Familial cutaneous heterotopic meningeal nodules

Cutaneous Meningioma: A Cytomorphological Diagnosis

Cutaneous meningiomas are rare tumors. These are ectopic meningothelial cells located in the dermis and subcutis, and are usually seen on the scalp. Here, we report the case of a 40-year-old woman who presented with a slowly growing asymptomatic mass over the scalp in the right parieto-occipital region. The lesion was firm, adherent to underlying structures, and covered by normal appearing skin. The cytomorphological features along with histological and immunohistochemical studies showing positivity for epithelial membrane antigen, Vimentin, and S100 helped in making a definitive diagnosis of cutaneous meningioma. No evidence of intracranial meningioma was noted in contrast-enhanced computed tomography of the brain.

Cervical rudimentary meningocele in adulthood

Almost all cases of cervical spinal dysraphism published to date have involved cystic lesions and were treated in very early childhood. The authors describe a unique case of a 21-year-old woman who harbored a solid cervical rudimentary meningocele. On preoperative CT and MR images, a cutaneous solid mass was shown to be connected to intraspinal contents by a stalk traversing the C-3 lamina defect. The authors resected the cutaneous mass and released the tethering neural band from the vertical axis of the spinal cord without causing injury. Pathological examination demonstrated a dense collagenous tissue containing clusters of meningocytes and psammoma bodies in the cutaneous mass. This rare entity, a spinal dysraphism with a benign natural history, may contribute to the current classification of cervical spinal dysraphism.

Cutaneous meningioma

Cutaneous meningioma is a rare tumor that most commonly occurs on the scalp and occurs in both congenital and acquired forms. It invokes a wide clinical differential diagnosis, but diagnosis is based on characteristic histologic and cytologic findings. Congenital lesions can often present years after birth and even in adult patients. Acquired lesions occur in adulthood. We review histologic, cytologic, and electron microscopic findings and explore how these are used to separate this entity from other entities in the differential diagnosis. While ultrastructural and cytologic findings are similar to those of more common intracranial meningiomas, these tumors exhibit a range of histologic differences. A lack of awareness of this entity precludes correct diagnosis.

Neurogenic tumors of soft tissue

Neurogenic tumors are an uncommon yet important category of soft tissue tumors in children and adolescents because of their frequent association with various genetic syndromes. The heterogeneous cellular composition of the peripheral nerve and the wide metaplastic capacity of the neural crest and its derivatives generate a variety of neoplasms with neurogenic differentiation. This article reviews the clinicopathologic features and differential diagnosis of neurogenic tumors in the first two decades of life, and highlights use of selected ancillary methods for diagnosis.

Congenital hamartoma of the scalp with meningothelial, sebaceus, muscular, and immature glandular components

A 4-month-old boy presented with a congenital, solitary, yellowish-red, eroded tumor on the scalp, histologically characterized by an ectopic proliferation of vascular and meningothelial elements intimately admixed with mature connective-tissue elements, adipose tissue, and smooth-muscular fibers. In addition, the presence of characteristic histopathological features of a nevus sebaceus and areas with immature glandular differentiation were observed. The diagnosis of a congenital hamartoma of the scalp with meningothelial, sebaceus, immature glandular, and muscular components was established. We review the heterogeneous group of cutaneous lesions with meningothelial elements and their pathogenesis.

The hair collar sign as a marker for neural tube defects

The hair collar sign has been described as a marker of cranial dysraphism, including encephaloceles, meningoceles, and heterotropic brain tissue. This report describes a male born with a hair collar sign who subsequently was found to have a Klippel-Feil anomaly, diastematomyelia, multiple segmental spine and rib anomalies, and a translocation between chromosomes 1 and 4; t(1;4) (q44;q10). While not previously documented, spine abnormalities may be an associated abnormality with the hair collar sign. Physicians should consider radiographic evaluation of the spine in all newborns with a hair collar sign, as well as genetic screening.

Heterotopic Neural Nodules of the Scalp

Congenital lesions of the scalp must be approached with caution because of the possibility of intracranial extension. Heterotopic neural nodules, a type of neuroectodermal malformation, are particularly dangerous. They manifest in the newborn as a small lump, are often confused with dermoid cysts, and may have a rudimentary stalk that communicates intracranially. The authors retrospectively reviewed the demographic, clinical, and histopathologic records of 11 infants with 12 heterotopic neural nodules of the scalp seen over the previous two decades. All lesions were located in the parietal or occipital region. All but one patient had an overlying area of alopecia surrounded by a ring of long, coarse hair (the "hair collar sign"), and nine of 11 children had a capillary stain surrounding the lesion. Preoperative imaging correctly identified calvarial defects in five patients. Excision was performed at an average age of 8.6 months. Histopathologic examination showed that nine lesions (nine patients) were heterotopic leptomeningeal tissue and three lesions (two patients) contained glial tissue. Heterotopic neural nodules of the scalp are rare congenital lesions with recognizable clinical and histologic features. Preoperative imaging is essential to document possible intracranial involvement and thus minimize possible penetration of the dura during resection.

Sequestrated meningocele of the scalp

A case of occipital sequestrated (rudimentary) meningocele in a 2-year-old girl is presented. The swelling was noticed at birth and did not grow over time. The skull radiograph showed no bone defect and ultrasound and computed tomography examinations demonstrated cystic mass with no connection to dura. The aim of this report is to draw the attention of radiology literature readers to this entity and to elaborate on the role of imaging in the preoperative assessment of such cases. The relation of sequestrated meningocele to the other conditions with ectopic meningeal tissue in the scalp is addressed.

Ectopic respiratory mucosa in the skin associated with skeletal malformation and polydactyly

We report a 19-year-old man with congenital erythematous plaque on his left arm that was found histopathologically to be composed of respiratory mucosa. The patient had a triphalangeal thumb and polydactyly in the left hand. This is, to our knowledge, only the third case of ectopic respiratory epithelium presenting as a superficial lesion in the skin to be reported in the English literature, and the first case associated with skeletal malformation and polydactyly.