1
|
Sigdel K, Ding ZF, Xie HX. Case of primary extracranial meningioma of the maxillary sinus presenting as buccal swelling associated with headache: A case report. World J Clin Cases 2022; 10:1008-1015. [PMID: 35127914 PMCID: PMC8790439 DOI: 10.12998/wjcc.v10.i3.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/20/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Meningiomas are benign tumors that originate from the meningothelial arachnoid cells, but they rarely develop extracranially. There is no specific surgical guideline for resecting them in the maxillary sinus, and little is known about their biological behavior and operative management.
CASE SUMMARY We present a 54-year-old female patient referred to our department with a primary extracranial meningioma that presented as buccal swelling associated with headache. On clinical examination the mass was non-tender, fixed, sessile and non-pulsatile situating in the right maxillary sinus. Computed tomography scan showed a well-defined mass of 7 cm × 6 cm × 6 cm compressing the surrounding structures. Magnetic resonance imaging revealed a well circumscribed heterogenous lesion with necrotic center and relatively hypointense on T2-weighted imaging. Imaging studies revealed no evidence of intracranial extension and metastatic nests. Biopsy showed grade I primary extracranial with low mitotic activity. Total maxillectomy with excision of tumor and adjacent paranasal structures following reconstruction of the orbit and maxilla with tissue patch was done by the maxillofacial surgeon. The biopsy reported fibrous meningioma based on the hematoxylin and eosin section. On immunohistochemistry the tumor cells were positive for vimentin, focally positive for epithelial membrane antigen and CD99 and negative for signal transducer and activator of transcription 6. The mass was removed surgically with reconstruction, and the pathological studies confirmed the diagnosis to be an extracranial meningioma. The present study briefly reviews the current knowledge concerning the diagnosis and treatment of extracranial meningiomas in the head and neck area and offers suggestions for managing extracranial meningiomas in the paranasal sinuses.
CONCLUSION To conclude, extracranial meningiomas in the paranasal sinuses may be successfully managed by surgical treatment without evident post-surgery complications.
Collapse
Affiliation(s)
- Krishna Sigdel
- Department of Head and Neck Oncology Surgery, West China School of Stomatology, Chengdu 610041, Sichuan Province, China
| | - Zhang-Fan Ding
- Department of Head and Neck Oncology Surgery, West China School of Stomatology, Chengdu 610041, Sichuan Province, China
| | - Hui-Xu Xie
- Department of Head and Neck Oncology Surgery, West China School of Stomatology, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
2
|
Yokoi H, Kodama S, Maruyama K, Fujiwara M, Shiokawa Y, Saito K. Endoscopic endonasal resection via a transsphenoidal and transpterygoid approach for sphenoid ridge meningioma extending into the sphenoid sinus: A case report and literature review. Int J Surg Case Rep 2019; 60:115-119. [PMID: 31212093 PMCID: PMC6581985 DOI: 10.1016/j.ijscr.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/28/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Large sphenoid ridge meningiomas are surgically challenging because of their extension to adjacent structures. Extracranial meningiomas are very rare; most are of the secondary type and have an intracranial origin. Improved surgical methods are required for treatment of this entity. PRESENTATION OF CASE Here, we describe a case of a huge sphenoid ridge meningioma extending into the sphenoid sinus that was resected by staged transcranial and endoscopic endonasal resection via a transsphenoidal and transpterygoid approach. It was possible to excise the tumor from the sphenoid sinus in a minimally invasive manner via this approach. DISCUSSION AND CONCLUSION The transsphenoidal and transpterygoid approach was useful for providing a surgical field that allowed adequate visualization for removal of a sphenoid tumor that had expanded well into the lateral fossa of the sphenoid bone.
Collapse
Affiliation(s)
- Hidenori Yokoi
- Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan.
| | - Satoru Kodama
- Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan; Kodama Ear, Nose, and Throat Clinic, Oita, Japan.
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
| | - Masachika Fujiwara
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan.
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
| | - Koichiro Saito
- Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan.
| |
Collapse
|
3
|
Albsoul N, Rawashdeh B, Albsoul A, Abdullah M, Golestani S, Rawshdeh A, Mohammad M, Alzoubi M. A rare case of extracranial meningioma in parapharyngeal space presented as a neck mass. Int J Surg Case Rep 2015; 11:40-43. [PMID: 25912007 PMCID: PMC4446679 DOI: 10.1016/j.ijscr.2015.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/19/2015] [Accepted: 04/03/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Meningiomas are the most common intracranial tumor, but rarely, they can develop extracranially, usually in the neck. There are very few cases of parapharyngeal meningioma reported in literature and little is known about their biological behavior and operative management. We present a patient with a primary parapharyngeal meningioma that presented as an anterior neck mass. CASE PRESENTATION The patient is a 55-year-old female who presented with neck mass. A CT scan and MRI revealed a large, well defined, mildly enhancing soft tissue mass located in the right carotid sheath extended from the level of the thyroid gland into the skull base jugular foramen superiorly. Cervical exploration with partial excision of the mass was performed. Histological examination revealed meningiothelial cells with intranuclear inclusions, arranged in a syncytial pattern. Mutiple psamoma bodies these findings are consistent with the diagnosis of meningioma. CONCLUSION Extracranial meningiomas are quite rare. The diagnosis of these types of tumors is challenging due to the non specific nature of the symptoms. The anatomic complexity of the region of parapharyngeal space also makes their detection difficult. Imaging modalities can aid in the diagnosis, but pathological examinations are essential in confirming a definite diagnosis.
