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Zhang H, Li X, Jiang Y. Multicentric primary ectopic meningiomas involving lung and cranial bone barrier: A rare case report. Medicine (Baltimore) 2025; 104:e41294. [PMID: 39889184 PMCID: PMC11789907 DOI: 10.1097/md.0000000000041294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Revised: 12/21/2024] [Accepted: 01/03/2025] [Indexed: 02/02/2025] Open
Abstract
RATIONALE Primary ectopic meningiomas (PEMs) are extremely rare, with limited literature available on the subject. Understanding their clinical and radiological characteristics is crucial for accurate diagnosis and treatment. PATIENT CONCERNS This study presents a case of a multicentric PEM involving the lungs and cranial bone barrier, aiming to provide new insights into its clinical and diagnostic features. DIAGNOSES A 46-year-old woman with no prior history of intracranial meningiomas or other tumors was found to have multiple lobulated nodules in the lungs during a routine physical examination. Computed tomography scans revealed well-defined lesions with mild to moderate heterogeneous enhancement. Magnetic resonance imaging showed a lesion at the cranial bone barrier, which presented as a high-signal area on T2-weighted FLAIR images and mild to moderate enhancement on T1-weighted images. The magnetic resonance spectroscopy displayed a broad Lip peak but lacked N-acetylaspartate or creatine peaks. Histopathological and immunohistochemical analyses confirmed the diagnosis of multicentric PEMs. INTERVENTIONS We performed surgical resection of the lesion on the cranial bone plate and conducted follow-up examinations for the multiple lesions in the lungs. OUTCOMES This case highlights the diagnostic challenges of multicentric PEMs involving the lungs and cranial bone barrier. Due to their extremely low incidence and nonspecific clinical manifestations, a comprehensive evaluation combining radiological, pathological, and immunophenotypic data is essential for accurate diagnosis. LESSONS This case underscores the importance of a thorough, multidisciplinary approach to diagnosis and treatment and provides valuable insights for managing similar rare cases.
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Affiliation(s)
- Huiyang Zhang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Xiang Li
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Yan Jiang
- Department of Radiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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Liu YJ, Han L, Cao J, Zheng HW, Yu LS. Primary Middle Ear Meningioma with Intact Tympanic Membrane: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2024; 103:364-369. [PMID: 34784773 DOI: 10.1177/01455613211058100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary ectopic meningioma of the middle ear is relatively rare in clinical practice. It is often difficult to distinguish it from chronic otitis media or otitis media with effusion due to its similar and atypical clinical symptoms. We report a case of epithelial tympanic ectopic meningioma with the main complaints of otalgia, aural fullness, and hearing loss. It was accidentally discovered during tympanotomy due to the symptoms of recurring refractory secretory otitis media. This article briefly reviews the relevant literature in recent years, summarizes the characteristics of primary ectopic tympanic meningioma with intact tympanic membrane, and emphasizes the diagnosis and treatment strategy of the middle ear mass.
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Affiliation(s)
- Yuan-Jun Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Lin Han
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Jie Cao
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hong-Wei Zheng
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Li-Sheng Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, Peking University People's Hospital, Peking University, Beijing, China
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Sbai AA, Rabhi A, Benfadil D, Lachkar A, Tsen AA, Elayoubi F. Primary nasosinus meningioma, an etiology masks another: Case report. Int J Surg Case Rep 2023; 106:108194. [PMID: 37105029 PMCID: PMC10164884 DOI: 10.1016/j.ijscr.2023.108194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Extracranial meningiomas of the sinonasal tract are rare tumors. The diagnosis is not generally evident. We report, through an observation, the clinical particularities, the diagnostic difficulties and the therapeutic approach of primary sinonasal meningiomas. CASE PRESENTATION We report the case of a 54-year-old woman who presented with complaints of right nasal obstruction with the notion of recurrent epistaxis evolving for one year. At the examination, nasal endoscopy found a voluminous purplish-gray mass filling both the middle meatus and the olfactory cleft. The CT examination showed an ethmoïdonasal tumoral process extending to orbital cavity and infratemporal fossa without endocranial extension. A transnasal approach was performed, histopathological examination demonstrates a méningothélial meningioma rank1. The clinical, endoscopic and CT controls did not show tumor residue or a local recurrence. CLINICAL DISCUSSION Meningioma is a common non-glial intracranial neoplasm. Primary or secondary extracranial meningioma (depending on whether they are isolated or associated with an intracranial tumor) location is uncommon, clinical presentation is nonspecific. Diagnostic confirmation is anatomopathological with immunohistochemically study. Imaging confirms the primary nature of these tumors. The prognosis is favorable after complete surgical excision without further adjuvant treatment. CONCLUSION Primary nasosinus meningiomas are rare, with non-specific symtomatology and common with other local pathologies. Imaging confirms the primary character of these tumors, anatomopathological examination completed by immunohistochemical study confirms the diagnosis. Surgery with complete exeresis remains the best option with a good prognosis.
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Affiliation(s)
- Achraf Amine Sbai
- Department of Ear Nose and Throat, Mohammed VI University Hospital, Medical School, Mohammed the First University, Oujda, Morocco.
| | - Amine Rabhi
- Department of Ear Nose and Throat, Mohammed VI University Hospital, Medical School, Mohammed the First University, Oujda, Morocco
| | - Drissia Benfadil
- Department of Ear Nose and Throat, Mohammed VI University Hospital, Medical School, Mohammed the First University, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed the First University, Morocco
| | - Azeddine Lachkar
- Department of Ear Nose and Throat, Mohammed VI University Hospital, Medical School, Mohammed the First University, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed the First University, Morocco
| | - Adil Abdenbi Tsen
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed the First University, Morocco; Department of Maxillofacial Surgery, Mohammed VI University Hospital, Medical School, Mohammed the First University, Oujda, Morocco
| | - Fahd Elayoubi
- Department of Ear Nose and Throat, Mohammed VI University Hospital, Medical School, Mohammed the First University, Oujda, Morocco; Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed the First University, Morocco
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Abir M, Rihab L, Bellakhdhar M, Malika O, Jihen H, Wassim K, Abdelkefi M. A rare case of primary sinonasal meningioma: A case report. Int J Surg Case Rep 2022; 99:107620. [PMID: 36122423 PMCID: PMC9568705 DOI: 10.1016/j.ijscr.2022.107620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance Extra cranial primary meningioma of sinonasal tract is a rare entity. It is often misdiagnosed as nasal polyp. Case presentation Here we report a case of a primary ethmoid sinus meningioma with extension into the nasal cavity in a 41-year-old man. The tumor was completely excised via endoscopic endonasalapproach and the histologic diagnosis of meningioma was established. The patient was regularly follow up for 12 months without recurrence of the tumor. Clinical discussion The final diagnosis of primary sinonasal meningioma is based on histopathology and immunohistochemistry analyses results. The importance of complete surgical resection is undoubted and also is a goodindicator prognosis. Conclusion The otolaryngologists should be aware of the diagnosis of primary meningioma; despite of its rarity it is considered as a possible cause of nasal obstruction.
Primary extra cranial meningioma is rare and its Histogenesis is still unknown. Clinical presentation of sinonasal ectopic meningiomas is not specific. Diagnosis is based on histopathological examination and immunohistochemistry. Complete resection is not always possible due to complex anatomy of nasal cavity and paranasal sinuses.
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Affiliation(s)
- Meherzi Abir
- University of Sousse, Faculty of Medicine of Sousse ENT Department, Farhat Hached Teaching Hospital, Sousse, Tunisia.
