Severe headache in a patient with meningioma showing extensive dural tail correlates with IgG4-positive plasma cells and eosinophils: A case report and review of literature

Abstract

Background:Meningiomas originate from meningothelial cells of the arachnoid membrane. Few cases of meningioma with infiltration of inflammatory cells, such as lymphocytes and plasma cells, have been reported, and the mechanisms underlying meningioma-induced inflammatory reactions have not been fully elucidated.Case Description:In this study, we report an extremely rare case of meningioma with infiltration of both IgG4-positive plasma cells and eosinophils showing extensive dural tail and reactive inflammation of the surrounding arachnoid tissue. The main clinical manifestation was a severe headache, which was improved by surgical excision of the tumor.Conclusion:Only 8 cases of meningioma with IgG4-positive plasma cells have been reported, and only one case exhibited eosinophil infiltration. IgG4-related inflammatory response might mediate inflammation in surrounding tissue, resulting in thickening of the dura adjacent to a meningioma and severe headache. The mechanisms underlying inflammation by meningiomas require further investigation.

Angiomatous meningioma associated with rapidly aggravated peritumoral leptomeningitis: A case report

“…reported a case of meningothelial meningioma with intraoperatively observed yellowish semisolid substances in the peritumoral subarachnoid space, in addition to extensive intratumoral infiltration of IgG4-positive plasma cells and eosinophils. [ 12 ] The present case was completely different from previous reports of meningioma with inflammation, because inflammatory cells were absent within the tumor itself. Our case was CNS WHO Grade-1 angiomatous meningioma, which grew slowly, but dramatically enhanced the peritumoral leptomeningeal inflammation in a month with poorly controlled epileptic seizures.…”

“…[ 4 , 6 , 13 , 19 , 24 , 26 ] There are increasing numbers of reports of IgG4-related diseases in the CNS including idiopathic hypertrophic pachymeningitis and meningioma with high infiltrates of IgG4-positive plasma cells within the tumor. [ 4 , 6 , 8 , 12 - 14 , 24 - 26 ] Kuranari et al . reported a case of meningothelial meningioma with intraoperatively observed yellowish semisolid substances in the peritumoral subarachnoid space, in addition to extensive intratumoral infiltration of IgG4-positive plasma cells and eosinophils.…”

“…[ 4 , 6 , 13 , 19 , 24 , 26 ] Meningiomas with immunoglobulin (Ig) G4-positive plasma cells were also reported to cause peritumoral inflammation. [ 12 , 13 ] However, all of the meningiomas had inflammatory cell infiltrates within the tumor itself, and there have been no reports of meningiomas causing peritumoral inflammation without inflammatory infiltrates within the tumor itself. The authors report the first case of angiomatous meningioma associated with severe peritumoral leptomeningitis without the infiltration of inflammatory cells into the tumor itself, which quickly improved after removal of the meningioma.…”