Collapse
Affiliation(s)
- Nader Albsoul
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Badi Rawashdeh
- University of Arizona Medical Center, Department of General Surgery, United States.
| | - Ahmad Albsoul
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Mohammad Abdullah
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Simin Golestani
- University of Arizona Medical Center, Department of General Surgery, United States
| | - Aasem Rawshdeh
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Mona Mohammad
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Mohammad Alzoubi
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| |
Collapse
|
4
|
Mnejja M, Hammami B, Bougacha L, Kolsi N, Mnif H, Chakroun A, Charfeddine I, Boudawara T, Ghorbel A. Primary sinonasal meningioma. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 129:47-50. [PMID: 21600866 DOI: 10.1016/j.anorl.2011.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 12/12/2010] [Accepted: 01/12/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Primary meningiomas of the sinonasal tract are rare tumors. Their positive diagnosis is difficult to establish. From one case observation, we report the clinical features, the diagnosis difficulties and the therapeutic modalities of primary meningioma of the sinonasal tract. CASE REPORT A seventeen-year-old girl consulted for a left unilateral nasal obstruction with progressive evolution without episodes of epistaxis, smell disorder or headaches over a year. Physical examination revealed a grayish polypoid tumor in the left nasal fossa. CT scan evidenced an isodense lesion of the left nasal fossa slightly enhanced pushing back the lateral nasal wall without invasion or intracranial connection. Biopsy was in favour of an inverted papilloma. The tumor was resected via endoscopic approach. Pathological examination established the diagnosis of meningothelial menigioma. The prognosis was favourable without recurrence after a six-month follow-up. CONCLUSION The positive diagnosis of primary sinonasal meningioma is difficult to establish because of their infrequent occurrence in this ectopic site and of their non-specific clinical appearance. The final diagnosis rests on the histological examination. Immunohistochemical studies are helpful to establish the accurate diagnosis. Imaging confirms the primitive nature of these tumors. Prognosis is excellent after complete surgical extirpation without the necessity of adjuvant therapy.
Collapse
Affiliation(s)
- M Mnejja
- Service ORL et chirurgie cervico-faciale, CHU Habib-Bourguiba, Sfax, Tunisia.
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
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 2011; 23:61-4. [PMID: 21251096 DOI: 10.1111/j.1365-2303.2010.00833.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M F Qutub
- King Saud bin Abdulaziz University for Health Sciences, College of Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | | | | | | |
Collapse
|
6
|
Primary meningioma of the nasal septum: a case report and review of literature. Appl Immunohistochem Mol Morphol 2010; 18:296-8. [PMID: 20090514 DOI: 10.1097/pai.0b013e3181cc7db9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Extracranial meningiomas are rare tumors that usually represent extensions from intracranial lesions. Here, we report a case of primary meningioma of the nasal septum. A 60-year-old man presented with nasal obstruction and postnasal drip. On examination he had a mass in the nasal cavity. Computed tomography studies revealed absence of intracranial extensions. The mass was successfully excised and the histologic diagnosis of meningioma was established. This report documents what we believe to be the first case (in English medical literature) of an extracranial meningioma, involving the nasal septum. The clinicopathologic features and pathogenesis of the primary nasal meningioma is briefly discussed.
Collapse
|
7
|
Mattox A, Hughes B, Oleson J, Reardon D, McLendon R, Adamson C. Treatment recommendations for primary extradural meningiomas. Cancer 2010; 117:24-38. [DOI: 10.1002/cncr.25384] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 03/21/2010] [Accepted: 03/23/2010] [Indexed: 12/17/2022]
|
8
|
Arias Marzán F, de Lucas Carmona G, Álvarez Flórez M, Febles García P. Meningioma primario extracraneal de senos paranasales. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:238-40. [DOI: 10.1016/j.otorri.2009.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 05/10/2009] [Accepted: 05/22/2009] [Indexed: 01/05/2023]
|
9
|
Extracranial meningioma of the paranasal sinuses. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
10
|
Kainuma K, Takumi Y, Uehara T, Usami SI. Meningioma of the paranasal sinus: a case report. Auris Nasus Larynx 2007; 34:397-400. [PMID: 17289320 DOI: 10.1016/j.anl.2006.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 09/14/2006] [Accepted: 10/01/2006] [Indexed: 12/29/2022]
Abstract
Extracranial meningioma of the paranasal sinus is a very rare condition of unclear etiology. Surgical excision is currently the only curative treatment but sometimes entails difficulties because of the complicated anatomic loci of the tumor. For the case reported here, we used a navigation system in endoscopic surgery for an extracranial meningioma of the paranasal sinus and were able to remove the tumor without complications by a transnasal approach alone. This is the first report of the use of such a system with endoscopic surgery for this condition. We discuss the clinical presentation, diagnosis, and treatment of this case as well as present a review of the literature.