| | - Lahmar Rihab
- University of Sousse, Faculty of Medicine of Sousse ENT Department, Farhat Hached Teaching Hospital, Sousse, Tunisia
| | - Mouna Bellakhdhar
- University of Sousse, Faculty of Medicine of Sousse ENT Department, Farhat Hached Teaching Hospital, Sousse, Tunisia
| | - Omri Malika
- University of Sousse, Faculty of Medicine of Sousse ENT Department, Farhat Hached Teaching Hospital, Sousse, Tunisia
| | - Hwass Jihen
- University of Sousse, Faculty of Medicine of Sousse ENT Department, Farhat Hached Teaching Hospital, Sousse, Tunisia
| | - Kermani Wassim
- University of Sousse, Faculty of Medicine of Sousse ENT Department, Farhat Hached Teaching Hospital, Sousse, Tunisia
| | - Mohamed Abdelkefi
- University of Sousse, Faculty of Medicine of Sousse ENT Department, Farhat Hached Teaching Hospital, Sousse, Tunisia
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Sinonasal Meningioma in a Siberian Tiger (Panthera tigris altaica). Vet Sci 2022; 9:vetsci9090457. [PMID: 36136673 PMCID: PMC9504017 DOI: 10.3390/vetsci9090457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/12/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Meningiomas are the most common primary brain tumour in dogs and cats. However, whilst there are numerous reports of meningiomas at extracranial sites in the dog (such as the spine, the eye and near the nasal cavity), in cats there have only been a few case reports of meningiomas arising in the spine, and no reports of post-mortem confirmed meningiomas arising in the eyes or near the nasal cavity. In this report, a 20-year-old captive tiger (Panthera tigris altaica) with a history of chronic eye inflammation, resulting in eventual removal of the eye, spontaneously developed epilepsy. Over the course of 2 years, the seizures worsened to the point where the animal was eventually euthanized. At autopsy, a mass was found near the nasal cavity and histological analysis showed tumour cells surrounded by a collagenous matrix. The diagnosis was sinonasal transitional meningioma. This is the first report of a captive wild felid with an extracranial meningioma, specifically a tiger with a sinonasal transitional meningioma. Abstract Meningiomas are the most common primary brain tumour in dogs and cats. However, whilst there are numerous reports of extracranial (spinal, orbital and sinonasal) meningiomas in the dog, there have only been a few case reports of spinal meningiomas, and no post-mortem confirmed orbital or sinonasal meningiomas in cats. In this report, a 20-year-old captive tiger (Panthera tigris altaica) with a history of chronic ocular inflammation resulting in enucleation, spontaneously developed tetanic convulsions (epileptic seizures) that over a 2-year period resulted in a gradually worsening condition and the animal was eventually euthanized. At autopsy, a focal, expansile, neoplastic mass was found in the caudal nasal cavity midline, abutting the cribriform plate and slightly compressing the calvarium. Histological analysis revealed nasal turbinates attached to a well-circumscribed expansile multi-lobular mass consisting of interlacing whorls and streams of neoplastic cells supported by a variably fibrous to microcystic collagenous matrix displaying rare psammoma bodies. The diagnosis was sinonasal transitional meningioma. This is the first report of a captive wild felid with an extracranial meningioma, specifically a tiger with a sinonasal transitional meningioma.
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Yokoya S, Hisaoka S, Fujiwara G, Oka H, Hino A. Posttraumatic rapid growing extradural meningioma: A case report on the effectiveness of echosonography. Surg Neurol Int 2022; 13:61. [PMID: 35242427 PMCID: PMC8888292 DOI: 10.25259/sni_1125_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Most meningiomas related to head trauma have been reported to show intradural lesions; however, they can also occur as primary extradural meningiomas (PEMs) and have often been reported to histologically demonstrate atypical or malignant subtypes. Therefore, early detection and complete resection of related tissues are required; however, to date, only a few PEM cases related to trauma or injury have been reported. Herein, we present a patient with a rapidly growing posttraumatic PEM, in which echosonography is efficient not only for early diagnosis but also for intraoperative strategies. Case Description: A 62-year-old male presented to a nearby clinic with a complaint of a painless head bump that gradually grew larger in relation to trauma 6 weeks earlier. He underwent echosonography and pointed out the possibility of a cranial tumor and consulted our hospital. Although preoperative imaging studies, such as computed tomography or magnetic resonance imaging, did not provide reliable information on dura mater invasion, echosonography demonstrated dural invasion and intradural lesions in which large vessels passed the surface of the lesion. Based on these findings, we could safely resect the lesion within a sufficient range. Conclusion: Echosonography may not only be a cue for an early diagnosis but also provide important information for the treatment strategy of PEM that is related to head trauma.
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Sigdel K, Ding ZF, Xie HX. Case of primary extracranial meningioma of the maxillary sinus presenting as buccal swelling associated with headache: A case report. World J Clin Cases 2022; 10:1008-1015. [PMID: 35127914 PMCID: PMC8790439 DOI: 10.12998/wjcc.v10.i3.1008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/20/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Meningiomas are benign tumors that originate from the meningothelial arachnoid cells, but they rarely develop extracranially. There is no specific surgical guideline for resecting them in the maxillary sinus, and little is known about their biological behavior and operative management.
CASE SUMMARY We present a 54-year-old female patient referred to our department with a primary extracranial meningioma that presented as buccal swelling associated with headache. On clinical examination the mass was non-tender, fixed, sessile and non-pulsatile situating in the right maxillary sinus. Computed tomography scan showed a well-defined mass of 7 cm × 6 cm × 6 cm compressing the surrounding structures. Magnetic resonance imaging revealed a well circumscribed heterogenous lesion with necrotic center and relatively hypointense on T2-weighted imaging. Imaging studies revealed no evidence of intracranial extension and metastatic nests. Biopsy showed grade I primary extracranial with low mitotic activity. Total maxillectomy with excision of tumor and adjacent paranasal structures following reconstruction of the orbit and maxilla with tissue patch was done by the maxillofacial surgeon. The biopsy reported fibrous meningioma based on the hematoxylin and eosin section. On immunohistochemistry the tumor cells were positive for vimentin, focally positive for epithelial membrane antigen and CD99 and negative for signal transducer and activator of transcription 6. The mass was removed surgically with reconstruction, and the pathological studies confirmed the diagnosis to be an extracranial meningioma. The present study briefly reviews the current knowledge concerning the diagnosis and treatment of extracranial meningiomas in the head and neck area and offers suggestions for managing extracranial meningiomas in the paranasal sinuses.
CONCLUSION To conclude, extracranial meningiomas in the paranasal sinuses may be successfully managed by surgical treatment without evident post-surgery complications.
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Affiliation(s)
- Krishna Sigdel
- Department of Head and Neck Oncology Surgery, West China School of Stomatology, Chengdu 610041, Sichuan Province, China
| | - Zhang-Fan Ding
- Department of Head and Neck Oncology Surgery, West China School of Stomatology, Chengdu 610041, Sichuan Province, China
| | - Hui-Xu Xie
- Department of Head and Neck Oncology Surgery, West China School of Stomatology, Chengdu 610041, Sichuan Province, China
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Umana GE, Scalia G, Vats A, Pompili G, Barone F, Passanisi M, Graziano F, Maugeri R, Tranchina MG, Cosentino S, Ippolito M, Tomasi SO, Raudino G, Chaurasia B, Iacopino DG, Nicoletti GF, Cicero S, Strigari L, Perrotta RE. Primary Extracranial Meningiomas of the Head and Neck. Life (Basel) 2021; 11:life11090942. [PMID: 34575090 PMCID: PMC8468587 DOI: 10.3390/life11090942] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 12/29/2022] Open
Abstract
Meningiomas represent the most common benign histological tumor of the central nervous system. Usually, meningiomas are intracranial, showing a typical dural tail sign on brain MRI with Gadolinium, but occasionally they can infiltrate the skull or be sited extracranially. We present a systematic review of the literature on extracranial meningiomas of the head and neck, along with an emblematic case of primary extracranial meningioma (PEM), which provides further insights into PEM management. A literature search according to the PRISMA statement was conducted from 1979 to June 2021 using PubMed, Web of Science, Google Scholar, and Scopus databases, searching for relevant Mesh terms (primary extracranial meningioma) AND (head OR neck). Data for all patients were recorded when available, including age, sex, localization, histological grading, treatment, possible recurrence, and outcome. A total of 83 published studies were identified through PubMed, Google Scholar, and Scopus databases, together with additional references list searches from 1979 to date. A total of 49 papers were excluded, and 34 manuscripts were considered for this systematic review, including 213 patients. We also reported a case of a 45-year-old male with an extracranial neck psammomatous meningioma with sizes of 4 cm × 3 cm × 2 cm. Furthermore, whole-body 68Ga-DOTATOC PET/CT was performed, excluding tumor spread to other areas. Surgical resection of the tumor was accomplished, as well as skin flap reconstruction, obtaining radical removal and satisfying wound healing. PEMs could suggest an infiltrative and aggressive behavior, which has never found a histopathological correlation with a malignancy (low Ki-67, <5%). Whole-body 68Ga-DOTATOC PET/CT should be considered in the patient’s global assessment. Surgical removal is a resolutive treatment, and the examination of frozen sections can confirm the benignity of the lesion, reducing the extension of the removal of healthy tissue surrounding the tumor.
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Affiliation(s)
- Giuseppe Emmanuele Umana
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95125 Catania, Italy; (F.B.); (M.P.); (S.C.)
