Meningioma with Remarkable Multiple Rosette Formation: A Diagnostically Difficult Case

Abstract

Background: Rosette formation is a rare morphological feature in meningiomas. It can be seen in angiomatous, meningothelial, transitional, secretory, papillary or rhabdoid subtype; however there are very few reports of meningiomas with rosettes, and the feature itself is not criterion for the WHO grade, so this feature sometimes makes the diagnosis difficult. Case presentation: A 62 y old Japanese woman stumbled and was admitted to a hospital. Magnetic resonance imaging showed a 50 mm extra-axial tumor on the right cerebral falx. Histologically, the tumor contained multiple rosettes that had a central nuclear-free zone without a vessel core. It also showed a sheet-like or whorled growth pattern and pseudopapillary structure. Some round tumor cells had abundantly dense eosinophilic cytoplasm, displaying rhabdoid features. High cellularity, small cells with a high nuclear-to-cytoplasmic ratio and prominent nucleoli were recognized, but the mitotic activity was less than 1/10 high-power fields. The tumor was immunohistochemically positive for EMA and synaptophysin (weakly) but negative for GFAP, progesterone, STAT6, S-100, NeuN and melan A. The Ki-67 labeling index was merely 0.5%. Although ependymoma was considered as the first differential diagnosis, it was ruled out, as perivascular pseudorosettes and ependymal rosettes were not seen. We ultimately made a diagnosis of atypical meningioma with a rosette-like and pseudopapillary pattern, WHO grade II. Discussion and conclusion: The meningiomas in this case showed remarkable rosette formation, but as this is not criterion for deciding WHO grade, grading was diagnostically difficult. Papillary meningioma was also considered as a critical differential diagnosis; however, our final diagnosis was made after considering the very low mitotic activity and Ki-67 labeling index, which were not consistent with WHO grade III. This case was very unique and diagnostically difficult. This report may be an aid for the diagnosis of pathologically unusual entity.

Meningioma with rosettes: A rare morphologic pattern

“…Sixteen cases of meningioma with rosettes have been described in the literature which are summarized in Table . Of these, 11 cases were reported in a multicentric study by Liverman et al .…”

“…In meningiomas, rosettes are something of a pathological curiosity, with only a handful of cases in the literature . However, their occurrence in meningiomas, albeit a rare one, is not surprising when one considers that meningothelial whorls are a result of disturbance in PCP in arachnoid cells .…”

“…Sixteen cases of meningioma with rosettes have been described in the literature which are summarized in Table 1. [8][9][10][11] Of these, 11 cases were reported in a multicentric study by Liverman et al 8 As with conventional meningioma, tumors with rosettes are noted in the elderly (age range: 18-86 years, mean: 59 years) with a male: female ratio of 7:9. They are most commonly located in the middle cranial fossa (n = 6, including those located in clivus and sphenoid wing).…”

“…In meningiomas, rosettes are something of a pathological curiosity, with only a handful of cases in the literature. [8][9][10][11] However, their occurrence in meningiomas, albeit a rare one, is not surprising when one considers that meningothelial whorls are a result of disturbance in PCP in arachnoid cells. 14 The in silico approach used in this report showed that there was a relative over-expression of some of the genes such as, TJP1 (ZO-1), JAM2, FZD2, PRKCI in meningiomas, when compared to normal meningothelial cells (Fig.…”

Development of Electronic-Nose Technologies for Early Disease Detection Based on Microbial Dysbiosis

“…This new information could potentially provide important complementary information for confirmations of disease diagnoses based on conventional disease biomarkers, symptomology and other diagnostic tests. Early disease diagnoses allow opportunities for more effective preemptive treatments that significantly improve prognoses, minimize patient recovery time, and reduce total healthcare costs [25].…”