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Xanthomatous meningioma: A metaplastic or degenerative phenomenon?

Wong YP, Tan GC, Kumar R

Neuropathology, 2018 Dec;38(6):619-623.
PMID: 30187570 DOI: 10.1111/neup.12511

Xanthomatous changes can be observed in various conditions including primary xanthomatosis that is linked to an underlying hypercholesterolemia and more commonly associated with secondary xanthomatous degenerative processes in neoplasm and chronic inflammation. Meningioma with extensive xanthomatous change is exceedingly rare. The presence of cholesterol clefts within this peculiar meningioma subtype has not been described. Herein, we report an unusual case of xanthomatous meningioma in an 83-year-old normolipidemic woman, who presented to us with worsening lower limb weakness and global aphasia. There was increasing evidence to suggest that the presence of xanthomatous changes in long-standing meningioma is merely a sequela of cellular degeneration rather than true metaplastic change as previously hypothesized. Hence, the diagnosis of "xanthomatous meningioma" in the metaplastic category should be revisited and considered as a distinct histological subtype. The possible histogenesis of such intriguing phenomenon is discussed with a review of the literature.

Matched MeSH terms: Meningioma/pathology*
Fulltext Venous Air Embolism during Elective Craniotomy for Parasagittal Meningioma

Hassan WMNW, Asmah Z, Saedah A

Med J Malaysia, 2013;68(1):69-70.
PMID: 23466772 MyJurnal

We report a case of a 59 year old man who developed venous air embolism (VAE) during an elective craniotomy for parasagittal meningioma resection. The surgery was done in the supine position with slightly elevated head position. VAE was provisionally diagnosed by sudden decreased in the end tidal carbon dioxide pressure from 34 to 18 mmHg, followed by marked hypotension and atrial fibrillation. Prompt central venous blood aspiration, aggressive resuscitation and inotropic support managed to stabilize the patient. Post operatively, he was admitted in neuro intensive care unit and made a good recovery without serious complications.

Matched MeSH terms: Meningioma*
Fulltext Tuberculosis of the skull mimicking a bony tumor

Rosli FJ, Haron R

Asian J Neurosurg, 2016 2 19;11(1):68.
PMID: 26889285 DOI: 10.4103/1793-5482.172594

We present a rare case of calvarial tuberculosis mimicking a solitary bone tumor, which was surgically removed. A 52-year-old female presented with a right forehead swelling, which gradually enlarged over the course of 2 years, with no symptoms or raised intracranial pressure or neurological deficits. Plain and contrast-enhanced brain computed tomography scans were done, revealing a punched-out lesion of the right frontal bone, with a nonenhancing lytic mass. With an initial diagnosis of an intraosseous meningioma, and later on intraoperatively thought to be a metastatic tumor, the mass was excised along with a rim of bone. Histopathological examination results came back as caseous necrosis, highly suggestive of tuberculosis. The patient was then treated with a 1 year regimen of anti-tuberculous medications. Tuberculosis of the cranium is a rare entity, and can mimic tumors or multiple myeloma. A high index of suspicion and knowledge is required for an early diagnosis. A combined surgical and medical therapy is curative.

Matched MeSH terms: Meningioma
Fulltext The socio-demographic and clinical factors associated with quality of life among patients with brain pathology in a tertiary referral hospital in Malaysia

Das, Priscilla, Naing, NyiNyi, Nadiah Wan-Arfah, Naing Noor Jan, K.O., Yee, Cheng Kueh, Rasalingam, Kantha

JUMMEC, 2019;22(1):50-57.
MyJurnal

Background: This paper investigates the quality of life of brain pathology patients in relation to their sociodemographic
profiles and clinical factors.

Methods: This is a cross-sectional study done at a tertiary referral hospital in Kuala Lumpur. A total of 100
patients were recruited in the study after excluding 22 patients who did not met the exclusion criteria. The
European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) self-administered
questionnaire was utilized in the study. The Global health status/QoL, Physical functioning, Role functioning,
Emotional functioning, Cognitive functioning, Social functioning, Fatigue, Nausea and vomiting, Pain, Dyspnoea,
Insomnia, Appetite loss, Constipation, Diarrhoea, and Financial difficulties were assessed in this study.