- Correspondence:
| | - Gianluca Scalia
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95125 Catania, Italy; (G.S.); (F.G.); (G.F.N.)
| | - Atul Vats
- Neurosurgery Department, James Cook University Hospital, Middlesbrough TS1, UK;
| | - Gianluca Pompili
- Department of General Surgery and Medical and Surgery Specialities, Section of Plastic Surgery, University of Catania—“Cannizzaro” Hospital, 95125 Catania, Italy; (G.P.); (R.E.P.)
| | - Fabio Barone
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95125 Catania, Italy; (F.B.); (M.P.); (S.C.)
| | - Maurizio Passanisi
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95125 Catania, Italy; (F.B.); (M.P.); (S.C.)
| | - Francesca Graziano
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95125 Catania, Italy; (G.S.); (F.G.); (G.F.N.)
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Postgraduate Residency Program in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, 90128 Palermo, Italy; (R.M.); (D.G.I.)
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Postgraduate Residency Program in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, 90128 Palermo, Italy; (R.M.); (D.G.I.)
| | | | - Sebastiano Cosentino
- Trauma Center, Gamma Knife Center, Nuclear Medicine Unit, Department of Advanced Technologies, Cannizzaro Hospital, 95125 Catania, Italy; (S.C.); (M.I.)
| | - Massimo Ippolito
- Trauma Center, Gamma Knife Center, Nuclear Medicine Unit, Department of Advanced Technologies, Cannizzaro Hospital, 95125 Catania, Italy; (S.C.); (M.I.)
| | - Santino Ottavio Tomasi
- Department of Neurological Surgery, Christian Doppler Klinik Paracelsus Medical University, 5020 Salzburg, Austria;
- Laboratory for Microsurgical Neuroanatomy, Christian Doppler Klinik, 5020 Salzburg, Austria
| | - Giuseppe Raudino
- Center Humanitas ICC, Misterbianco, Ortho-Neuro, 95125 Catania, Italy;
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj 44300, Nepal;
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP “Paolo Giaccone”, Postgraduate Residency Program in Neurological Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, 90128 Palermo, Italy; (R.M.); (D.G.I.)
| | - Giovanni Federico Nicoletti
- Department of Neurosurgery, Highly Specialized Hospital and of National Importance “Garibaldi”, 95125 Catania, Italy; (G.S.); (F.G.); (G.F.N.)
| | - Salvatore Cicero
- Trauma Center, Gamma Knife Center, Department of Neurosurgery, Cannizzaro Hospital, 95125 Catania, Italy; (F.B.); (M.P.); (S.C.)
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40122 Bologna, Italy;
| | - Rosario Emanuele Perrotta
- Department of General Surgery and Medical and Surgery Specialities, Section of Plastic Surgery, University of Catania—“Cannizzaro” Hospital, 95125 Catania, Italy; (G.P.); (R.E.P.)
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Reichel CA. Rare Diseases of the Oral Cavity, Neck, and Pharynx. Laryngorhinootologie 2021; 100:S1-S24. [PMID: 34352905 PMCID: PMC8432966 DOI: 10.1055/a-1331-2851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diseases occurring with an incidence of less than 1-10 cases per 10 000 individuals are considered as rare. Currently, between 5 000 and 8 000 rare or orphan diseases are known, every year about 250 rare diseases are newly described. Many of those pathologies concern the head and neck area. In many cases, a long time is required to diagnose an orphan disease. The lives of patients who are affected by those diseases are often determined by medical consultations and inpatient stays. Most orphan diseases are of genetic origin and cannot be cured despite medical progress. However, during the last years, the perception of and the knowledge about rare diseases has increased also due to the fact that publicly available databases have been created and self-help groups have been established which foster the autonomy of affected people. Only recently, innovative technical progress in the field of biogenetics allows individually characterizing the genetic origin of rare diseases in single patients. Based on this, it should be possible in the near future to elaborate tailored treatment concepts for patients suffering from rare diseases in the sense of translational and personalized medicine. This article deals with orphan diseases of the lip, oral cavity, pharynx, and cervical soft tissues depicting these developments. The readers will be provided with a compact overview about selected diseases of these anatomical regions. References to further information for medical staff and affected patients support deeper knowledge and lead to the current state of knowledge in this highly dynamic field.
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Affiliation(s)
- Christoph A Reichel
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, KUM-Klinikum, Ludwig-Maximilians-Universität München, München
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Sommer F. Rare Diseases of the Nose, the Paranasal Sinuses, and the Anterior Skull Base. Laryngorhinootologie 2021; 100:S1-S44. [PMID: 34352902 PMCID: PMC8354577 DOI: 10.1055/a-1331-2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to their low incidence and thus resulting limited diagnostic criteria as well as therapeutic options, rare diseases of the nose, the paranasal sinuses, and the anterior skull base are a significant challenge. The value as of which a disease has to be considered as rare amounts to a maximum of 5 patients per 10 000 people. Within these diseases, however, there are extreme differences. Some rare or orphan diseases like for example the inverted papilloma belong to regularly diagnosed and treated diseases of larger departments of oto-rhino-laryngology whereas other rare diseases and malformations have only been described in less than 100 case reports worldwide. This fact emphasizes the necessity of bundling the available experience of diagnostics and therapy. The present article gives an overview about rare diseases of the nose, the paranasal sinuses, and the anterior skull base from the field of diseases/syndromes of the olfactory system, malformations of the nose and paranasal sinuses, ventilation and functional disorders as well as benign and malignant tumors. The classification and data on diagnostic and therapeutic options were established based on the current literature.
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Affiliation(s)
- Fabian Sommer
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Universitätsklinik Ulm
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Kaur A, Ali R, Omar E, Hashim H. An Infratemporal Meningioma: A Diagnostic Dilemma. J Radiol Case Rep 2021; 15:1-10. [PMID: 33717402 DOI: 10.3941/jrcr.v15i1.3898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 46-year-old male presented with painless, recurrent bilateral ear discharge and an enlarging right temporal swelling. There were no neurological deficits. Imaging revealed an enhancing, soft tissue mass at the right infratemporal region involving the right temporalis muscle with a small, enhancing intradural component and associated hyperostosis of the greater wing of the right sphenoid bone. Tumour debulking of the right temporalis tumour was performed. Tumour invasion of the right temporalis muscle was noted intraoperatively. Histopathological result was consistent with fibrous meningioma WHO Grade 1 involving surgical resection margins. Follow-up MRI revealed residual right temporal extracranial component. Thus, plans were made for a second stage tumour debulking, however at time of writing, surgery had not been performed. This case highlights the differing appearances of the common meningioma occurring extracranially with elaboration of its differential diagnosis and management.
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Affiliation(s)
- Arlinder Kaur
- Department of Radiology, Hospital Sungai Buloh, Malaysia
| | - Rofiah Ali
- Department of Radiology, Hospital Sungai Buloh, Malaysia
| | - Effat Omar
- Centre for Pathology Diagnostic and Research Laboratories, Faculty of Medicine, Universiti Teknologi MARA, Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (iPPerForm), Faculty of Medicine, Universiti Teknologi MARA, Malaysia
| | - Hilwati Hashim
- Department of Radiology, Faculty of Medicine, Universiti Teknologi MARA, Malaysia
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Yokoi H, Kodama S, Maruyama K, Fujiwara M, Shiokawa Y, Saito K. Endoscopic endonasal resection via a transsphenoidal and transpterygoid approach for sphenoid ridge meningioma extending into the sphenoid sinus: A case report and literature review. Int J Surg Case Rep 2019; 60:115-119. [PMID: 31212093 PMCID: PMC6581985 DOI: 10.1016/j.ijscr.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/28/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Large sphenoid ridge meningiomas are surgically challenging because of their extension to adjacent structures. Extracranial meningiomas are very rare; most are of the secondary type and have an intracranial origin. Improved surgical methods are required for treatment of this entity. PRESENTATION OF CASE Here, we describe a case of a huge sphenoid ridge meningioma extending into the sphenoid sinus that was resected by staged transcranial and endoscopic endonasal resection via a transsphenoidal and transpterygoid approach. It was possible to excise the tumor from the sphenoid sinus in a minimally invasive manner via this approach. DISCUSSION AND CONCLUSION The transsphenoidal and transpterygoid approach was useful for providing a surgical field that allowed adequate visualization for removal of a sphenoid tumor that had expanded well into the lateral fossa of the sphenoid bone.
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Affiliation(s)
- Hidenori Yokoi
- Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan.
| | - Satoru Kodama
- Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan; Kodama Ear, Nose, and Throat Clinic, Oita, Japan.
| | - Keisuke Maruyama
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
| | - Masachika Fujiwara
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan.
| | - Yoshiaki Shiokawa
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
| | - Koichiro Saito
- Department of Otolaryngology, Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan.
