Extracranial meningioma presenting as a tumor of the neck

Hoye, Stephen J.; Hoar, Carl Sherman; Murray, Joseph E.

doi:10.1016/0002-9610(60)90394-9

Cited by 168 publications

(63 citation statements)

References 13 publications

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“…Increasing evidence supports the development of meningiomas from arachnoid cap cells, with different mechanisms to suggest how extracranial meningiomas arise. In the ear or mastoid bone specifically, an intracranial meningioma can extend by the path of least resistance and follow the tegmen tympani (through dehiscence), the sulci of the greater and lesser superficial petrosal nerves, the posterior fossa plate (geniculate ganglion area), the internal auditory canal (porus internus, lateral semicircular canal, or perilabyrinthine cell tracts), or the jugular foramen by direction extension, origination from arachnoid cell clusters in the sheaths of cranial nerves or vessels as they exit foramina or suture lines of the skull, or without any apparent demonstrable connection to the CNS (8,10,12,18,23,27,31,35,39,(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56). Arachnoid cells are identified outside the neuraxis, thereby giving rise to meningiomas in the ear and temporal bone.…”

Section: Discussionmentioning

confidence: 99%

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

et al. 2003

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"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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Section: Discussionmentioning

confidence: 99%

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

et al. 2003

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“…Each category is further divided into convexity (C) or skull base (B) forms. The case presented here falls into the third type of meningioma described by Hoye et al [11] and type III B of the Lang et al [2] classification.…”

Section: Discussionmentioning

confidence: 99%

“…Hoye et al [11] classified PEMs into 4 groups: (1) primary intracranial tumors with direct extracranial extension; (2) tumors originating form arachnoidal cell rests within the sheaths of cranial nerves; (3) tumors occurring extracranially without apparent connection with the foramina of cranial nerves, and (4) benign-appearing intracranial meningiomas with extracranial metastases.…”

Section: Discussionmentioning

confidence: 99%

Intradiploic Orbital Roof Meningioma with Pneumosinus Dilatans in a Child: A Case Report and Review of the Literature

Khalatbari¹,

Borghei-Razavi

Moharamzad³

2011

Pediatr Neurosurg

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Intradiploic meningioma of the orbital roof is a type of intraosseous meningioma. It is very rare in children, and only 7 cases have been reported in the pediatric age group. We report a case of a 14-year-old female who presented with progressive exophthalmos, diplopia and pain involving the right eye. Computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed an intradiploic orbital roof tumor with diploe expansion and pneumosinus dilatans. The tumor was completely removed surgically. The histopathological diagnosis was transitional meningioma. The clinical and radiological findings of intadiploic meningioma are discussed with a review of the relevant literature.

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“…[22,23] If a total resection is not achievable, decompression of nerves and vital structures should be performed. Extended tumour resection and skull remodelling are other crucial treatment aspects.…”

Section: Treatmentmentioning

confidence: 99%

Giant intraosseous meningioma mimicking fibrous dysplasia

Huscher¹,

Öhlschlegel²,

Fournier

2016

CRCP

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We illustrate a case of a giant primary intraosseous meningiomas (PIMs) with optic nerve compression treated by partial resection. A 48-year-old female presented with visual disturbances exophthalmus, diplopia and eye pain due to optic nerve compression. The patient had a past history of fibrous dysplasia treated surgically with partial resection by ENT in 2010. Histology confirmed the diagnosis. Two years later she presented with further decrease in visual acuity and diffuse hyperostosis. In this context she underwent a neurosurgical procedure consisting in craniotomy and further partial resection of the lesion including optic canal decompression. The second pathological examination demonstrated an extensive meningioma (WHO grade I) of the skull base.We recommend that in cases of diffuse hyperostosis the differential diagnosis include diffuse intraosseous meningioma. If complete surgical resection is not achievable, a biopsy to confirm the diagnosis is recommended. Treatment options include complete or partial resection followed by adjuvant radiotherapy.Key Words: Skull base, Meningioma, Hyperostosis, Fibrous dysplasia CASE REPORTA 48-year-old woman presented with a 3-year history of progressive right sided visual disturbance, exophthalmus, diplopia and eye pain. The patient underwent a cranial CT scan which showed a diffuse bilateral frontal and skull base hyperostosis, especially evident on the right side, and extending bilaterally from the sphenoid bones, down to the clinoid processes, orbits, temporal bones and the right frontal bone as seen in Figure 1. The right optic nerve was displaced with narrowing of the optic canal. These findings were consistent with fibrous dysplasia. Diffuse hyperostosis could also be consistent with an osteosarcoma, although this was less likely. The mass effect of the tumor involving both orbits caused compression of the eye muscles with subsequent exophthalmos, also more evident on the right side. The general practitioner referred the patient to an ophthalmologist who diagnosed exophthalmos with compressive optic nerve atrophy, decreased vision and secondary glaucoma. The ophthalmologist then referred the patient to an ENT doctor.The patient underwent surgical decompression of the right orbit via a transethmoidal, transsphenoidal and transpalpebral approach. During the operation, visualization of the orbital content was inadequate and bleeding from the bone prevented completion of the planned operation. The ENT suggested a second operation via a right subfrontal craniotomy to further decompress the orbit and the optic nerve. The first histopathological analysis seemed to confirm the suspicion of fibrous dysplasia and the patient was discharged. Ophthalmological and radiological follow-up was conducted via CT and MRI.

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Extracranial meningioma presenting as a tumor of the neck

Cited by 168 publications

References 13 publications

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

Intradiploic Orbital Roof Meningioma with Pneumosinus Dilatans in a Child: A Case Report and Review of the Literature

Giant intraosseous meningioma mimicking fibrous dysplasia

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