meningioma


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  • Clinical

    • most common intracranial tumor
    • predominance in middle aged females
    • associated with NF2 (22q)

  • Grading, Subtypes

    • grade I, common
      • meningothelial (oval cells, pseudonuclear inclusions)
      • fibrous (collagen bundles)
      • mixed (meningothelial + fibrous)
    • grade I, others
      • psammomatous (psammoma > tumor)
      • angiomatous (vessels > tumor)
      • microcystic (white spaces)
      • secretory (PAS+ globules)
      • lymphoplasmacyte-rich (inflammation > tumor)
      • metaplastic (mesenchymal, myxoid, xanthomatous)
    • grade II
      • chordoid (pink cells in gray-blue mucinous matrix)
      • clear cell (glycogen laden cells)
      • atypical meningioma
        • hypercellular with 5+ mitoses per 10 hpf
        • alternatively, 3 of the following
          • hypercellular
          • sheet like
          • necrosis
          • 4 mitoses per 10 hpf
          • small cells with high NC ratio
          • prominent nucleoli
    • grade III
      • papillary (pseudopapillae, perivascular pseudorosettes)
      • rhabdoid (eccentric nuclei, pink cytoplasm)
      • anaplastic (20+ mitosis per 10 hpf, high grade cytology

  • Grading, other

    • brain invasion = grade II

  • Stains

    • positive: EMA (less so in atypical and anaplastic), vimentin, PR
    • varies: S100
    • secretory variant: CEA+
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