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13
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Pérez-Accino J, Suñol A, Munro E, Philbey AW, Marioni-Henry K. Feline meningioma with extensive nasal involvement. JFMS Open Rep 2019; 5:2055116919833732. [PMID: 30834133 PMCID: PMC6393824 DOI: 10.1177/2055116919833732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Case summary A 9-year-old male neutered domestic longhair cat was presented with a 3 week history of lethargy and pain of unknown origin. A large extra-axial mass was demonstrated on MRI of the head, with cribriform plate destruction, extensive nasal invasion and intracranial expansion, producing a severe mass effect. The mass was isointense on T1-weighted imaging, predominantly hypointense with some hyperintense areas on T2-weighted imaging and fluid attenuation inversion recovery, markedly contrast enhancing, and caused transtentorial and cerebellar herniation. Histopathological evaluation confirmed a transitional (mixed) meningioma. Relevance and novel information To our knowledge this is the first report of a meningioma with extensive nasal involvement in a cat. Based on this case, meningioma should be considered as a differential diagnosis for tumours involving the nasal cavity and frontal lobe with cribriform plate destruction.
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Affiliation(s)
- Jorge Pérez-Accino
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, UK
| | - Anna Suñol
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, UK
| | - Elizabeth Munro
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, UK
| | - Adrian W Philbey
- Easter Bush Pathology, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, UK
| | - Katia Marioni-Henry
- Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, UK
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Abstract
Primary extracranial meningioma is a rare tumor, unlike its common intracranial counterpart. Infrequently found in the head and neck region, it can cause local or neurologic symptoms depending on its location and interaction with cranial nerves. While uncommon, it is an important diagnosis to have on the differential of periorbital lesions as surgical removal and prognosis are generally good. The authors present the first report of a patient with primary extracranial meningioma originating in the lacrimal sac fossa.
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Primary Atypical Meningioma of the Nasal Cavity: A Case Report and Review of the Literature. Case Rep Otolaryngol 2018; 2018:7541892. [PMID: 29682381 PMCID: PMC5846460 DOI: 10.1155/2018/7541892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/09/2018] [Accepted: 02/07/2018] [Indexed: 01/22/2023] Open
Abstract
Background Meningioma is a central nervous system tumor that typically arises in proximity to meninges. Extracranial primary atypical meningioma of sinonasal tract is a rare one. Methods We discuss the clinical, radiological, and histological presentation of an elderly female with primary atypical meningioma of the nasal cavity, which was excised via endoscopic endonasal approach. Results There was no recurrence even up to 20 months of follow-up after endoscopic excision. Conclusion Extracranial primary atypical meningioma should be kept in mind as one of the differential diagnoses of nasal mass. Histopathological diagnosis along with immunohistochemistry should be used for definitive diagnosis.
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16
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Su CQ, Lu SS, Zhou MD, Hong XN. Ectopic meningioma in a patient with neurofibromatosis Type 2: a case report and review of the literature. BJR Case Rep 2018; 4:20180007. [PMID: 31489219 PMCID: PMC6711269 DOI: 10.1259/bjrcr.20180007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/31/2018] [Accepted: 04/12/2018] [Indexed: 11/15/2022] Open
Abstract
Ectopic meningioma occurring in the region of parapharyngeal space is rare in
clinical practice and brings great challenge in its diagnosis. This report
details such a case in a 14-year-old girl with neurofibromatosis Type 2, which
is a highly infrequent association. The clinical manifestations, imaging
findings, and pathological manifestations are described, and the relevant
literature is reviewed to highlight characteristic imaging findings of ectopic
meningiomas.
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Affiliation(s)
- Chun Qiu Su
- Department of Radiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,China
| | - Shan Shan Lu
- Department of Radiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,China
| | - Mao Dong Zhou
- Department of Radiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,China
| | - Xun Ning Hong
- Department of Radiology,The First Affiliated Hospital of Nanjing Medical University,Nanjing,China
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17
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Abstract
Extracranial meningiomas are rare with a reported incidence of 1-2 %. Diagnosis is a challenge due to the unusual site of occurrence. The treatment of choice is surgical excision. A case that presented with primary lesion in the cheek with no detected intracranial extension is being reported.
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18
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Mourad M, Chan D, Ducic Y. Surgical Management of Extracranial Meningiomas Arising in the Head and Neck. J Oral Maxillofac Surg 2016; 74:1872-8. [PMID: 27087283 DOI: 10.1016/j.joms.2016.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/13/2016] [Accepted: 03/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine outcomes in the management of extracranial meningiomas of the head and neck. PATIENTS AND METHODS This is a retrospective single-surgeon series performed at a tertiary-care referral center. In all, 23 patients met the inclusion criteria, consisting of 12 men and 11 women. The mean age of patients treated was 60.5 years (range, 32 to 71 years). Subsite involvement included the infratemporal fossa (n = 8), greater wing of the sphenoid and orbit (n = 7), clivus (n = 2), and parapharyngeal space (n = 6). RESULTS In all, recurrence occurred in 21% of patients (n = 5) who underwent gross tumor resection. Two patients underwent subtotal resection because of the tumor's location within the clivus with adjuvant CyberKnife therapy (Accuray, Sunnyvale, CA). Both patients had persistent disease with no new neurologic symptoms. Examination showed that 100% of patients (N = 23) had dural involvement. Post-ablative complications occurred in 43% of patients (n = 10). CONCLUSIONS We presently report the largest series of surgical treatment for extracranial meningiomas. Gross tumor resection should be the mainstay of therapy, except in anatomically restricted regions such as the petrous apex and clivus. Adjuvant therapy including CyberKnife therapy may be used in such lesions. All lesions showed dural involvement. A more unified nomenclature is required for the characterization of these lesions.
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Affiliation(s)
- Moustafa Mourad
- Resident Physician, Division of Facial Plastic Surgery, Department of Otolaryngology-Head & Neck Surgery, The New York Eye & Ear Infirmary, New York, NY
| | - David Chan
- Fellow Physician, Department of Otolaryngology Head and Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX
| | - Yadranko Ducic
- Professor, Department of Otolaryngology Head and Neck Surgery, Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX.
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19
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Saade R, Hessel A, Ginsberg L, Fuller G, Bell D. Primary extradural meningioma presenting as a neck mass: Case report and review of the literature. Head Neck 2015; 37:E92-5. [DOI: 10.1002/hed.23874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rami Saade
- Department of Head and Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Amy Hessel
- Department of Head and Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Lawrence Ginsberg
- Department of Radiology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Greg Fuller
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Diana Bell
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
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20
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Primary Extracranial Meningioma: The Royal Pearl Experience. Indian J Otolaryngol Head Neck Surg 2015; 67:120-3. [PMID: 26075163 DOI: 10.1007/s12070-015-0856-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022] Open
Abstract
The extracranial occurrence of meningioma, which is a tumour of the central nervous system, is rare. Two cases of primary extracranial meningioma of the psammomatous variant are reported here. Both cases were managed successfully by endoscopic endonasal approach. Literature has been reviewed and their clinicopathological features are described.
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21
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Albsoul N, Rawashdeh B, Albsoul A, Abdullah M, Golestani S, Rawshdeh A, Mohammad M, Alzoubi M. A rare case of extracranial meningioma in parapharyngeal space presented as a neck mass. Int J Surg Case Rep 2015; 11:40-43. [PMID: 25912007 PMCID: PMC4446679 DOI: 10.1016/j.ijscr.2015.04.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 03/19/2015] [Accepted: 04/03/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Meningiomas are the most common intracranial tumor, but rarely, they can develop extracranially, usually in the neck. There are very few cases of parapharyngeal meningioma reported in literature and little is known about their biological behavior and operative management. We present a patient with a primary parapharyngeal meningioma that presented as an anterior neck mass. CASE PRESENTATION The patient is a 55-year-old female who presented with neck mass. A CT scan and MRI revealed a large, well defined, mildly enhancing soft tissue mass located in the right carotid sheath extended from the level of the thyroid gland into the skull base jugular foramen superiorly. Cervical exploration with partial excision of the mass was performed. Histological examination revealed meningiothelial cells with intranuclear inclusions, arranged in a syncytial pattern. Mutiple psamoma bodies these findings are consistent with the diagnosis of meningioma. CONCLUSION Extracranial meningiomas are quite rare. The diagnosis of these types of tumors is challenging due to the non specific nature of the symptoms. The anatomic complexity of the region of parapharyngeal space also makes their detection difficult. Imaging modalities can aid in the diagnosis, but pathological examinations are essential in confirming a definite diagnosis.
