Extradural en-plaque spinal lipomatous meningioma: A case report and literature review

Abstract

Background: Extradural spinal meningiomas are rare, and few appear as lipomatous meningiomas in an “en-plaque” form. The transitional fibroblastic subtype, with lipid accumulation within the tumoral cells, is typically more aggressive and surgically challenging to resect. Case Description: A 42-year-old male presented with neck pain and progressive paresthesias in both upper extremities. Based on the radiological findings, the tentative preoperative diagnosis was lymphoma. However, the biopsy confirmed a meningioma. The patient underwent a combined extradural anterior and posterior approach, resulting in full tumor resection. Histopathologically, the final report documented a lipomatous meningioma. Conclusion: Extradural spinal lipomatous meningiomas (i.e., “en-plaque”) are rare and typically result in rapid clinical deterioration. The radiological diagnosis may be difficult, while ultrasonography helps to define their extradural location facilitating planning for gross total anterior/posterior excision where indicated.

Case Report: Upper Thoracic Purely Extradural Spinal Meningioma With Nerve Root Attachment: A Case Report and Literature Review

“…Some tumors are attached to the dura and appear as carpet-like growth, with poor tumor-dura interface, and must be incised and bluntly peeled off. Extensive paraspinal infiltration, complete envelopment of the sheath, close adhesion to the dural, and intratumoral calcification make the tumor not suitable to be completely removed ( 33 ). To avoid severe surgical complications, it is acceptable to use subtotal resection to reduce the mass effect and improve myelopathy symptoms ( 13 ).…”

Lipomatous Meningioma: Clinical-Pathological Findings, Imaging Characterisation and Correlations of a Rare Type of Meningioma

“…Almost all found lesions were located in the supratentorial region (frontal, temporal or parietal lobe), except for 3 cases (7,32), in which the spine was involved. Lattes et al…”

“…in vivo 35: 3031-3037 (2021) 3034 Macroscopically, the lesions were yellowish, soft, and difficult to differentiate from adipose tissue. The different histological findings of lipomatous meningiomas are described as meningothelial meningiomas with a lipomatous component in 38% of cases, transitional meningiomas with a lipomatous component in 12% (7,25,27,32,33), secretory meningioma with a lipomatous component in 8% (8)(9)(10)(11)34), microcystic meningioma with a lipomatous component in 3% (7,27), and in only one case the histological diagnosis was Chordoid Meningioma with a lipomatous component (7). The meningothelial cell with lipomatous metaplasia exhibited immunoreactivity to Epithelial Membrane Antigen (EMA) in 37 cases (5, 7-10, 15,16, 23-28, 33, 35, 36), and Vimentin in 15 cases (5, 9, 10, 15, 16, 23-26, 28, 35-37).…”

Freiburg Neuropathology Case Conference

“…Spinal meningiomas facing towards the epidural space are rare and account for 3.5–7% of all spinal meningiomas [ 6 ]. An exclusively “en plaque” configuration only occurs in 3.5% of all spinal extradural meningiomas [ 7 ]. It is characterized by infiltrative nature, sheet-like growth and occasionally extradural spread.…”