Results: The most severe impairment in functioning was with lowest score of cognitive functioning (mean
score=61) and the most severe symptom was fatigue (mean score=45). There were significant differences in
quality of life scores in different socio-demographic groupsand types of brain pathology patients. Patients aged
below 40 years old or less had better physical functioning, less symptoms of fatigue and insomnia compared
to patients who were more than 40 years old. Male patients faced more financial difficulties compared with
female patients. Patients who were married had increased insomnia compared to the single patients. Employed
patients had better physical functioning and less financial difficulties compared with patients who were
unemployed. Patients who earned >RM 2500.00 monthly had better physical functioning, less symptoms of pain and less financial difficulties than patients who earned ≤RM 2500.00. Patients with qualifications lower
than SPM tended to face more financial difficulties compared to patients with qualifications of SPM or higher.
Meningioma patients had better social functioning compared with others, whereas Carvenoma patients had
better physical functioning. Meningioma patients had more symptoms of insomnia compared with other
patients. All the findings were with p value less than 0.05.

Conclusion: The quality of life of patients with brain pathology is affected by socio-demographic factors and
clinical diagnoses. Efforts should be made to improve the overall quality of life of these patients.

Matched MeSH terms: Meningioma
Fulltext The relationship of p53 protein in meninigioma grading and their various influencing factors amongst neurosurgical patients in Hospital Kuala Lumpur

Kantha R, Saffari HM, Suryati MY

Med J Malaysia, 2007 Aug;62(3):194-6.
PMID: 18246905 MyJurnal

Meningioma, is the second most frequent intracranial tumor in Malaysia and are classified according to the World Health Organization classification. The relationship of p53 protein in the determination of meningioma grading and their influencing factors were studied via immunohistochemistry studies on 77 intracranial meningiomas (67 benign, 10 atypical). The higher the p53 reaction was correlated to the poorer the histological grade (19.4% in benign and 90% in atypical meningioma) (p < 0.001). Other variables like age, sex, ethnicity, demographic location, surgical clearance, midline shift and contrast enhancement of CT Scan Brain and clinical features were found not to be significant.

Matched MeSH terms: Meningioma/classification*
Fulltext The importance of ophthalmic signs in the diagnosis of suprasellar meningioma - a case report

Tan AK, Mallika P, Md Aziz S, Asokumaran T, Intan G

Malays Fam Physician, 2009;4(1):26-29.
PMID: 25606155 MyJurnal

A forty-two year old lady presented with gradual, painless, progressive blurring of vision of her left eye for four months. There were no other associated ocular or systemic complaints. Examination showed decreased visual acuity in both eyes and a pale optic disc on the left side. Visual field examination revealed a temporal field defect of the right eye which aroused the suspicion of an intracranial mass lesion. MRI of her brain revealed a suprasellar meningioma. We would like to emphasize the importance of visual field examination of both eyes in patients presenting with unilateral loss of vision.

Matched MeSH terms: Meningioma
The grossly enlarged or "Missing" sella

Wong WK

Med J Malaysia, 1975 Dec;30(2):139-48.
PMID: 1228380
Matched MeSH terms: Meningioma/radiography
Syringomyelia associated with a cauda equina meningioma involving the conus medullaris

Chee CP, Tan CT, Nuruddin R

Br J Neurosurg, 1990;4(6):529-33.
PMID: 2076215

An unusual case of syringomyelia secondary to a cauda equina meningioma involving the conus medullaris is described. The tumour was totally removed with decompression of an adjacent cyst and syrinx resulting in resolution of the symptoms and radiological appearance.

Matched MeSH terms: Meningioma/complications*; Meningioma/surgery
Fulltext Somatic mitochondrial DNA D-loop mutations in meningioma discovered: A preliminary data

Mohamed Yusoff AA, Mohd Khair SZN, Wan Abdullah WS, Abd Radzak SM, Abdullah JM

J Cancer Res Ther, 2020 12 22;16(6):1517-1521.
PMID: 33342822 DOI: 10.4103/jcrt.JCRT_1132_16

Background and Objective: Meningiomas are among the most common intracranial tumors of the central nervous system. It is widely accepted that the initiation and progression of meningiomas involve the accumulation of nucleus genetic alterations, but little is known about the implication of mitochondrial genomic alterations during development of these tumors. The human mitochondrial DNA (mtDNA) contains a short hypervariable, noncoding displacement loop control region known as the D-Loop. Alterations in the mtDNA D-loop have been reported to occur in most types of human cancers. The purpose of this study was to assess the mtDNA D-loop mutations in Malaysian meningioma patients.
Materials and Methods: Genomic DNA was extracted from 21 fresh-frozen tumor tissues and blood samples of the same meningioma patients. The entire mtDNA D-loop region (positions 16024-576) was polymerase chain reaction amplified using designed primers, and then amplification products were purified before the direct DNA sequencing proceeds.
Results: Overall, 10 (47.6%) patients were detected to harbor a total of 27 somatic mtDNA D-loop mutations. Most of these mtDNA mutations were identified in the hypervariable segment II (40.7%), with 33.3% being located mainly in the conserved sequence block II of the D310 sequence. Furthermore, 58 different germline variations were observed at 21 nucleotide positions.
Conclusion: Our results suggest that mtDNA alterations in the D-loop region may be an important and early event in developing meningioma. Further studies are needed, including validation in a larger patient cohort, to verify the clinicopathological outcomes of mtDNA mutation biomarkers in meningiomas.

