A 38-year old woman with a dural based lesion

Symptomatic xanthogranuloma of the lateral ventricle in a pregnant patient treated with delayed resection: A case report and systematic review

Intracranial xanthogranulomas (XG) are a rare benign histiocytic neoplasm and most often within the choroid. The majority are asymptomatic and are found incidentally on imaging or post-mortem examination or autopsy. We present a case of symptomatic XG in a pregnant patient who underwent a delayed transcortical, transventricular approach for lateral ventricle XG resection following the completion of her pregnancy. Four years post-operatively, the patient is neurologically intact and without recurrence. Our review of the literature showed differences among XG depending on location. The clinical and radiological features of XG are often indistinguishable from tumors arising from the choroid plexus and should be considered as a rare etiology in the differential of newly diagnosed intraventricular lesions.

Spontaneous regression of infantile dural-based non-Langerhans cell histiocytosis after surgery: case report

The authors report the case of a large left occipital mass lesion in an 8-month-old boy who presented with seizure. Neuroimaging demonstrated an approximately 5-cm extraaxial tumor, and the patient underwent partial resection. The tumor was strongly attached to the tentorium and falx. In the postoperative course the residual lesion regressed spontaneously, and after 5 years only a slight residual tumor remained along the tentorium. Histopathological examination of the tumor revealed non-Langerhans cell histiocytosis (non-LCH). However, the tumor was not diagnosed as juvenile xanthogranuloma (JXG) because it lacked Touton giant cells. Hence, the authors described this lesion as a fibroxanthogranuloma. Most intracraniospinal non-LCHs have been reported as JXG; however, several cases of xanthomatous tumors with histopathological features resembling those of JXG have been described as fibrous xanthoma, xanthoma, fibroxanthoma, and xanthogranuloma. Among JXG and the xanthomatous tumors, a review of the literature revealed several cases of dural-based tumors; these dural-based tumors have had favorable courses, including the case described in this report. In addition, the patient in the present case experienced spontaneous regression of the residual tumor. The authors report this unique case and review the literature on isolated intracraniospinal non-LCHs, especially in cases of dural-based lesion.

Histiocytic meningioma: A distinctive subtype of meningioma?

Meningioma with extensive histiocytic changes is rare. We describe a case of histiocytic meningioma which occurred in a 55-year-old woman. The patient had a progressive headache and a decline in fine motor coordination and memory for the past four years. Magnetic resonance imaging demonstrated a well-demarcated, dura-based and contrast-enhancing mass lesion in the right superior frontoparietal region. Histopathologically, the tumor showed neoplastic meningothelial proliferation with extensive and multifocal histiocytic infiltration. The histiocytic component constituted approximately half of the entire tumor. Immunohistochemically, both meningothelial and histiocytic cells showed immunoreactivity for epithelial membrane antigen (EMA), while the histiocytic cells were also positive for CD4 and CD68. In addition, there were scattered S100-positive histiocytes throughout the tumor. Proliferative index highlighted by Ki67 immunostain was 1.6%. There were no high-grade changes such as frequent mitoses, necrosis, or brain parenchymal invasion in the specimen. With review of the literature, we propose that this type of meningioma should be considered as a separate subtype of meningioma. The biological basis and differential diagnosis are discussed.