Case report

TRANSITIONAL
MENINGIOMA
By : Roy Herbon Sinambela
Supervisor : dr. H. Soekimin, Sp.PA (K)
DEPARTMENT OF ANATOMICAL PATHOLOGY FACULTY OF MEDICINE
UNIVERSITAS SUMATERA UTARA
MEDAN - 2022
INTRODUCTION
• Meningiomas are the most common primary tumors of the
central nervous system found.
• Its heterogeneous morphological features
• Fifteen different variants and grouped into three grading based
on biological properties and the rate of recurrence.
• From of all the variants, meningothelial, fibroblastic, and
transitional meningiomas are the most common and benign
variants
• Depending on the location, size, and histopathological grading,
meningiomas in it is generally treated by complete resection of
the tumor mass.
• Recurrence usually occurs in moderate to malignant tumors
with a Ki-67 proliferation index above 3%.
• The prognosis for meningiomas is generally good, especially for
slow-growing WHO grade 1 meningiomas
CASE REPORT
• ♀, 57 years old
• Came to General Hospital Haji Mina Medan with complaints of
headache
• Craniotomy and cerebral tumor excision were performed right
temporal.
• The excision tissue resulting from the craniotomy was then
examined Anatomic Pathology Laboratory of Medan Haji
General Hospital with number 206/ H/ 21.
Mikroskopis
The tissue preparation from the right temporal shows a mass tumors
consisting of cells that are round and oval in shape that form nests
with round to oval nuclear morphology, regular nuclear membrane,
fine chromatin, and eosinophilic cytoplasm. In other foci, a tumor
mass composed of cells was also seen spindle-shaped that forms a
whorl structure, with an oval-shaped core morphology to spindle,
regular nuclearmembrane, fine chromatin, eosinophilic cytoplasm.
The stroma consists of fibrous connective tissue with minimal
infiltration of mononuclear inflammatory cells. On in some foci,
interstitial hemorrhage is also present. Partially dilated blood vessels
and congestion.
A. Nests and fascicle structures of tumor cells (HE, 40 x)
B. Structure whorl and fasciculus (HE, 100x)
C. Fibroblastic component (HE, 200x).
D. Whorl, structure characteristic of transitional meningiomas (HE, 200x).
• Based on the results of the microscopic description, the patient
was diagnosed with Meningioma Transitional WHO grade 1 with
ICD-O : 9537/0.
DISCUSSION
• Meningioma is a tumor that is mostly benign slow, and most
likely originates from the meningothelial cells of the arachnoid
layer.
• Meningiomas are the most common central nervous system
tumors and its incidence reaches 30% of all primary intracranial
tumors
• Environmental factors as a known cause of meningiomas are
ionizing radiation
• Other causes of meningiomas, especially those occurring at a
young age without A gender-specific predilection is
neurofibromatosis type 2 (NF2).
• Apart from schwannomas, Meningiomas are characteristic
features of an autosomal dominant disorder for germline
mutations of the NF2 gene on chromosome 22q12
• Most cases of meningiomas are intracranial, intraspinal, or
orbital.
• Less common tumor sites are intraventricular and epidural.
• Most spinal meningiomas occur in the thoracic region spinalis is
more common in the female group with an incidence rate of 10
times higher than the male group.
• Clinically, meningiomas grow slowly so that the symptoms and
signs Neurological symptoms usually result from the
compression of the tumor into surrounding structures.
• Deficit Neurologic symptoms are usually specific, depending on
the location and size of the tumour.
• Diagnosis, monitoring, and determining the best approach to
management can be identified through imaging.
• On MRI, meningiomas appear as dural masses with increased
contrast and isodens.
• Calcifications are often found and can be seen in the CT scan.
• The characteristic feature of meningiomas is a “dural tail” in the
around the perimeter mass of the dura.
• Macroscopically, most meningiomas are spherical masses with
a spongy or dense consistency, well-defined, and sometimes
lobed, attached to the dura.
• Invasion of the dura or dura sinus is quite common.
• Sometimes Sometimes meningiomas can invade nearby cranial
bony structures resulting in this produces a hyperostotic picture
that clearly indicates bone invasion.
• Microscopically, meningiomas show a wide variety of histologic
features and therefore.
• WHO divides it into 15 types of variants which are then divided
into three degrees (grading).
• The degree of meningioma is closely related to the biologic
nature of these tumors and also affects the prognosis of the
tumor.
• Most meningiomas are benign lesions and are classified as
WHO grade 1, although some of these are classified as grade 2
and grade 3 because of the higher risk of recurrence higher and
shorter survival times. Meningiomas grade 2 and grade 3.
Meningioma variants based on WHO classification
 Histology of various variants of
meningiomas (WHO grade 1).
A.Meningothelial
with syncytial growth of meningothelial
cells. B. Fibroblastic with fasciculus
growth pattern.C. Transitional with the
formation of a whorl pattern.
D.Psammomatous with a number of
calcified psammoma bodies.
E.Angiomatous with a number of tightly
arranged blood vessels. F. Microcystic
with microcystic degeneration.
G.Secretory with PAS-positive
pseudopsammoma bodies production. H.
Lymphoplasmacyte-rich with chronic
inflammatory cell infiltration Metaplastic
with xanthomatous changes of tumor
cells. (A–D, F, H, I: hematoxylin-eosin;
E.Immunohistochemical staining of
endothelial cells with anti-CD34
antibody; G: periodic acid
Schiff stain).
 Histology of a WHO grade 2 meningioma.
A. Atypical meningiomas with increased mitotic activity. B. Clear-cell meningioma with clear
cytoplasm and rich in glycogen. C. Chordoid meningioma, showing chordoma-like tumor cell growth
with myxoid matrix. All were stained with hematoxylin-eosin.
 Histology of a WHO grade 3 meningioma.
A. Anaplastic meningiomas with cellular anaplasia with multiple mitotic features. B. Rhabdoid
meningioma, containing a number of large round tumor cells with eccentrically located nuclei. C.
Papillary meningioma showing a pseudopapillary growth pattern; A and C were stained with
hematoxylin-eosin and B was stained with toluidine blue.
• Immunohistochemical examination for meningiomas can be
done through staining epithelial membrane antigen, vimentin,
laminin, fibronection, carcinogenic embryonic antigen, S100,
and keratin.
• Variable expression of meningoma seen on examination
progesterone receptors, androgens, glucocorticoids,
somatostatin, epidermal derived growth factor, insulin-like
growth factor-I and II, transforming growth factor-ß, interferon-ά,
fibroblast growth factor-1, estrogen, prolactin, and platelet-
derived growth factor receptor
• Management is usually determined by the size of the tumor, the
location of the tumor, the nature of the tumor, clinical symptoms,
the patient's age, and the patient's health status.
• The patient's prognosis is generally good, especially for grade 1
tumors that are growing slow.
• Approximately 90% of meningiomas are classified as grade 1 and
have a risk of Post-resection recurrence is only 7% to 20%.
• While meningioma grade 2 with an incidence rate of 5% to 7% will
experience a recurrence of 40%.
• Grade 3 meningiomas, which account for less than 3%, will recur
by 50% to 80%.
CONCLUSION
We report a case of a 57-year-old woman with complaints of
main headache. The results of the CT-scan show a space
occupying lesion in the area right parietal. The patient had
undergone a craniotomy for removal of the tumor mass and the
results of histopathological examination showed a transitional
meningioma WHO grade 1 in the right temporal region. These
intracranial tumors generally have a good prognosis well with a
low risk of recurrence.