Matched MeSH terms: Meningioma/blood; Meningioma/genetics*; Meningioma/pathology
Fulltext Radiation-induced meningioma following radiotherapy for pituitary adenonoma: a case report

Ellyda, M.N., Win Mar@Salmah, J.

International Medical Journal Malaysia, 2013;12(1):63-66.
MyJurnal

It is well known that ionizing radiation has an onco-genetic activity and has been implicated in the causation of brain tumors. However, when a new growth appears adjacent to the site of previous tumor, the diagnosis is more toward recurrence. In addition to that, the possible cause might be overlooked, when it occurs many years after radiation treatment. We report a case of radiation-induced meningioma developed 20 years after the patient received radiotherapy for pituitary adenoma.

Matched MeSH terms: Meningioma
Prosthetic Rehabilitation of Cranial Deformity in Hyperostotic Convexity Meningioma

Nandini Y, Venkatesh SB

Contemp Clin Dent, 2019 11 28;9(4):674-677.
PMID: 31772486 DOI: 10.4103/ccd.ccd_537_18

Cranial defects lead to unesthetic appearance and are a constant source of apprehension to the patient. Meningioma with calvarial extension requires the excision of the involved bone for complete excision. Such total excision would leave behind a bony defect which would need reconstruction. Presurgical fabrication of acrylic flap helps in reconstruction of such cranial defect following complete excision in single stage, thereby decreasing the cost and morbidity of surgery. Further, it facilitates the reproduction of the contours, and the tissue bed is not exposed to the heat of polymerization or to the free monomer. The authors report a case of hyperostotic convexity meningioma in a middle-aged female where heat-cured acrylic resin alloplastic implant was prefabricated and used successfully.

Matched MeSH terms: Meningioma
Fulltext Primary non-Hodgkin's lymphoma of the cranial vault mimicking a meningioma: a case report

Muin IA, Saffari HM, Hasimah YN

Med J Malaysia, 1997 Mar;52(1):86-8.
PMID: 10968060

Primary non-Hodgkin's lymphoma of the brain is rare. Majority of the lesions are intraaxial, multicentric and involve the leptomeninges. We report a case of malignant primary non-Hodgkin's lymphoma arising from the cranial vault. Computed tomography of the brain showed an extraaxial lesion in the right parietal region mimicking a meningioma.

Matched MeSH terms: Meningioma/diagnosis*
Fulltext Primary Central Nervous System Fibrosarcoma

Vinodh VP, Harun R, Sellamuthu P, Kandasamy R

J Neurosci Rural Pract, 2017 Aug;8(Suppl 1):S111-S113.
PMID: 28936084 DOI: 10.4103/jnrp.jnrp_165_17

We report a rare case of a young female with primary brain fibrosarcoma, and to the best of our knowledge, we believe that only <50 cases have been reported or described worldwide so far. Fibrosarcoma is a malignant neoplasm, in which histologically the predominant cells are fibroblasts that divide excessively without cellular control and they can invade local tissues or metastasize. Primary central nervous system fibrosarcomas are very aggressive neoplasms and generally have a poor prognosis. This tumor is either from sarcomatous transformation of a meningioma or arises de novo within the brain parenchyma. Our patient, a 48-year-old woman, who presented with progressive speech disorder over the period of 4 months, showed a left temporoparietal lesion with surrounding edema and local mass effect. Total surgical resection was achieved. Histopathology revealed classical fibrosarcoma features and secondary screening revealed no other distant lesion as diagnosis of primary brain fibrosarcoma was established. This case is deemed to be extremely rare because most reports claim that recurrence is within 6 months with poor prognosis; however, this patient is currently recurrence-free at 3 years. This would suggest of the possibility for a relook into this disease's course and recurrence rate when complete excision is achieved. Due to extreme rarity of these tumors, more comparative studies will be needed to improve the disease outcome.