Collapse
Affiliation(s)
- Kazuyuki Kainuma
- Department of Otolaryngology, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan.
| | | | | | | |
Collapse
|
11
|
Bassiouni H, Asgari S, Hübschen U, König HJ, Stolke D. Dural involvement in primary extradural meningiomas of the cranial vault. J Neurosurg 2006; 105:51-9. [PMID: 16871880 DOI: 10.3171/jns.2006.105.1.51] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The authors retrospectively analyzed a consecutive series of patients with cranial vault primary extradural meningioma (PEM), with particular regard to the tumor’s dural involvement. The pertinent literature was reviewed.
Methods
Clinical data were retrospectively obtained in a consecutive series of 16 patients treated for a PEM at two institutions between 1992 and 2004. The authors created a classification system based on dural involvement of the tumors.
Nine women and six men (mean age 55 years) presented with a painless, slowly progressive swelling. Preoperative magnetic resonance (MR) imaging revealed dural enhancement at the site of tumor in 11 patients. On surgical inspection, the tumor infiltrated the dura in all but three patients. Histological examination of tissue samples demonstrated tumor infiltration of the dura in all 14 patients in whom the dura had been resected. Three recurrent tumors were observed on follow-up examination during a mean period of 5.8 years (range 1.5–13 years) and required extirpation. In addition to one patient in whom there was histological evidence of malignancy, the other two cases involved two patients in whom no apparent dural involvement was observed during the first surgery. In a review of the literature, the authors found that histological examination showed dural involvement in 22%; the dura was not histologically evaluated in the remaining patients (78%). Postoperative follow-up data exceeding 2 years were only provided in two of the reported cases.
Conclusions
Tumor infiltration of the dura should be assumed in PEMs of the cranial vault, and resection of the dura at the site of craniotomy is recommended to prevent tumor recurrence.
Collapse
Affiliation(s)
- Hischam Bassiouni
- Department of Neurosurgery, University Hospital Essen, Essen, Germany.
| | | | | | | | | |
Collapse
|
12
|
Hameed A, Gokden M, Hanna EY. Fine-needle aspiration cytology of a primary ectopic meningioma. Diagn Cytopathol 2002; 26:297-300. [PMID: 11992371 DOI: 10.1002/dc.10094] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Meningiomas are benign tumors derived from arachnoid cells. Most commonly an intracranial lesion, meningiomas may be found extracranially in various anatomic sites. A 23-yr-old white female presented with left-sided palpable mass located submucosally in the floor of the mouth. CT scan revealed no evidence of mass elsewhere in the head and neck region. Fine-needle aspiration cytology (FNAC) showed loose and cohesive cellular fragments with lobular growth pattern and uniform round or ovoid cells. The diagnosis of low-grade salivary gland neoplasm, not further classified, was made. The tumor was locally excised. The differential diagnoses of an extracranial meningioma and pleomorphic adenoma were discussed at the frozen section. Based on light microscopic, immunohistochemical, and electron microscopic (EM) findings, the final diagnosis of an ectopic meningioma was rendered. Ectopic meningiomas may pose a diagnostic challenge to clinicians and cytopathologists. It is easily forgotten in the list of differential diagnosis at an ectopic site. Primary ectopic meningioma in a region containing salivary gland(s) may mimic benign and low-grade malignant salivary gland tumors in FNAC.
