Diffuse pulmonary meningothelial like nodules simulating metastatic thymoma

Tamburini, Nicola; Morandi, Luca; Rinaldi, Rosa; Maniscalco, Pio; Quarantotto, Francesco; Montinari, Elena; Papi, Alberto; Anania, Gabriele; Cavallesco, Giorgio

doi:10.21037/jtd.2018.05.178

Cited by 1 publication

(1 citation statement)

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“…Minute meningothelial-like nodules (MMNs) are common incidental findings of unclear significance encountered during a histologic examination of lung tissue, primarily surgical lung biopsies, generally lacking any clinical significance [1][2][3][4]. Their frequency depends on the extent of sampling in lung resections performed for other diseases, namely, primary/metastatic malignancies, infections, and interstitial lung diseases (ILD), among others [5][6][7][8]. When MMNs are widely disseminated in both lungs, they may be recognizable at chest CT scan leading to a diagnosis of interstitial lung disease (ILD) with the micronodular pattern reported in the literature as diffuse pulmonary meningotheliomatosis (DPM) .…”

Section: Introductionmentioning

confidence: 99%

Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)?

et al. 2023

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Pulmonary minute meningothelial-like nodules (MMNs) are common incidental findings in surgical specimens, consisting of tiny proliferation (usually no larger than 5–6 mm) of bland-looking meningothelial cells showing a perivenular and interstitial distribution, sharing morphologic, ultrastructural, and immunohistochemical profiles with meningiomas. The identification of multiple bilateral MMNs leading to an interstitial lung disease characterized by diffuse and micronodular/miliariform patterns radiologically allows the diagnosis of diffuse pulmonary meningotheliomatosis (DPM). Nevertheless, the lung is the most common site of metastatic primary intracranial meningioma, and differential diagnosis with DPM may be impossible without clinic–radiologic integration. Herein, we report four cases (three females; mean age, 57.5 years) fitting the criteria of DPM, all incidentally discovered and histologically evidenced on transbronchial biopsy (2) and surgical resection (2). All cases showed immunohistochemical expression of epithelial membrane antigen (EMA), progesterone receptor, and CD56. Notably, three of these patients had a proven or radiologically suspected intracranial meningioma; in two cases, it was discovered before, and in one case, after the diagnosis of DPM. An extensive literature review (44 patients with DPM) revealed similar cases with imaging studies excluding intracranial meningioma in only 9% (4 of 44 cases studied). The diagnosis of DPM requires close correlation with the clinic–radiologic data since a subset of cases coexist with or follow a previously diagnosed intracranial meningioma and, thus, may represent incidental and indolent metastatic deposits of meningioma.

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