Matched MeSH terms: Meningioma
Fulltext Prevalence of mitochondrial DNA common deletion in patients with gliomas and meningiomas: A first report from a Malaysian study group

Mohamed Yusoff AA, Mohd Khair SZN, Abd Radzak SM, Idris Z, Lee HC

J Chin Med Assoc, 2020 Sep;83(9):838-844.
PMID: 32732530 DOI: 10.1097/JCMA.0000000000000401

BACKGROUND: The 4977-bp common deletion (mtDNA) is a well-established mitochondrial genome alteration that has been described in various types of human cancers. However, to date, no studies on mtDNA in brain tumors have been reported. The present study aimed to determine mtDNA prevalence in common brain tumors, specifically, low- and high-grade gliomas (LGGs and HGGs), and meningiomas in Malaysian cases. Its correlation with clinicopathological parameters was also evaluated.
METHODS: A total of 50 patients with pathologically confirmed brain tumors (13 LGGs, 20 HGGs, and 17 meningiomas) were enrolled in this study. mtDNA was detected by using polymerase chain reaction (PCR) technique and later confirmed via Sanger DNA sequencing.
RESULTS: Overall, mtDNA was observed in 16 (32%) patients and it was significantly correlated with the type of tumor group and sex, being more common in the HGG group and in male patients.
CONCLUSION: The prevalence of mtDNA in Malaysian glioma and meningioma cases has been described for the first time and it was, indeed, comparable with previously published studies. This study provides initial insights into mtDNA in brain tumor and these findings can serve as new data for the global mitochondrial DNA mutations database.

Matched MeSH terms: Meningioma/genetics*; Meningioma/metabolism; Meningioma/pathology
Prediction of Histological Grade and Completeness of Resection of Intracranial Meningiomas: Role of Peritumoural Brain Edema

Palaniandy K, Haspani MSM, Zain NRM

Malays J Med Sci, 2017 May;24(3):33-43.
PMID: 28814931 MyJurnal DOI: 10.21315/mjms2017.24.3.5

BACKGROUND: Meningioma is the commonest primary intracranial tumour in adults. Excision is curative for low grade meningioma, whereas high-grade meningioma requires adjuvant therapy following surgery. Several studies have examined the association between peritumoural brain Edema - a common feature in meningioma - and histological grading with mixed results. The present study attempted to elucidate this association and if peritumoural brain Edema affects the intra-operative judgement of surgeons on the completeness of resection.
METHODS: An observational study was conducted among those who underwent surgery for meningioma. Eighteen subjects were recruited each for low- and high-grades, respectively. Magnetic resonance imaging (MRI) prior to surgery was employed for interpreting the Edema index and MRI after surgery was used to determine residual tumour.
RESULTS: Median age was 50 years, male to female ratio was 1:3.5, 69.4% had peritumoural brain Edema and 75% had reported gross resection. Among the reported gross total resection cases, 40.7% had residual tumour. Analysis showed statistically significant association between peritumoural brain Edema (P = 0.027) and tumour volume (P = 0.001) with high-grade meningioma, however multivariate analysis did not present any association. No association was noted between judgement of tumour resection by surgeons and peritumoural brain Edema.
CONCLUSION: Odds ratio for peritumoural brain Edema remained high and the tumour volume exhibited marginal P-value marginal significance for prediction of high grade meningioma. These two factors may still contribute to the tumour grade and should be included in further studies on the prognosis of meningioma.

Matched MeSH terms: Meningioma
Occupational and ambient radiation exposures from Lu-177 DOTATATE during targeted therapy

Sulieman A, Mayhoub FH, Salah H, Al-Mohammed HI, Alkhorayef M, Moftah B, et al.

Appl Radiat Isot, 2020 Oct;164:109240.
PMID: 32819499 DOI: 10.1016/j.apradiso.2020.109240

Lutetium-177 (DOTATATE) (177Lu; T1/2 6.7 days), a labelled β- and Auger-electron emitter, is widely used in treatment of neuroendocrine tumours. During performance of the procedure, staff and other patients can potentially receive significant doses in interception of the gamma emissions [113 keV (6.4%) and 208 keV (11%)] that are associated with the particle decays. While radiation protection and safety assessment are required in seeking to ensure practices comply with international guidelines, only limited published studies are available. The objectives of present study are to evaluate patient and occupational exposures, measuring ambient doses and estimating the radiation risk. The results, obtained from studies carried out in Riyadh over an 11 month period, at King Faisal Specialist Hospital and Research Center, concerned a total of 33 177Lu therapy patients. Patient exposures were estimated using a calibrated Victoreen 451P survey meter (Fluke Biomedical), for separations of 30 cm, 100 cm and 300 cm, also behind a bed shield that was used during hospitalization of the therapy patients. Occupational and ambient doses were also measured through use of calibrated thermoluminescent dosimeters and an automatic TLD reader (Harshaw 6600). The mean and range of administered activity (in MBq)) was 7115.2 ± 917.2 (4329-7955). The ambient dose at corridors outside of therapy isolation rooms was 1.2 mSv over the 11 month period, that at the nursing station was below the limit of detection and annual occupational doses were below the annual dose limit of 20 mSv. Special concern needs to be paid to comforters (carers) and family members during the early stage of radioisotope administration.

