Aggressive meningioma with jugular vein extension. Case report with ultrastructural observations

Extracranial Intraluminal Extension of Atypical Meningioma within the Internal Jugular Vein

Meningiomas represent the most common benign intracranial neoplasms, and may spread by direct extension into nearby venous sinuses, but gross spread to the extracranial venous system is uncommon. We report the case of a patient with extracranial intraluminal spread of meningioma within the internal jugular vein to level III of the neck. Review of the preoperative assessment and management is also presented.

Transjugular extension of meningioma into the mediastinum-a case report

A case of a tentorial meningioma with atypical histological features invading the transverse sinus and extending along the internal jugular vein up to the superior mediastinum is described. This report illustrates one of the many ways meningiomas spread beyond the cranial cavity and the difficulty in managing such a problem.

Jugular foramen chordoid meningioma

Chordoid meningioma (CM) is a rare histological variant of meningioma and is classified as an atypical meningioma on pattern alone. Herein is described the first case of CM occurring in the jugular foramen. The patient was a 45-year-old woman with a 2 year history of progressive right hearing loss. Magnetic resonance imaging (MRI) demonstrated a large, dumbbell-shaped, homogenously gadolinium-enhanced mass in the right jugular foramen, extending medially to the cerebellopontine angle and caudally into the upper carotid space. Angiographic findings supported a diagnosis of schwannoma. Intraoperatively, the tumor appeared to involve the right glossopharyngeal nerve completely and the vagus nerve incompletely, and was incompletely resected. Microscopically, the tumor consisted predominantly of cords and nests of medium-sized cells with bland cytological features, surrounded by a pale basophilic mucin. Immunohistochemically, the tumor cells demonstrated reactivity for epithelial membrane antigen (membranous) and vimentin, with negative staining for S-100 protein, cytokeratin, CD34, glial fibrillary acidic protein (GFAP), synaptophysin, and chromogranin A. Based on the chordoid histology, an organoid lobular arrangement of the tumor cells, and the location of the tumor (jugular foramen), the differential diagnosis included not only a chordoma but also a paraganglioma (glomus jugulare tumor). Histological identification of typical meningotheliomatous areas, plus selective immunohistochemical panel, is important to establish the correct diagnosis.

Electron microscopy in tumor diagnosis: indications for its use in the immunohistochemical era

The electron microscope reveals much more information on tumor cell structure than can be obtained with the light microscope, and some of the data are useful in diagnostic studies. In this review, major contributions of electron microscopy in the main tumor categories are discussed. To select between immunocytochemistry and electron microscopy, the probable contributions of each in the context of the particular case must be assessed. Usually, electron microscopy will only be requested after a battery of immunostaining procedures has been performed and found to be insufficient, but there are occasions when ulstrastructural study is logically the first choice after routine light microscopy. It is worth taking tissue for possible electron microscopy from any tumor that is known or anticipated to be a diagnostic problem.

Malignant meningioma of the scalp

A nodule from the scalp of a 14-year-old boy was diagnosed by light and electron microscopy as a meningioma. There was no evidence of an intracranial lesion or involvement of the bone of the skull. The tumor was excised but recurred and metastasized to lung and chest wall.

Extracranial, extraspinal meningiomas of the head and neck

The head and neck is the most frequent location for extraneuraxial meningiomas, be they wholly extracranial or extraspinal or extensions of central nervous system meningiomas. Regardless of anatomic site of origin, nearly all meningiomas arise from meningocytes of arachnoid granulations. Ectopic arachnoid cell clusters have a predilection for areas of dural penetration of cranial nerves, and it is in these areas that most extracranial meningiomas are found. Surgical excision is the mainstay of treatment and must be planned by radiologic studies to determine the extent of the tumor and the presence or absence of a companion central nervous system meningioma. The often locally invasive and aggressive behavior of the meningiomas belies their benign histologic appearance.

Primary calvarial meningiomas

Two cases of primary calvarial meningioma developing epidurally and protruding extracranially without subdural involvement are reported. The relevant literature on calvarial meningioma is reviewed.

Meningiomas presenting in the paranasal sinuses and temporal bone

Head and neck meningiomas are primarily intracranial neoplasms; they rarely present in extracranial locations. Two cases of meningiomas in the paranasal sinuses and seven cases in the temporal bone are described. The pathology, pathogenesis, clinical evaluation, and therapy are discussed. It is stressed that intracranial components of such meningiomas be sought and, as appropriate, treated.