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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 69
| Issue : 5 | Page : 1477-1478 |
Is It Worth Reporting Meningioma With Xanthomatous Variant? A Pathologist Perspective
Pakesh Baishya1, Swarnava Tarafdar2, Nishant Goyal3, Ravi H Phulware1
1 Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Department of Radio-diagnosis, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
3 Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| Date of Submission | 07-Apr-2021 |
| Date of Decision | 13-Jul-2021 |
| Date of Acceptance | 02-Aug-2021 |
| Date of Web Publication | 30-Oct-2021 |
Correspondence Address:
Ravi H Phulware
Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.329575
How to cite this article:
Baishya P, Tarafdar S, Goyal N, Phulware RH. Is It Worth Reporting Meningioma With Xanthomatous Variant? A Pathologist Perspective. Neurol India 2021;69:1477-8 |
Sir,
A 62-year-old female presented with headache, lower limb weakness, and hypercholesterolemia for eight months. On radiology, T2W coronal image [Figure 1]a showed large, slightly hyperintense signal intensity extra-axial broad-based toward falx cerebri mass lesion with edema in the adjacent brain parenchyma (thick arrow) and CSF cleft (thin arrow). A 3D TOF angiography image [Figure 1]b showed supply from branches of the right anterior cerebral artery territory (thin arrow). | Figure 1: (a) T2W coronal image shows large slightly hyperintense signal intensity extra-axial broad-based toward falx cerebri mass lesion with edema in the adjacent brain parenchyma (thick arrow) and CSF cleft (thin arrow). (b) A 3D TOF angiography image shows supply from branches of right anterior cerebral artery territory (thin arrow)
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On operative findings, an extra-axial, pinkish grey, soft, moderately vascular lesion was noted arising from the right side of falx cerebri. The histopathology revealed a tumor arranged in fascicles and whorls with cells showing round nuclei, indistinct cell borders, and few psammoma bodies with a prominent xanthomatous appearance at places [Figure 2]a,[Figure 2]b,[Figure 2]c. No mitotic activity was noted. On immunohistochemistry, epithelial membrane antigen (EMA) was positive for both xanthomatous and non-xanthomatous cells [Figure 2]d whereas CD68 was positive only in xanthomatous cells [Figure 2]e. Ki67 index was <1%. A diagnosis of Xanthomatous meningioma, WHO grade I was rendered. | Figure 2: (a) (Haematoxylin and eosin [H and E] ×100) Tumour arranged in fascicles and whorls with cells showing round nuclei, indistinct cell borders, and few psammoma bodies. The majority of the neoplastic cells exhibit a prominent xanthomatous appearance. No mitotic activity was noted. (b) Higher magnification shows xanthomatous areas with tumor cells having clear vacuolated cytoplasm and bland round to oval nuclei. (c) Higher magnification demonstrating areas of whorl formation and psammomatous bodies. (d) On immunohistochemistry, EMA was positive for both xanthomatous and non-xanthomatous cells. (e) CD68 was positive only in xanthomatous cells
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| » Discussion | |  |
Keppe, in 1994, first described the lipidized meningioma, which interestingly expresses macrophage antigen.[1] Until the last decade, only less than twenty cases were reported in English literature.[2] Although the exact etiology of this change is not known, there are case reports that suggest radiation, hyperlipidemia, and long-standing degeneration can bring about these morphological and biochemical changes of the tumor cells.[3] The current case also exhibits the presence of hyperlipidemia.
In our case, a gradual transition of meningothelial neoplastic cells into xanthomatous cells is noted, and this is proved by the similar staining EMA by both the population of cells. One more interesting phenomenon is the staining of CD68 by the Xanthomatous cells, which supports the original findings of Keppe et al.[1],[2],[3]. It is important to note that the presence of xanthomatous change does not always represent the benign nature of the tumor as these changes are also seen in atypical and anaplastic meningioma.[4] The most relevant cause of reporting this particular case is that one should not confuse the Xanthomatous cells as foamy histiocytes and understand that these changes are a representation of metaplastic changes of the tumor cells. A more detailed study of this tumor is required to reveal information regarding the importance of biochemical changes in these tumor cells and their clinical significance.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | | |
| 1. | Kepes JJ. Lipidized meningothelial tumor cells in “xanthomatous” meningioma express macrophage antigen. J Neuropathol Exp Neurol 1994;53:384-8.  |
| 2. | Ersoz S, Yilmaz ZS, Eyuboglu I, Yazar U. Xanthomatous meningioma: A case report. Turk Neurosurg 2019;29:141-4. |
| 3. | Roncaroli F, Scheithauer BW, Laeng RH, Cenacchi G, Abell-Aleff P, Moschopulos M. Lipomatous meningioma: A clinicopathologic study of 18 cases with special reference to the issue of metaplasia. Am J Surg Pathol 2001;25:769-75. |
| 4. | Taraszewska A, Matyja E, Bogucki J. Xanthomatous changes in atypical and anaplastic meningiomas. Light and electron microscopic investigations. Folia Neuropathol 2000;38:125-34. |
[Figure 1], [Figure 2]
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