Matched MeSH terms: Meningioma/radiotherapy*
Fulltext Occipital Falcine Anaplastic Hemangiopericytoma Mimicking Meningioma

Kanesen D, Kandasamy R, Idris Z

J Neurosci Rural Pract, 2016 Dec;7(Suppl 1):S95-S98.
PMID: 28163517 DOI: 10.4103/0976-3147.196463

The rarity of hemangiopericytoma (HPC) and its controversial histological classification result in its frequent misdiagnosis and thus make the treatment quite challenging. It is often difficult to distinguish these tumors from meningiomas based on clinical features and radiological findings. This is a case report of a man, diagnosed clinically and radiologically as meningioma, which turned out to be anaplastic HPC on histological examination. A 30-year-old man presented with 3 months of progressively worsening of headache and blurring of vision. Clinical examination revealed the right homonymous hemianopia with reduced visual acuity and papilledema bilaterally. Magnetic resonance imaging revealed a multilobulated and heterogenous extraaxial lesion attached to the occipital falx. It measured 9.0 cm (AP) × 5.5 cm (W) × 5.8 cm (CC) and expands bilaterally with major bulk on the left. An occipital craniotomy followed by a subtotal tumor excision was only achieved due to profuse bleeding intraoperatively. Histopathology confirmed an anaplastic HPC (WHO Grade 3). The importance of differentiation between HPCs and meningiomas cannot be overemphasized. A preoperative correct diagnosis is difficult, but it is important that it should be made. Multilobulated (mushroom appearance), prominent internal signal voids, relatively narrow dural attachment, and lytic destruction without calcifications are useful findings to distinguish HPCs from meningiomas.

Matched MeSH terms: Meningioma
Fulltext Meningioma--the Sarawak General Hospital experience

Wong SH, Chan SH

Med J Malaysia, 2002 Dec;57(4):467-73.
PMID: 12733172

The aim of this study was to determine the factors for the large size of intracranial meningiomas at the time of presentation to the Sarawak General Hospital. The data was collected prospectively from 1/3/2000 to 28/2/2001. During this period a total of 57 cases of intracranial tumours were operated upon. Twenty of these cases (35%) were meningioma, making meningioma the most common intracranial tumour operated in the Neurosurgery service here with one to two cases operated per month. Headache was the most common symptom. The average duration of symptoms before the diagnosis was made was twenty-five months, the longest being fifteen years. The patients needed an average of seven visits prior to the diagnosis.

Matched MeSH terms: Meningioma/diagnosis; Meningioma/epidemiology*; Meningioma/therapy
Fulltext Meningioma with intracranial haemorrhage: A rare occurrence.

Ho, C.C.K., Benedict, M.S.

International Medical Journal Malaysia, 2008;7(1):0-0.
MyJurnal

Meningiomas with intracranial haemorrhage is a rare occurrence and carries a high mortality rate. We present here a case we encountered, where intratumoural, subdural and intraventricular haemorrhage occurred. The pathophysiology and mechanism of intracranial tumoural haemorrhage, is discussed.

Matched MeSH terms: Meningioma
Meningioma Mimicking Fibrous Dysplasia

Kamaluddin NA, Samsudin AHZ, Wan Hitam WH, Ibrahim M

Cureus, 2019 Sep 27;11(9):e5782.
PMID: 31723541 DOI: 10.7759/cureus.5782

Despite being among the common primary intracranial tumors, intraosseous craniofacial meningioma is the least common subtype of meningioma accounting for only 1-2% of intracranial meningiomas. Interestingly, it can display clinical and radiologic features that can be confused for fibrous dysplasia. Scan imaging and biopsy are crucial for the diagnosis as well as for further proper treatment. We report a case of unilateral eye proptosis and optic neuropathy which was initially thought for fibrous dysplasia. Later the histopathology revealed meningioma grade 1. As the clinical presentations are almost undifferentiated, diagnosis and further prompt treatment are challenging.

Matched MeSH terms: Meningioma

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