Ebook Practical differential diagnosis in surgical neuropathology: Part 2
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Ebook Practical differential diagnosis in surgical neuropathology: Part 2
1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2ibed under a variety of names including mcningothclioma, endothelioma, arachnothelioma. meningocytoma. leptomeningioma. dural cxothclioma. arachnoidal flbroblastoma, and fungus of the dura mater (1,2). The morphologic heterogeneity of this group of neoplasms has been recognized for a long lime. Desp Ebook Practical differential diagnosis in surgical neuropathology: Part 2ite the wide variety of phenotypic appearances of meningioma, it is thought that this group of neoplasms is similar in that they are derived from aracEbook Practical differential diagnosis in surgical neuropathology: Part 2
hnoidal cap cells which arc most frequently situated within the lepto-mcninges and that they share certain immunohistochemical and ultraslructural fea1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2riation in appearance. They also continue to challenge the efforts of most to reliably predict, based on histopathology, which tumors arc more likely to behave in an aggressive manner.The etiology of meningioma still remains unknown in most cases. Clearly, a subset of tumors appear to arise as a res Ebook Practical differential diagnosis in surgical neuropathology: Part 2ult of prior radiation therapy (3.4). In cytogenetic studies, an association with neurofibromatosis type II has pointed to an abnormality of chromosomEbook Practical differential diagnosis in surgical neuropathology: Part 2
e 22 as an underlying etiology in a number of these neoplasms (5.6). Alterations in other chromosomes have been described in a subset of these tumors 1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2tric-aged patients may also be affected. Intracranial meningiomas clearly show a female predominance. Some studies have suggested that growth of meningiomas may be accelerated during the luteal phase of the menstrual cycle and during pregnancy (9,10). An association between meningiomas and other hor Ebook Practical differential diagnosis in surgical neuropathology: Part 2monally dependent tumors, in particularbreast carcinoma and certain gynecologic malignancies, has also been documented (11.12). These findings have prEbook Practical differential diagnosis in surgical neuropathology: Part 2
ompted some to examine the potential role of estrogen and progesterone and their receptors, as well as androgen receptors in meningiomas (I3-Ỉ5). Desp1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2y of agents, have proven to be generally unsatisfactory and arc not utilized in the routine management of these neoplasms (15).Meningiomas have been described in a variety of locations and generally arc seen arising in association with the dura and leptomcningcs. The most common sites of origin incl Ebook Practical differential diagnosis in surgical neuropathology: Part 2ude the parasagittal region, cavernous sinus region, tubcrculhim sella, lamina cribrosa. foramen magnum. and torcular zones. Less commonly, they can oEbook Practical differential diagnosis in surgical neuropathology: Part 2
ccur in other locations including the optic nerve sheath, spinal cord region, intraventricular region and a variety of ectopic sites throughout the b<1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2 associated with increased intracranial pressure and seizures are the most common presentations.The gross appearance of most meningiomas is that of a well-circumscribed, dural based mass which typically compresses rather than infiltrates the underlying brain parenchyma (Fig. 19-1). The gross appeara Ebook Practical differential diagnosis in surgical neuropathology: Part 2nce is dependent upon the histologic subtype of meningioma. A variety of gross features including cystic degeneration, prominent calcification, metaplEbook Practical differential diagnosis in surgical neuropathology: Part 2
astic bone or cartilage formation, and pigmentation may all be present. Rarely meningiomas grow in an en plaque fashion. Hyperostosis of the skull ove1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2enerally contrast enhancing, fairly discrete lesions. Often there is extension of the contrast enhancement along the inner8990PRACTICAL DIFFERENTIAL DIAGNOSIS IN SURGICAL NEUROPATHOLOGYFig. 19-1. Well circumscribed meningioma attached to the dura.Fig. 19-2. Syncytial meningioma composed of lobules o Ebook Practical differential diagnosis in surgical neuropathology: Part 2f of plump meningothclial cells.surface of lhe dura at the lateral borders of the meningioma which has been referred to as a “dural tail”. Edema of thEbook Practical differential diagnosis in surgical neuropathology: Part 2
e underlying parenchyma may be quite prominent, particularly in more aggressive behaving neoplasms (/6./7/ In the rare tumors that invade the underlyi1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2s and peritumoral edema are often more prominent in these cases as well.Table 19-1 summarizes the histologic subtypes of meningioma that are currently recognized by the World Health Organization Histological Classification of Tumours of the Central Nervous System (/Ebook Practical differential diagnosis in surgical neuropathology: Part 2
efly, mcningo-thelial meningiomas are comprised of lobules of plump meningioma cells with ill-defined cell borders (Figs. 19-2 and 19-3). Cells arc of1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2seen in association with this type. Fibrous meningioma is characterized by a fascicular architecture and is composed of elongated cells w ith increased collagen and reticulin deposition (Fig. 19-4). The so-called transitional meningioma represents a combination of both the men-ingothelial and fibrou Ebook Practical differential diagnosis in surgical neuropathology: Part 2s patterns. Exact criteria as to how much of a minor component needs to be present in order to use this designation do not exist. Psammomatous meningiEbook Practical differential diagnosis in surgical neuropathology: Part 2
omas often have a background meningothelioma-tous meningioma pattern with an abundance of psammoma bodies (Fig. 19-5). In general, distinction of one 1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri Ebook Practical differential diagnosis in surgical neuropathology: Part 2milarly act in a low-grade fashion includeTable 19-1Meningioma Classification-VariantsMcningothclial (syncytial)Fibrous (fibroblastic)Transitional (mixed)PsammomatousAngiomatous (angioblast ic)Microcystic (humid)Secretory (pseudopnammomatous)ChordoidLymphopla-smacytc-richMetaplastic’Rhabdoid’Papilla Ebook Practical differential diagnosis in surgical neuropathology: Part 2ry’Clear cell’Atypical meningioma’Malignant/anaplastic meningiomaFig. 19-3. Cytologic preparation of syncytial meningioma.’Histologic variants associaEbook Practical differential diagnosis in surgical neuropathology: Part 2
ted with more aggressive behavior.CHAPTER 19/MENINGIOMA1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descri1 9 MeningiomaIN 1922, Harvey Cushing ADOPTED the term "meningioma” IO include a variety of meningeal based neoplasms which had been previously descriGọi ngay
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