Primary extra-cranial meningioma in the right submandibular region of an 18-year-old woman: a case report

Abstract

IntroductionExtra-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 presentationAn 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.ConclusionOur 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.

Cytopathology of Extracranial Ectopic and Metastatic Meningiomas

“…To date, the cytomorphology of extracranial meningiomas has been reported predominantly via case reports in the literature [9,10,11,12,13,14,15,16,17,19,20,21,23,24,25,26,27,28]. To the best of our knowledge, this study represents the largest series detailing the cytomorphology of such tumors.…”

“…Previously published case reports of metastatic and primary ectopic meningiomas described tumors with typical low-grade cytomorphology [9,10,11,12,13,14,15,16,17,19,20,21,23,24,25,26,27,28]. In our study most cytology samples, particularly those from ectopic tumors, also revealed typical morphological features characteristic of low-grade intracranial meningiomas such as spindle-shaped tumor cells, whorls (concentric spheres of tumors cells), intranuclear pseudoinclusions, nuclear grooves and psammoma bodies [2].…”

“…Although the cytomorphology of squashed intracranial meningiomas have been well described for intraoperative neuropathology consultations involving these tumors [1,8], the cytological findings of extracranial meningiomas have been limited to case reports. Primary ectopic meningiomas diagnosed by fine-needle aspiration (FNA) have been reported in the head and neck [9,10,11,12,13,14], orbit [15,16,17,18], bone [19], skin [20] and lung [21,22]. Metastatic meningiomas diagnosed by FNA have been documented in the lung [11,23,24,25,26], liver [27] and soft tissues [28].…”

Primary Extracranial Meningioma of the Sphenoid Sinus: A Hidden Menace

“…2 It is believed that the arachnoid cells along the peripheral nerves are responsible for the origin in these cases. 3 In the following section, we describe the hospital course of a patient who presented with an extracranial meningioma involving the sphenoid sinus.…”

An Ectopic Meningioma in Nasal Floor

“…11,12 However, recently, good result was reported to be achieved without antifungal treatment for noninvasive aspergillosis. 13 Historically, patients with aspergillosis infection have been treated with amphotericin B or combined therapy with amphotericin B and flucytosine or itraconazole.…”