Two distinct case reports with foamy cell and differential diagnosis: Xanthomatous meningioma and review of literature

Year 2021, , 834 - 839, 30.06.2021

İsmail Saygın , Emel Çakır , İlker Eyüpoğlu

https://doi.org/10.17826/cumj.839932

Abstract

Meningiomas are the most common primary intracranial tumor thought to derived from arachnoidal cap cells in the meningeal coverings of the spinal cord and brain. The current WHO classification, published in 2016, includes nine different subtypes of grade 1 meningiomas, three different subtypes of grade 2 meningiomas, and three different subtypes of grade 3 meningiomas. Metaplastic meningioma is a rare variant which shows focal or diffuse mesenchymal tissue component. Xanthomatous meningioma which has foamy cell changes is a quite rare variant of metaplastic meningioma. Two patients, 54 and 59 years old, who applied to our clinic with similar symptoms, were operated for meningioma. Histopathological examination of their biopsy showed that neoplastic cells had oval-round nuclei and eosinophilic cytoplasm. In xanthomatous meningioma, some neoplastic cells had clear vacuolated cytoplasm (foamy cells). In microscopic examination of resection material in one of these patients, cells in some areas of the tumor had clear vacuolated cytoplasm (foamy cells). These neoplastic cells were scattered among other meningothelial cells and they were positive for EMA. To the best of our knowledge, until today there have been only 14 reported xanthomatous meningioma cases in English literature. Here, we aimed to discuss the pathogenesis and differential diagnosis of xanthomatous meningioma in two different cases

Keywords

Foamy cell, xanthomatous, metaplastic, histiocytic, meningioma

Köpüksü hücreli iki farklı olgu sunumu ve ayırıcı tanı: Ksantomatöz meningiom ve literatürün gözden geçirilmesi

Abstract

Meningiomlar, omurilik ve beynin meningeal kılıflarındaki araknoidal kap hücrelerinden türediği düşünülen en yaygın primer intrakranyal tümördür. 2016 yılında yayınlanan son WHO sınıflaması, dokuz farklı evre I meningiom alt tipi, üç farklı evre II meningiom alt tipi ve üç farklı evre III meningiom alt tipi içermektedir. Metaplastik meningioma, fokal veya diffüz mezenkimal doku bileşeni içeren nadir bir varyanttır. Köpüksü hücre değişiklikleri içeren ksantomatöz meningiom ise oldukça nadir görülen bir metaplastik meningiom varyantıdır. Kliniğimize benzer şikayetlerle gelen 54 ve 59 yaşlarında iki hasta meningiom tanısıyla opere edildi. Biyopsilerinin histopatolojik incelemesinde oval-yuvarlak nükleuslu ve eozinofilik sitoplazmalı hücrelerden oluşan neoplazm görüldü. Bu hastalardan birinin rezeksiyon materyalinin mikroskobik incelemesinde, tümörün bazı bölgelerindeki hücreler berrak vakuollü sitoplazmaya (köpüksü hücreler) sahipti. Köpüksü görünüme sahip bu neoplastik hücreler diğer meningotelyal hücreler arasında dağılmıştı ve EMA ile pozitif reaksiyon verdi. Bildiğimiz kadarıyla, bugüne kadar literatürde sadece 14 ksantomatöz meningiom vakası bildirilmiştir. Burada ksantomatöz meningiomun patogenezini ve ayırıcı tanısını iki farklı vakada tartışmayı amaçladık.

Keywords

Köpüksü hücre, ksantomatoz, metaplastik, histiositik, menengiom

References

• Referans1. Chougule M, Pawar V, Chivate SD, Sunil VJ. Xanthomatous Meningioma: A Rare Case Report. International Journal of Health Sciences and Research 2015;5(3): 445-8.
• Referans2. Ersoz S, Sagnak YZ, Eyuboglu I, Yazar U. Xanthomatous Meningioma: A Case Report. Turk Neurosurg 2017;1-4.
• Referans3. Fujii Y, Toyama M, Watanabe M, Taniguchi Y, Kaneko H. A case of a hypodense meningioma. CT Kenkyu 1988;10: 337-42.
• Referans4. Germano A, Galatioto S, La Rosa G, Caffo M, Cardia E: Xanthomatous posterior pyramid meningioma in a 2-year-old girl. Childs Nerv Syst 1997;13: 406-11.
• Referans5. Husain S, Alkhalidi HM, Raddaoui E. A 38-year-old woman with a dural based lesion. Brain Pathol 2012;22: 433-7.
• Referans6. Ijiri R, Tanaka Y, Hara M, Sekido K: Radiation-associated xanthomatous meningioma in a child. Childs Nerv Syst 2000;16: 304-8.
• Referans7. Ikota H, Nakazato Y: A case of metaplastic meningioma with extensive xanthomatous change. Neuropathology 2008;28: 422-6.
• Referans8. Ishida M, Fukami T, Nitta N, Iwai M, Yoshida K, Kagotani A, Nozaki K, Okabe H: Xanthomatous meningioma: A case report with review of the literature. Int J Clin Exp Pathol 2013;6(10): 2242-6.
• Referans9. Katayama Y, Tsubokawa T, Tanaka A, Koshinaga M, Nemoto N. Magnetic resonance imaging of xanthomatous meningioma. Neuroradiology 1993;35: 187-9.
• Referans10. Kepes JJ: Lipidized meningothelial tumor cells in “xanthomatous” meningioma express macrophage antigen. J Neuropathol Exp Neurol 1994;53: 384-8.
• Referans11. Liu L, Stone J, Hoffpauir JT, Xiong Z: Histiocytic meningioma: A distinctive subtype of meningioma? Intractable & Rare Diseases Research 2014;3(2): 57-9.
• Referans12. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Ellison DW, Figarella-Branger D, Perry A, Reifenberger G, Deimling AV. WHO Classification of Tumours of the Central Nervous System. (IARC WHO Classification of Tumours) Revised 4th Edition, 2016.
• Referans13. Machara T, Katsumata Y, Noda M, Shirouzu I. Low-density meningioma on CT. Am J Neuroradiol 1990;11(6): 1265.
• Referans14. Sato S, Nabeshıma K, Ohno A, Hınoura Y, Yokogamı K, Mıyahara D. A case of xanthomatous meningioma-Usefulness of cytologic preparations in intraoperative diagnosis. J. Jpn. Soc. Clin. Cytol 2003;42(2): 107-11.
• Referans15. Uematsu Y, Takayama M, Oiwa Y, Itakura T. A Case Report and Review of Xanthomatous Meningioma. Progress in Oncology 2002;12(1): 31-6.
• Referans16. Yamashita J, Handa H, Morimoto M, Oda Y, Nakashima Y. Xanthomatous Meningioma. Journal of Computer Assisted Tomography 1981;5(2): 272-3.