulin M showed weak positive staining. There was widespread vimentin except in the cells with hyaline inclusions. Glial fibrillary acidic protein and S100 were negative. These results provide additional confirmation of immunohistochemical data that can serve as evidence for epithelial and secretory differentiation in meningiomas.

Topics: Aged; Carcinoembryonic Antigen; Cell Differentiation; Cytoplasm; Epithelium; Humans; Hyalin; Immunohistochemistry; Inclusion Bodies; Keratins; Male; Membrane Glycoproteins; Meningeal Neoplasms; Meningioma; Microscopy, Electron; Middle Aged; Mucin-1

Only few investigations have so far become known in the context of cytokeratin expression in cells of the arachnoid and in meningioma. Immunohistochemical studies, using three monoclonal anti-cytokeratin antibodies, were conducted into six arachnoids and 43 meningiomas. Consideration was given to all histological types of meningioma but the papillary type. Three arachnoids and nine meningiomas responded positively to cytokeratin. The highest ratio of positive meningiomas, that is four in ten, was recorded from unfixed cryostat sections, using the monoclonal antibody A45-B/B3.

Topics: Arachnoid; Humans; Immunohistochemistry; Keratins; Meningeal Neoplasms; Meningioma

A tumor arising in the pituitary fossa and having some of the histological and ultrastructural features of a recently described tumor, purportedly originating from the folliculo-stellate cells of the anterior pituitary, is presented. The results of our ultrastructural and immunohistochemical studies, however, favored a meningeal origin and suggested that the neoplasm was most likely a secretory meningioma.

Topics: Adenoma; Diagnosis, Differential; Female; Humans; Keratins; Membrane Glycoproteins; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1; Pituitary Neoplasms; Vimentin

Twenty-nine cases of meningioma were studied by immunoperoxidase staining using broad-spectrum antibodies to cytokeratin (AE1/AE3), carcinoembryonic antigen (CEA) and epithelial membrane antigen (EMA). Twenty-six cases (90%) showed positive staining for EMA. All cases were negative for cytokeratin and CEA except for the two cases of secretory meningioma. Normal arachnoidal cells of the leptomeninges from 15 autopsies were studied similarly, and 10 cases (67%) demonstrated positive staining for EMA, but not for CEA and cytokeratin. Literature from previous investigations on epithelial markers of meningiomas is reviewed. It is concluded that meningiomas and normal arachnoidal cells share similar immunohistochemical properties, and that EMA is a useful epithelial marker for meningiomas.

Topics: Adult; Aged; Antibodies, Monoclonal; Arachnoid; Carcinoembryonic Antigen; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Membrane Glycoproteins; Meningeal Neoplasms; Meningioma; Middle Aged; Mucin-1

Thirteen meningiomas of varying light microscopic features were studied immunohistologically using a panel of monoclonal antibodies directed against epithelial, mesenchymal, and neural components. All 13 meningiomas showed expression of epithelial membrane antigen, vimentin, and S100 protein, as did normal meninges. Five of the 13 meningiomas also showed focal expression of cytokeratins, with double labelling showing expression of cytokeratins and vimentin by different cells. The cytokeratin expression was especially noticeable in cells surrounding the hyaline bodies of meningiomas. These results provide further evidence that meningiomas have features of both mesenchymal and epithelial tissues.

Topics: Antigens, Neoplasm; Epithelium; Humans; Immunoenzyme Techniques; Keratins; Membrane Proteins; Meningeal Neoplasms; Meningioma; Mucin-1; S100 Proteins; Vimentin

Meningiomas are composed of cells which display both mesenchymal and epithelial features. To investigate the epithelial nature of these cells, we studied the distribution of epithelial membrane antigen (EMA) in 22 meningiomas; for comparison, we also studied eight central schwannomas, neoplasms with which meningiomas sometimes may be confused histologically. All 22 meningiomas (12 transitional, six meningotheliomatous, three fibroblastic, and one psammomatous) demonstrated immunoreactive EMA, whereas all eight schwannomas were EMA-negative. There was no consistent relationship between histologic growth pattern and nature of EMA staining in the meningiomas: meningothelial areas, spindle cell areas, and whorls all showed EMA immunoreactivity of varying degrees. We also evaluated the distribution of S-100 protein and keratin in these tumors. All schwannomas showed diffuse S-100 positivity, which was often more intense in the nuclei than in the cytoplasm. In nine meningiomas (41%), S-100 immunostaining was observed, but this was usually focal, and nuclear staining was never more intense than cytoplasmic staining. One meningioma, but none of the schwannomas, showed clusters of keratin-positive cells. We conclude the following: EMA immunoreactivity is a characteristic feature of meningiomas, regardless of pattern of growth, and the combination of immunoperoxidase staining for EMA and S-100 protein may be used to distinguish meningiomas from schwannomas in problematic cases.

Topics: Antigens; Diagnosis, Differential; Female; Humans; Immunoenzyme Techniques; Keratins; Male; Membrane Proteins; Meningeal Neoplasms; Meninges; Meningioma; Mucin-1; Neurilemmoma; S100 Proteins

Fifty formalin-fixed, paraffin-embedded meningiomas were studied with a panel of ten antibodies directed against epithelial antigens, intermediate filaments, and neuroectodermal antigens. Twenty-five (50%) of these were stained with monoclonal antibodies (MoAb) to epithelial membrane antigen (EMA), 12 (24%) with keratin antibodies, 9 (18%) for vimentin, and 4 (8%) for S100 protein. Monoclonal antibodies to Leu-7, desmin, neurofilament 200 kDa, and glial fibrillary acidic protein (GFAP) all failed to stain any of the 50 neoplasms. Overall, 34 (68%) meningiomas stained with one or more antibodies. Sixteen (32%) failed to stain at all. The dual epithelial and mesenchymal nature of meningiomas is supported in this study. Applications to diagnostic surgical pathology and histogenetic implications are discussed.

Topics: Antibodies, Monoclonal; Histocytochemistry; Humans; Immunoenzyme Techniques; Keratins; Membrane Proteins; Meningeal Neoplasms; Meningioma; Mucin-1; Phenotype; S100 Proteins; Staining and Labeling; Vimentin

Topics: Abnormalities, Multiple; Adult; Carcinoma, Basal Cell; Chromosome Aberrations; Chromosome Disorders; Creatinine; Female; Humans; Jaw Diseases; Keratins; Male; Meningioma; Metabolic Clearance Rate; Middle Aged; Odontogenic Cysts; Phosphates; Syndrome