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Affiliation(s)
- Nader Albsoul
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Badi Rawashdeh
- University of Arizona Medical Center, Department of General Surgery, United States.
| | - Ahmad Albsoul
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Mohammad Abdullah
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Simin Golestani
- University of Arizona Medical Center, Department of General Surgery, United States
| | - Aasem Rawshdeh
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Mona Mohammad
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
| | - Mohammad Alzoubi
- Jordan University Hospital, Department of General Surgery, Amman, Jordan
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22
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Szewczyk-Bieda MJ, White RD, Budak MJ, Ananthakrishnan G, Brunton JN, Sudarshan TA. A whiff of trouble: tumours of the nasal cavity and their mimics. Clin Radiol 2014; 69:519-28. [PMID: 24525221 DOI: 10.1016/j.crad.2013.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/06/2013] [Accepted: 12/10/2013] [Indexed: 12/28/2022]
Abstract
A range of disease entities can affect the nasal cavity, often presenting with variable and non-specific symptoms. There is considerable overlap between the clinical and radiological features of neoplastic and non-neoplastic entities. The nasal cavity is often included in routine imaging of the brain, middle ear, skull base, and paranasal sinuses and should be included as a critical review area. The definitive diagnosis is in most cases confirmed by histopathological analysis. However, this review highlights the role of imaging in identifying nasal cavity disease, eliciting features of aggressive or indolent behaviour, and helping to narrow the differential diagnosis, thus facilitating a systematic approach when reviewing the nasal cavity.
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Affiliation(s)
- M J Szewczyk-Bieda
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK.
| | - R D White
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK; Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - M J Budak
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
| | - G Ananthakrishnan
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK; Department of Clinical Radiology, Manchester Royal Infirmary Hospital, Manchester, UK
| | - J N Brunton
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
| | - T A Sudarshan
- Clinical Radiology Department, Ninewells Hospital and Medical School, Dundee, UK
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23
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Primary extracranial meningioma presenting as a cheek mass. Clin Exp Otorhinolaryngol 2013; 6:266-8. [PMID: 24353870 PMCID: PMC3863679 DOI: 10.3342/ceo.2013.6.4.266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/14/2011] [Indexed: 11/08/2022] Open
Abstract
Meningioma is well known as common disease of the central nervous system, whereas primary extracranial meningioma is rare, representing 1% to 2% of all meningiomas. We have experienced a case of primary extracranial meningioma presenting as a right cheek mass. The tumor was completely excised via a right lateral rhinotomy incision. Histopathologic examination confirmed the diagnosis of primary extracranial meningioma.
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24
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Panjvani SI, Gandhi MB, Sarvaiya AN, Chaudhari BR, Gupta GS. An extracranial invasive meningioma mimicking malignant bone tumor - "carpet meningioma". J Clin Diagn Res 2013; 7:1159-62. [PMID: 23905128 DOI: 10.7860/jcdr/2013/5394.3100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/27/2013] [Indexed: 11/24/2022]
Abstract
Meningioma is a common benign intracranial neoplasm. The incidence of an extracranial extension to other sites is rare. Due to the neglected intracranial component, the chances of an under diagnosis or a misdiagnosis of the extracranial component is there, which may adversely affect the management and therefore, the prognosis. Here, we are reporting a case of a 39 years old male patient with a preoperative probable diagnosis of a malignant bone tumour which involved the skull bone, which was made, based on the imaging studies , which was histopathologically found to be an invasive meningioma with an extensive extracranial skull vault involvement and was confirmed by immunohistochemistry. We have proposed a term, "carpet meningioma" for this extracranial invasive meningioma, because it had covered the skull vault like a carpet. The follow up studies after 1 year have revealed no evidence of a recurrence.
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Affiliation(s)
- Sahil I Panjvani
- 3 Year Resident, Department of Pathology, Smt. NHL Municipal Medical College , Ahmedabad, Gujarat, India
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25
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Kumar S, Hasija S, Goyal R, Kataria SP, Sen R, Wadhera R. Ectopic parapharyngeal meningioma: diagnosis of a rare entity on FNAC. J Surg Case Rep 2012; 2012:rjs024. [PMID: 24968421 PMCID: PMC3855163 DOI: 10.1093/jscr/rjs024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Meningioma is a tumour most commonly located intracranially that may rarely extend extracranially. Ectopic meningioma presenting as parapharyngeal mass is a rare entity. We report a case of an 18-year-old female who presented with a complaint of swelling below the right angle of mandible associated with difficulty in swallowing for the last 3 months. The swelling measured 1.5 × 1 cm and was firm, fixed, non-pulsatile, non-transilluminant and non-tender. Computer tomography revealed a heterogenous enhancing mass with foci of calcification in parapharyngeal space without any intracranial component. Intraoral fine needle aspiration cytology was performed. A cytological diagnosis of spindle cell lesion of neural origin with the closest possibility of meningioma was rendered. Excision biopsy confirmed the diagnosis of ectopic parapharyngeal meningioma. It is important for clinicians and pathologists to be aware of this entity at the unusual site.
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Affiliation(s)
- Sanjay Kumar
- Department of Pathology, PGIMS, Rohtak, Haryana, India
| | - Sonia Hasija
- Department of Pathology, PGIMS, Rohtak, Haryana, India
| | - Rama Goyal
- Department of Pathology, PGIMS, Rohtak, Haryana, India
| | | | - Rajeev Sen
- Department of Pathology, PGIMS, Rohtak, Haryana, India
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26
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Aiyer RG, Prashanth V, Ambani K, Bhat VS, Soni GB. Primary extracranial meningioma of paranasal sinuses. Indian J Otolaryngol Head Neck Surg 2012; 65:384-7. [PMID: 24427682 DOI: 10.1007/s12070-012-0565-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 11/29/2022] Open
Abstract
Meningioma is the most common nonglial intracranial neoplasm, arising from meningocytes (arachnoid cap cells) of arachnoid granulation tissue and constitutes 15-20 % of all intracranial tumors. Approximately 6-17 % of all meningiomas can be found in extracranial or extra spinal sites. The head and neck is the most frequent location of extraneuraxial meningiomas, commonly seen as an extension of primary intracranial tumor (secondary extracranial meningioma). Less than 2 % of all meningiomas arise at a primary ectopic site (primary extracranial meningioma). Meningioma of nose and paranasal sinuses is a very rare tumor. The overall incidence is about 0.1 % of all tumors in the nose and sinuses. To date, very few cases of this primary extracranial meningioma of paranasal sinuses have been reported. In this report we are going to present three rare cases of primary extracranial meningioma of paranasal sinuses operated in our department over a period of 22 years (1986-2008).
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Affiliation(s)
- Ranjan G Aiyer
- Department of E.N.T & Head-Neck Surgery, S.S.G. Hospital & Medical College, 390007 Baroda, Gujarat India ; 3/2 Jesal Apartment, Abhishek Colony, Race Cource, Vadodara, 390007 Baroda, Gujarat India
| | - V Prashanth
- Department of E.N.T & Head-Neck Surgery, S.S.G. Hospital & Medical College, 390007 Baroda, Gujarat India
| | - Kirti Ambani
- Department of E.N.T & Head-Neck Surgery, S.S.G. Hospital & Medical College, 390007 Baroda, Gujarat India
| | - Vadish S Bhat
- Department of E.N.T & Head-Neck Surgery, S.S.G. Hospital & Medical College, 390007 Baroda, Gujarat India
| | - Geeta B Soni
- Department of E.N.T & Head-Neck Surgery, S.S.G. Hospital & Medical College, 390007 Baroda, Gujarat India
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27
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Dhingra S, Mohindra S, Gupta S, Gupta N, Shankar A. Intracranial meningioma presenting as a parapharyngeal tumour—A unique extracranial presentation. INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY EXTRA 2011; 6:325-328. [DOI: 10.1016/j.pedex.2011.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
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28
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Iaconetta G, Santella A, Friscia M, Abbate V, Califano L. Extracranial primary and secondary meningiomas. Int J Oral Maxillofac Surg 2011; 41:211-7. [PMID: 22078714 DOI: 10.1016/j.ijom.2011.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 07/07/2011] [Accepted: 08/31/2011] [Indexed: 11/30/2022]
Abstract
Meningioma is a well-recognized tumour of the central nervous system. However, extracranial non-dural or ectopic meningiomas are rare and in most of the reported cases, meningiomas are diagnosed only after histopathologic examination. Over the last 5 years, the authors have seen three cases. In these case reports, they discuss the salient features of these lesions, which can aid the preoperative diagnosis and management of these patients. One of the cases is a rarity, owing to the extreme extracranial position which allowed the pressure of the tumour abrade the adjacent structures. In one case, reconstruction of the skull bone using polymeric materials (Acrylic matter) was necessary. In the other two cases, titanium plates and screws were used to reconstruct the jaw.
