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Ossified Metaplastic Meningioma with Intratumoral Hemorrhage

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Author(s): Hui-Chun Tai | Chih-Jung Chen | Chien-Min Chen | Wei-Liang Chen | Pi-Yu Chen

Journal: Journal of Cytology & Histology
ISSN 2157-7099

Volume: 01;
Issue: 01;
Start page: 001;
Date: 2010;
Original page

Keywords: Metaplastic meningioma | Ossified meningioma | Intratumoral hemorrhage

ABSTRACT
Background: Metaplastic meningioma is a rare subtype of WHO grade I meningioma. Among the diverse types of mesenchymal differentiation seen in this tumor, the presence of extensive “ossified change” or “ossification” is rare. Most cases of osseous meningioma in the literature occurred in spinal level and intracranial location is relatively rare. The pathogenesis is postulated to be associated with increased level of intratumoral alkaline phosphatase.Case presentation: We reported a case of intracranial ossified meningioma with extensive ossification and intratumoral hemorrhage. The patient was a 60-year-old male with clinical presentation of left-side limb weakness. Radiologic features revealed extensive intratumoral calcifi cation. Surgical treatment resulted in complete resection without any complications. Upon histological examination, the meningioma was found to be comprised of meningothelial-likeand spindle cells admixed with extensive mature lamellar bone tissue. In addition, multifocal hemorrhage and areas of infarct were also found. Immunohistochemical studies revealed that the immunophenotype of tumor cells was identical to that of menigothelial type meningioma. The tumor also contained a rich intratumoral vascular network highlighted by CD34 stain.Conclusion: Here we report a rare presentation of intratumoral hemorrhage in an intracranial ossified meningioma. Intratumoral hemorrhage is hardly seen in this kind of meningioma in the literature. In addition, the rarity of extensively ossification in this intracranial tumor may make it hard to distinguish from extensive hyperostosis of skull bone, intraosseous meningioma and periosteal osteoblastoma clinically. Although, the true mechanism of ossification is still not clear, be aware of this rare entity is important for clinical practice.
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