Collapse
Affiliation(s)
- Arif Hameed
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 517, Little Rock, AR 72205-7199, USA.
| | | | | |
Collapse
|
13
|
Swain RE, Kingdom TT, DelGaudio JM, Muller S, Grist WJ. Meningiomas of the paranasal sinuses. AMERICAN JOURNAL OF RHINOLOGY 2001; 15:27-30. [PMID: 11258651 DOI: 10.2500/105065801781329419] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Extracranial meningiomas are rare tumors, comprising approximately 2% of all meningiomas. Previously reported sites include the orbit, parapharyngeal space, and rarely, the paranasal sinuses. A retrospective chart review of patients with meningiomas was performed over the last 25 years, and three patients were identified with meningiomas involving the paranasal sinuses. The locations included the frontal sinus, the ethmoid sinus, and the sphenoid sinus. Presenting symptoms included facial pain and nasal obstruction; two patients noted facial swelling. Diagnosis was established via endoscopic transnasal biopsy in two patients. Computed tomographic (CT) guided biopsy was utilized to confirm the diagnosis in the third patient. Surgical extirpation was successfully performed with tumors arising from the ethmoid and frontal sinuses. The patient with neoplasm in the sphenoid sinus underwent radiation therapy. Extracranial meningiomas of the paranasal sinuses are rare tumors that may present a diagnostic and therapeutic challenge. We present three cases and discuss the clinical presentation, radiographic findings, diagnostic evaluation, and treatment options.
Collapse
Affiliation(s)
- R E Swain
- Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | | | | | | |
Collapse
|
14
|
Reino AJ. Factors in the pathogenesis of tumors of the sphenoid and maxillary sinuses: a comparative study. Laryngoscope 2000; 110:1-38. [PMID: 11037807 DOI: 10.1097/00005537-200010001-00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS To explain the processes that lead to the development of tumors in the maxillary and sphenoid sinuses. STUDY DESIGN A 32-year review of the world's literature on neoplasms of these two sinuses and a randomized case-controlled study comparing the normal mucosal architecture of the maxillary to the sphenoid sinus. METHODS Analysis of a 32-year world literature review reporting series of cases of maxillary and sphenoid sinus tumors. Tumors were classified by histological type and separated into subgroups if an individual incidence rate was reported. Histomorphometry of normal maxillary and sphenoid sinus mucosa was performed in 14 randomly selected patients (10 sphenoid and 4 maxillary specimens). Specimens were fixed in 10% formalin, embedded in paraffin, and stained with periodic acid-Schiff (PAS) and hematoxylin. Histomorphometric analysis was performed with a Zeiss Axioscope light microscope (Carl Zeiss Inc., Thornwood, NY) mounted with a Hamamatsu (Hamamatsu Photonics, Tokyo, Japan) color-chilled 3 charge coupled device digital camera. The images were captured on a 17-inch Sony (Sony Corp., Tokyo, Japan) multiscan monitor and analyzed with a Samba 4000 Image Analysis Program (Samba Corp., Los Angeles, CA). Five random areas were selected from strips of epithelium removed from each sinus, and goblet and basal cell measurements were made at magnifications x 100 and x 400. RESULTS The literature review revealed that the number and variety of tumors in the maxillary sinus are much greater than those in the sphenoid. The incidence of metastatic lesions to each sinus is approximately equal. No recognized pattern of spread from any particular organ system could be determined. On histomorphometric study there were no statistically significant differences between the sinuses in the concentration of goblet cells, basal cells, or seromucinous glands. CONCLUSIONS Factors involved in the pathogenesis of tumors of the maxillary and sphenoid sinuses include differences in nasal physiology, embryology, morphology, and topography. There are no significant histological differences in the epithelium and submucous glands between the two sinuses to explain the dissimilar formation of neoplasms.
Collapse
Affiliation(s)
- A J Reino
- Manhattan Ear, Nose and Throat Associates, New York, New York 10128, USA
| |
Collapse
|
15
|
Abstract
Juxtaoral organs known as organs of Chievitz are intramuscular embryonic structures found close to the angle of the mandible near the insertion of the pterygomandibular raphae. They are considered of neuroepithelial origin with no known function. We describe the first tumor of the organ of Chievitz which presented intraorally in a child. Immunohistochemically, the Chievitz nests showed positive reaction for vimentin, cytokeratins, and epithelial membrane antigen and ultrastructurally demonstrated cytoplasmic processes and intermediate filament bundles. These observations, together with light microscopic features, suggest that the epithelial nests of the organ of Chievitz are meningothelial rather than neuroepithelial.
Collapse
Affiliation(s)
- M S Vadmal
- Department of Laboratories, North Shore University Hospital, Manhasset, NY 11030, USA
| | | | | | | |
Collapse
|
16
|
El-Daly A, Pitman KT, Ferguson BJ, Snyderman CH. Primary extracranial meningioma of the maxillary antrum. Skull Base 1997; 7:211-5. [PMID: 17171033 PMCID: PMC1656652 DOI: 10.1055/s-2008-1058598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A case of primary extracranial meningioma of the maxillary antrum is reported. A 45-year-old male presented with symptoms of chronic sinusitis. Imaging studies showed a soft tissue mass with calcification, filling the maxillary antrum. The mass was removed surgically, and pathological studies revealed a ribroblastic meningioma. The maxillary antrum is an uncommon location of primary extracranial meningioma, and our case is the sixth to be reported in that location.
Collapse
|