Giant Intraparenchymal Meningioma in a Female Child: Case Report and Literature Review

Incidental pediatric intraparenchymal meningioma: illustrative case

BACKGROUND

Meningiomas are the most common benign tumors among CNS neoplasms. In the pediatric population, however, they account for only 0.4%-4.6% of all intracranial neoplasms; they are rare inside the brain parenchyma and are frequently confused with other entities, such as glioneuronal tumors and cavernomas, among others.

OBSERVATIONS

The authors describe the case of a 4-year-old male who presented to the emergency department for evaluation of periorbital cellulitis and was incidentally diagnosed with a brain tumor. MRI demonstrated an expansive heterogeneous lesion, 2.2 × 1.9 × 1.8 cm, in the left lingual gyrus. Spectroscopy and perfusion imaging suggested a low-grade glioneuronal tumor. After thorough discussion, the family and medical team elected to pursue surgical treatment. The patient had an uneventful postoperative recovery, and subsequent pathological and immunohistochemical analysis confirmed the diagnosis of a fibrous meningioma (WHO grade 1).

LESSONS

Intraparenchymal meningiomas are a rare and misdiagnosed tumor, especially in the pediatric age group, and therefore are not usually considered in the differential diagnosis of intra-axial neoplasms in children. When suspected, surgery may be encouraged due to the tendency of these tumors to exhibit more aggressive behavior compared with adult meningiomas. https://thejns.org/doi/10.3171/CASE24611.

Imaging features of pediatric meningiomas: emphasis on unusual locations

PURPOSE

This article aims to analyze pediatric meningioma's imaging characteristics, especially those in unusual locations.

METHODS

Pediatric patients with pathologically confirmed meningiomas at our hospital from January 2010 to January 2024 were enrolled. Meningiomas located in the cerebral convexity, parasagittal falcine region, anterior skull base, middle skull base, sphenoid ridge, cerebellopontine angle (CPA), olfactory groove, or juxtasella were considered in usual locations. Meningiomas found in other areas were considered in unusual locations. Clinical information, pathology results, and imaging features of pediatric meningiomas in usual and usual locations were analyzed and compared.

RESULTS

A total of 18 patients (19 meningiomas) were enrolled, including 14 males and 4 females, with an average age of 14 years (ranging from 6 to 18 years). A total of 12 (63.2%) meningiomas were in the unusual location, including four (33.3%) were intraparenchymal, four (33.3%) were intraventricular, two (16.7%) were intraosseous, one (8.3%) case was in the paranasal sinus, and one (8.3%) was intraspinal. The meningiomas in unusual locations usually lacked the meningeal tail sign, and the misdiagnosis rate on preoperative imaging was significantly higher than that of meningiomas in usual locations.

CONCLUSION

Pediatric meningiomas are prone to occur in unusual locations. When they occur in usual locations, they often lack typical radiographic features of meningiomas, leading to potential misdiagnosis before surgery. Recognition of the imaging characteristics of meningiomas in unusual locations in children may facilitate accurate preoperative imaging diagnosis.

Pediatric Meningiomas: Current Insights on Pathogenesis and Management

Meningiomas are rare tumors in children, ranging from 0.4 to 4% of intracranial tumors. Differently from their adult counterpart, pediatric meningiomas (PMs) often show peculiar aspects such as the development of tumoral cysts, the involvement of the intraventricular space, and missing attachment to the dura mater. The most important difference with adults is represented by the high incidence of WHO grade II and III variants, which can account for more than 70% of cases. The prognosis of PMs mainly depends on the initial surgical resection because radiotherapy, which is the main treatment option in the case of tumor recurrence or progression, does not seem to increase the relapse free survival and the overall survival, and chemotherapy still misses specific and effective protocols.On these grounds, the need to better understand these tumors, to favor an appropriate multidisciplinary management, is particularly felt. The present review is focused on the advances on the pathogenesis, the molecular aspects, and the managements of PMs, with the goal to improve the knowledge of these challenging neoplasms.

Interhemispheric Pediatric Meningioma, YAP1 Fusion-Positive

Meningiomas are uncommon in children and usually arise in the context of tumor-predisposing syndromes. Recently, YAP1-fusions have been identified for the first time as potential NF2-independent oncogenic drivers in the development of meningiomas in pediatric patients. We report a case of a YAP1-fusion-positive atypical meningioma in a young child and compare it with the previous ones reported. Extending the clinico-pathological features of YAP1-fused meningiomas, we suggest additional clues for diagnosis and emphasize the urgent need for an integrated multilayered diagnostic approach, combining data from histological and molecular analyses, neuroradiology, and clinical findings.