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Affiliation(s)
- Giorgio Iaconetta
- Department of Neurosurgery, School of Medicine, University of Naples Federico II, Naples, Italy
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29
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Taori K, Kundaragi NG, Disawal A, Jathar C, Gaur PP, Rathod J, Patil V. Imaging features of extra cranial parapharyngeal space meningioma: case report. IRANIAN JOURNAL OF RADIOLOGY : A QUARTERLY JOURNAL PUBLISHED BY THE IRANIAN RADIOLOGICAL SOCIETY 2011; 8:176-81. [PMID: 23329938 PMCID: PMC3522327 DOI: 10.5812/kmp.iranjradiol.17351065.3132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 07/13/2011] [Accepted: 08/21/2011] [Indexed: 11/16/2022]
Abstract
Parapharyngeal tumors are less common in clinical practice and are often difficult to diagnose upon clinical examination due to the anatomic complexity of the region. We report a rare case of extracranial parapharyngeal space meningioma presenting as a cervical mass with encasement of cranial nerves giving tram track appearance and features on various imaging modalities [Radiographs, Ultrasound, Computed tomography (CT) scan and Magnetic resonance imaging (MRI)].
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Affiliation(s)
- Kishor Taori
- Department of Radiodiagnosis, Government Medical College, Nagpur Maharashtra, India
- Corresponding author: Kishor Taori, Department of Radiodiagnosis, Government Medical College, P O. Box: 440003, Nagpur Maharashtra, India. Tel.: +91-7122704995, Fax: +91-7122704995, E-mail:
| | - Nischal G. Kundaragi
- Department of Radiodiagnosis, Government Medical College, Nagpur Maharashtra, India
- Hospital Chennai, SRM University Medical College, Tamilnadu, India
| | - Amit Disawal
- Department of Radiodiagnosis, Government Medical College, Nagpur Maharashtra, India
| | - Chetan Jathar
- Department of Radiodiagnosis, Government Medical College, Nagpur Maharashtra, India
| | - Prajwalit P. Gaur
- Department of Radiodiagnosis, Government Medical College, Nagpur Maharashtra, India
| | - Jawahar Rathod
- Department of Radiodiagnosis, Government Medical College, Nagpur Maharashtra, India
| | - Virendra Patil
- Department of Radiodiagnosis, Government Medical College, Nagpur Maharashtra, India
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30
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Jalisi S. Atypical meningioma presenting as a nasal mass-multidisciplinary management. J Craniomaxillofac Surg 2011; 40:e115-8. [PMID: 21840726 DOI: 10.1016/j.jcms.2011.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/22/2011] [Accepted: 06/26/2011] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To report a case of recurrent extracranial atypical meningioma successfully managed by a multidisciplinary team. METHODS Case report and literature review concerning successful management of recurrent extracranial meningioma based on pathology and extent of resection. RESULTS A 48-year-old woman who presented with a nasal mass, anosmia and headaches. Physical exam and imaging showed recurrent meningioma involving the entire anterior frontal meninges extending into the frontal bone and down into the nasal cavity via the anterior ethmoid. Combined modality surgical intervention was successful and the patient recovered suffering no neurological sequelae. CONCLUSION This is a very rare presentation of meningioma that the craniomaxillofacial surgeon should consider when formulating a differential diagnosis for a nasal mass. Long-term surveillance is crucial as recurrence can have devastating consequences. Aggressive multidisciplinary care is needed to prevent future recurrences and to improve survival.
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Affiliation(s)
- Scharukh Jalisi
- Department of Otolaryngology-Head and Neck Surgery, Boston University Medical Campus, Boston, MA 02118, USA.
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Deshmukh SD, Rokade VV, Pathak GS, Nemade SV, Ashturkar AV. Primary extra-cranial meningioma in the right submandibular region of an 18-year-old woman: a case report. J Med Case Rep 2011; 5:271. [PMID: 21722387 PMCID: PMC3224503 DOI: 10.1186/1752-1947-5-271] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 07/02/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction Extra-cranial meningioma or ectopic meningioma is a rare tumor. This tumor has been reported in various anatomic sites in the head and neck, mediastinum, skin and soft tissues. We report a rare case of ectopic meningioma in the submandibular region detected by using fine-needle aspiration cytology, histopathology and immunohistochemistry. This case represents another unusual site for extra-cranial meningioma, which prompted us to report it. Case presentation An 18-year-old Dravidian woman presented with swelling in the right submandibular region. The computed tomographic scan findings were suggestive of a neoplastic mass lesion in the right submandibular region. Fine-needle aspiration cytology led to the differential diagnosis of a monomorphic adenoma of a salivary gland or an ectopic meningioma. The patient underwent excision of the submandibular gland and tumor. The histological examination and immunohistochemistry studies confirmed that the lesion was an extra-cranial meningioma. At her two-year follow-up examination, there was no recurrence of the tumor. Conclusion Our experience with this case indicates that, although rare, meningioma should be entertained in the differential diagnosis of a mass lesion in the head and neck region.
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Affiliation(s)
- Sanjay D Deshmukh
- Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital, Narhe, Pune-411041, India.
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Primary meningioma of the nasal septum: a case report and review of literature. Appl Immunohistochem Mol Morphol 2010; 18:296-8. [PMID: 20090514 DOI: 10.1097/pai.0b013e3181cc7db9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Extracranial meningiomas are rare tumors that usually represent extensions from intracranial lesions. Here, we report a case of primary meningioma of the nasal septum. A 60-year-old man presented with nasal obstruction and postnasal drip. On examination he had a mass in the nasal cavity. Computed tomography studies revealed absence of intracranial extensions. The mass was successfully excised and the histologic diagnosis of meningioma was established. This report documents what we believe to be the first case (in English medical literature) of an extracranial meningioma, involving the nasal septum. The clinicopathologic features and pathogenesis of the primary nasal meningioma is briefly discussed.
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Liu Y, Wang C, Zhu S, Li F, Wang H, Liu M, Zhang L, Wu C. Clinical characteristics and treatment of ectopic meningiomas. J Neurooncol 2010; 102:81-7. [PMID: 20607355 DOI: 10.1007/s11060-010-0288-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
Abstract
We have examined the clinical characteristics and treatment of ectopic meningiomas (EMs). Samples from 17 patients with EMs were analyzed, and their clinical characteristics, mechanism, and treatment were studied in combination with the literature. The main clinical manifestations of EMs included increased intracranial pressure, epilepsy, local mass, and local occupying effects, but diagnosis of EMs depended on the pathology. Surgical removal can achieve the double objectives of confirmed diagnosis and treatment of tumors. The clinical characteristics of EMs vary with the sites of tumors. Operation is the treatment of first choice. Prognosis is better than that of typical meningiomas.
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Affiliation(s)
- Yuguang Liu
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan 250012, People's Republic of China.
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34
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Arias Marzán F, de Lucas Carmona G, Álvarez Flórez M, Febles García P. Meningioma primario extracraneal de senos paranasales. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:238-40. [DOI: 10.1016/j.otorri.2009.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 05/10/2009] [Accepted: 05/22/2009] [Indexed: 01/05/2023]
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Extracranial meningioma of the paranasal sinuses. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010. [DOI: 10.1016/s2173-5735(10)70042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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36
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Primary meningioma of the middle ear: case report. The Journal of Laryngology & Otology 2009; 124:572-4. [DOI: 10.1017/s0022215109991745] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To report a rare case of primary meningioma of the middle ear.Method:We describe the case of a 55-year-old woman who presented with decreased hearing and fullness in the left ear, with a middle-ear mass. We also review the world literature regarding primary extracranial meningioma of the middle ear and its management.Results:Primary middle-ear meningioma, a rare clinical entity, was diagnosed in this patient based on an initial transmastoid biopsy. Magnetic resonance imaging with gadolinium enhancement excluded the presence of an intracranial component. Complete excision of the tumour was achieved using a combined approach tympanoplasty. The patient had an uneventful post-operative course.Conclusion:Meningiomas, although rare in the middle ear, need to be included in the differential diagnosis of middle-ear lesions presenting to the otolaryngologist. This case emphasises the management strategy required when dealing with a middle-ear mass.
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Rushing EJ, Bouffard JP, McCall S, Olsen C, Mena H, Sandberg GD, Thompson LDR. Primary extracranial meningiomas: an analysis of 146 cases. Head Neck Pathol 2009; 3:116-30. [PMID: 19644540 PMCID: PMC2715454 DOI: 10.1007/s12105-009-0118-1] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 04/11/2009] [Indexed: 12/17/2022]
Abstract
Primary extracranial meningiomas are rare neoplasms, frequently misdiagnosed, resulting in inappropriate clinical management. To date, a large clinicopathologic study has not been reported. One hundred and forty-six cases diagnosed between 1970 and 1999 were retrieved from the files of the Armed Forces Institute of Pathology. Histologic features were reviewed, immunohistochemistry analysis was performed (n = 85), and patient follow-up was obtained (n = 110). The patients included 74 (50.7%) females and 72 (49.3%) males. Tumors of the skin were much more common in males than females (1.7:1). There was an overall mean age at presentation of 42.4 years, with a range of 0.3-88 years. The overall mean age at presentation was significantly younger for skin primaries (36.2 years) than for ear (50.1 years) and nasal cavity (47.1 years) primaries. Symptoms were in general non-specific and reflected the anatomic site of involvement, affecting the following areas in order of frequency: scalp skin (40.4%), ear and temporal bone (26%), and sinonasal tract (24%). The tumors ranged in size from 0.5 up to 8 cm, with a mean size of 2.3 cm. Histologically, the majority of tumors were meningothelial (77.4%), followed by atypical (7.5%), psammomatous (4.1%) and anaplastic (2.7%). Psammoma bodies were present in 45 tumors (30.8%), and bone invasion in 31 (21.2%) of tumors. The vast majority were WHO Grade I tumors (87.7%), followed by Grade II (9.6%) and Grade III (2.7%) tumors. Immunohistochemically, the tumor cells labeled for EMA (76%; 61/80), S-100 protein (19%; 15/78), CK 7 (22%; 12/55), and while there was ki-67 labeling in 27% (21/78), <3% of cells were positive. The differential diagnosis included a number of mesenchymal and epithelial tumors (paraganglioma, schwannoma, carcinoma, melanoma, neuroendocrine adenoma of the middle ear), depending on the anatomic site of involvement. Treatment and follow-up was available in 110 patients: Biopsy, local excision, or wide excision was employed. Follow-up time ranged from 1 month to 32 years, with an average of 14.5 years. Recurrences were noted in 26 (23.6%) patients, who were further managed by additional surgery. At last follow-up, recurrent disease was persistent in 15 patients (mean, 7.7 years): 13 patients were dead (died with disease) and two were alive; the remaining patients were disease free (alive 60, mean 19.0 years, dead 35, mean 9.6 years). There is no statistically significant difference in 5-year survival rates by site: ear and temporal bone: 83.3%; nasal cavity: 81.8%; scalp skin: 78.5%; other sites: 65.5% (P = 0.155). Meningiomas can present in a wide variety of sites, especially within the head and neck region. They behave as slow-growing neoplasms with a good prognosis, with longest survival associated with younger age, and complete resection. Awareness of this diagnosis in an unexpected location will help to avoid potential difficulties associated with the diagnosis and management of these tumors.
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Affiliation(s)
- Elisabeth J. Rushing
- Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000 USA
| | - John-Paul Bouffard
- Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000 USA
| | - Sherman McCall
- Department of Molecular Pathology, Armed Forces Institute of Pathology, Washington, DC USA
| | - Cara Olsen
- Department of Preventive Medicine and Biometrics, Uniformed University of the Health Sciences, Bethesda, MD USA
| | - Hernando Mena
- Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000 USA
| | - Glenn D. Sandberg
- Department of Neuropathology and Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000 USA
| | - Lester D. R. Thompson
- Department of Pathology, Southern California Permanente Medical Group, Los Angeles, CA USA
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38
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Takahama A, León JE, de Almeida OP, Kowalski LP. Nonlymphoid mesenchymal tumors of the parotid gland. Oral Oncol 2008; 44:970-4. [PMID: 18282791 DOI: 10.1016/j.oraloncology.2007.12.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Revised: 12/05/2007] [Accepted: 12/06/2007] [Indexed: 11/20/2022]
Abstract
Salivary gland tumors are uncommon and most of them are of epithelial origin. Mesenchymal tumors affecting the parotid are extremely rare, and we present a series of 19 cases. All parotid tumors (600 cases) treated at the Department of Head and Neck Surgery from A.C. Camargo Hospital, Brazil from 1953 to 2003 were reviewed and 19 cases of nonlymphoid mesenchymal origin were selected. The histological characteristics were reviewed and clinical features were obtained from the medical charts. 15 out of 19 were benign tumors, including 5 lymphangiomas, 5 neurofibromas, and one case each of schwannoma, lipoma, solitary fibrous tumor, meningioma and giant cell tumor. Four malignant tumors were classified as rhabdomyosarcoma, fibrosarcoma, Langerhans cell histiocytosis and endodermal sinus tumor. From the malignant cases, only the patient with fibrosarcoma died due the tumor, the other three are alive with no signs of recurrence. In our series of 600 cases of parotid gland tumors, nonlymphoid mesenchymal tumors corresponded to 3.16% (19 cases; 15 benign and 4 malignant). All cases were treated by surgery with no recurrences, except one case of fibrosarcoma whose patient died of distant metastasis.
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Affiliation(s)
- Ademar Takahama
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Avenida Limeira 901, CP 52 Areião-Piracicaba-SP, CEP-13414-903, Brazil.
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39
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McGuire TP, Palme CE, Perez-Ordonez B, Gilbert RW, Sándor GKB. Primary intraosseous meningioma of the calvaria: analysis of the literature and case report. ACTA ACUST UNITED AC 2007; 104:e34-41. [PMID: 17656124 DOI: 10.1016/j.tripleo.2007.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 03/12/2007] [Accepted: 03/18/2007] [Indexed: 01/19/2023]
Abstract
Meningiomas are the most common of the benign intracranial neoplasms. They are uncommon as primary or secondary extracranial entities. Of these, the primary intraosseous variant may represent the rarest form. We report the case of a rare primary intraosseous meningioma presenting as a localized, symptom-free supraorbital bony expansion in an 81-year-old female patient and tabulate the previously reported cases of primary intraosseous meningiomas of the craniomaxillofacial region for analysis.
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Affiliation(s)
- Taylor P McGuire
- Facial Cosmetic and Reconstructive Surgery, Department of Surgery, Baptist Memorial Golden Triangle Hospital and Center for Oral and Facial Surgery, Columbus, MS, USA
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40
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Kainuma K, Takumi Y, Uehara T, Usami SI. Meningioma of the paranasal sinus: a case report. Auris Nasus Larynx 2007; 34:397-400. [PMID: 17289320 DOI: 10.1016/j.anl.2006.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Revised: 09/14/2006] [Accepted: 10/01/2006] [Indexed: 12/29/2022]
Abstract
Extracranial meningioma of the paranasal sinus is a very rare condition of unclear etiology. Surgical excision is currently the only curative treatment but sometimes entails difficulties because of the complicated anatomic loci of the tumor. For the case reported here, we used a navigation system in endoscopic surgery for an extracranial meningioma of the paranasal sinus and were able to remove the tumor without complications by a transnasal approach alone. This is the first report of the use of such a system with endoscopic surgery for this condition. We discuss the clinical presentation, diagnosis, and treatment of this case as well as present a review of the literature.
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Affiliation(s)
- Kazuyuki Kainuma
- Department of Otolaryngology, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan.
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41
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Shetty C, Avinash KR, Auluck A, Mupparapu M. Extracranial meningioma of the parapharyngeal space: report of a case and review of the literature. Dentomaxillofac Radiol 2007; 36:117-20. [PMID: 17403892 DOI: 10.1259/dmfr/56368887] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Parapharyngeal tumours are frequently encountered in clinical practice and are often difficult to diagnose upon clinical examination due to the anatomic complexity of the region. We report a rare case of extracranial meningioma of the parapharyngeal space in a patient with no history of von Recklinghausen's disease, family history of meningioma or central neurofibromatosis (NF-2). The purpose of this report is to reiterate and emphasize the role of CT and MRI in the diagnosis of parapharyngeal masses, and to describe the characteristic radiological features of extracranial meningiomas.
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Affiliation(s)
- C Shetty
- Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, India
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42
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Jovanovic MB, Berisavac I, Perovic JV, Grubor A, Milenkovic S. Huge extracranial asymptomatic frontal invasive meningioma: a case report. Eur Arch Otorhinolaryngol 2005; 263:223-7. [PMID: 16021461 DOI: 10.1007/s00405-005-0977-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2004] [Accepted: 03/27/2005] [Indexed: 12/27/2022]
Abstract
Meningioma is a well-recognized tumor of the central nervous system, but it rarely appears as an extracranial tumor secondarily extended into the paranasal sinuses. Meningiomas arise from arachnoid cap cells that form the external membrane of the brain. Most meningiomas are slow growing and are usually not associated with substantial underlying brain edema; they cause symptoms by the compression of adjacent neural structures. An interesting natural history of a neglected meningioma with extracranial extension is described. The diagnosis of meningioma was established by CT imaging, finally based on the histopathology and immunochemistry. The meningioma cells in our male patient were positive for progesterone receptors. The patient underwent surgical treatment and recovered without complications. On follow-up 1 year later there were no signs of process expansion.
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Affiliation(s)
- Milan B Jovanovic
- Department of Otorhinolaryngology and Maxillofacial and Cervical Pathology, Clinical Hospital Centre Zemun, Belgrade, Serbia and Montenegro.
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43
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Petrulionis M, Valeviciene N, Paulauskiene I, Bruzaite J. Primary extracranial meningioma of the sinonasal tract. Acta Radiol 2005; 46:415-8. [PMID: 16134320 DOI: 10.1080/02841850510021210] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Meningiomas occurring outside the cerebrospinal axis can be primary at an extracranial site (nasal cavity, paranasal sinuses, and nasopharynx) or secondary extending from an intracranial lesion. Magnetic resonance imaging findings of an 8-year-old child with primary meningioma before and after surgery have been reviewed and compared to computed tomography and histological evaluation. The child had difficulty breathing through the left nostril and tearing of the left eye. After physical and radiological examination, a tumor comprising the left lower, middle turbinate, and ethmoidal cells was found and radically extirpated. On histological examination, the tumor was identified as meningothelial meningioma. On the basis of the clinical, radiological, and histological features, the tumor was diagnosed as extracranial meningioma of the sinonasal tract. A follow-up examination 6 months later revealed no evidence of recurrence of the tumor.
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Affiliation(s)
- M Petrulionis
- Clinic of Ear, Nose and Throat Disease and Clinic of Pulmonology and Radiology, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
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44
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Shaw R, Kissun D, Boyle M, Triantafyllou A. Primary meningioma of the scalp as a late complication of skull fracture: case report and literature review. Int J Oral Maxillofac Surg 2004; 33:509-11. [PMID: 15183418 DOI: 10.1016/j.ijom.2003.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2003] [Indexed: 11/28/2022]
Abstract
A case of primary meningioma of the scalp is presented in which the anatomical association with a previous skull fracture is demonstrated and pathogenesis discussed. The investigations and surgical treatment are briefly described. Review of the literature reveals a strong association between trauma of the central nervous system and intracranial meningioma. Occasional reports also exist of extra-cranial meningioma following trauma. This is, however, the first report of such an association in the scalp.
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Affiliation(s)
- R Shaw
- Maxillofacial Unit, University Hospital Aintree, Longmoor Lane, Fazakerly, Liverpool L9 7AL, UK.
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45
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Thompson LDR, Bouffard JP, Sandberg GD, Mena H. Primary ear and temporal bone meningiomas: a clinicopathologic study of 36 cases with a review of the literature. Mod Pathol 2003; 16:236-45. [PMID: 12640104 DOI: 10.1097/01.mp.0000056631.15739.1b] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
"Primary" ear and temporal bone meningiomas are tumors that are frequently misdiagnosed and unrecognized, resulting in inappropriate clinical management. To date, a large clinicopathologic study of meningiomas in this anatomic site has not been reported. Thirty-six cases of ear and temporal bone meningiomas diagnosed between 1970 and 1996 were retrieved from our files. Histologic features were reviewed, immunohistochemical analysis was performed (n = 19), and patient follow-up was obtained (n = 35). The patients included 24 females and 12 males, aged 10-80 years (mean, 49.6 years), with female patients presenting at an older age (mean, 52.0 years) than male patients (mean, 44.8 years). Patients presented clinically with hearing changes (n = 20), otitis (n = 7), pain (n = 5), and/or dizziness/vertigo (n = 3). Symptoms were present for an average of 24.6 months. The tumors affected the middle ear (n = 25), external auditory canal (n = 4), or a combination of temporal bone and middle ear (n = 7). The tumors ranged in size from 0.5 to 4.5 cm in greatest dimension (mean, 1.2 cm). Radiographic studies demonstrated a central nervous system connection in 2 patients. Histologically, the tumors demonstrated features similar to those of intracranial meningiomas, including meningothelial (n = 33), psammomatous (n = 2), and atypical (n = 1). An associated cholesteatoma was identified in 9 cases. Immunohistochemical studies confirmed the diagnosis of meningioma with positive reactions for epithelial membrane antigen (79%) and vimentin (100%). The differential diagnosis includes paraganglioma, schwannoma, carcinoma, melanoma, and middle ear adenoma. Surgical excision was used in all patients. Ten patients developed a recurrence from 5 months to 2 years later. Five patients died with recurrent disease (mean, 3.5 years), and the remaining 30 patients were alive (n = 25, mean: 19.0 years) or had died (n = 5, mean: 9.5 years) of unrelated causes without evidence of disease. We conclude that extracranial ear and temporal bone meningiomas are rare tumors histologically similar to their intracranial counterparts. They behave as slow-growing neoplasms with a good overall prognosis (raw 5-y survival, 83%). Extent of surgical excision is probably the most important factor in determining outlook because recurrences develop in 28% of cases.
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Affiliation(s)
- Lester D R Thompson
- Department of Endocrine and Otorhinolaryngic-Head & Neck Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA
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46
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Sen S, Saha S. A rare case of primary extracranial meningioma of the Paranasal Sinuses. Indian J Otolaryngol Head Neck Surg 2001; 53:318-20. [PMID: 23119836 DOI: 10.1007/bf02991561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A rare case of Extracranial Meningioma with Paranasal Sinus involvement has been reported with review of available literature.
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Affiliation(s)
- S Sen
- BD - 325, Salt Lake City Kolkata - 700 064, India
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47
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Swain RE, Kingdom TT, DelGaudio JM, Muller S, Grist WJ. Meningiomas of the paranasal sinuses. AMERICAN JOURNAL OF RHINOLOGY 2001; 15:27-30. [PMID: 11258651 DOI: 10.2500/105065801781329419] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Extracranial meningiomas are rare tumors, comprising approximately 2% of all meningiomas. Previously reported sites include the orbit, parapharyngeal space, and rarely, the paranasal sinuses. A retrospective chart review of patients with meningiomas was performed over the last 25 years, and three patients were identified with meningiomas involving the paranasal sinuses. The locations included the frontal sinus, the ethmoid sinus, and the sphenoid sinus. Presenting symptoms included facial pain and nasal obstruction; two patients noted facial swelling. Diagnosis was established via endoscopic transnasal biopsy in two patients. Computed tomographic (CT) guided biopsy was utilized to confirm the diagnosis in the third patient. Surgical extirpation was successfully performed with tumors arising from the ethmoid and frontal sinuses. The patient with neoplasm in the sphenoid sinus underwent radiation therapy. Extracranial meningiomas of the paranasal sinuses are rare tumors that may present a diagnostic and therapeutic challenge. We present three cases and discuss the clinical presentation, radiographic findings, diagnostic evaluation, and treatment options.
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Affiliation(s)
- R E Swain
- Department of Otolaryngology-Head & Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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48
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Affiliation(s)
- S P Reddi
- Division of Oral & Maxillofacial Surgery, University of Miami School of Medicine, FL, USA.
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49
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Qasho R, Lunardi P, Lo Bianco FM, di Stefano M. Rare combination of spinal lesions and subcutaneous meningioma in a 44 year old man. J Neurooncol 1998; 38:77-82. [PMID: 9540060 DOI: 10.1023/a:1005981110128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 44 year-old man with subcutaneous meningioma and rare combination of spinal lesions, consisting of dermal sinus and lipoma of the filum terminale. The literature concerning the subcutaneous meningioma is reviewed and the embryogenesis of these lesions is discussed.
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Affiliation(s)
- R Qasho
- Department of Neurological Sciences, La Sapienza University of Rome, Italy
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50
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Tsunoda R, Fukaya T. Extracranial meningioma presenting as a tumour of the external auditory meatus: a case report. J Laryngol Otol 1997; 111:148-51. [PMID: 9102441 DOI: 10.1017/s0022215100136692] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A rare case of extracranial meningioma presenting as a tumour of the external auditory meatus is reported. Biopsy indicated a diagnosis of meningioma, but the radiological appearance was unusual. For example, computed tomography (CT) scans showed an unenhanced tumour mainly located in the squamous part of the temporal bone which expanded into the external meatus destroying the temporal bone. Magnetic resonance imaging (MRI) revealed that the tumour did not extend into the intradural space. This meningioma, had an obvious tendency for extracranial development. According to the operative findings, the tumour arose from the middle cranial fossa dura and extended through the air cells of the temporal bone into the external meatus, instead of growing intracranially. Secondary extracranial meningiomas of the temporal bone usually have a large intracranial component and cause neurological symptoms. However, this was a very rare case of a small meningioma causing no symptoms except for conductive hearing loss.
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Affiliation(s)
- R Tsunoda
- Department of Otolaryngology, Kanto Teishin Hospital, Tokyo, Japan
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