|Year : 2017 | Volume
| Issue : 1 | Page : 143-144
Dilip Kumar Das
Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait
|Date of Web Publication||10-Nov-2016|
Dilip Kumar Das
Department of Pathology, Faculty of Medicine, Kuwait University, P. O. Box: 24923, Safat 13110
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Das DK. Commentary. J Neurosci Rural Pract 2017;8:143-4
Meningiomas are predominantly benign neoplasms derived from meningothelial cells, which exhibit a broad spectrum of differentiation potency corresponding to different histological subtypes. As per recent, the World Health Organization classification (Grades I, II, and III) of meningiomas, the Grade I meningiomas consist of nine subtypes, namely, meningothelial, fibrous, transitional, psammomatous, angiomatous, microcystic, secretory, lymphoplasmacyte-rich, and metaplastic. Metaplastic meningiomas, being one of the rarest subtypes, account for 3% of all meningiomas, and contains focal or widespread mesenchymal components such as osseous, cartilaginous, lipomatous, myxoid, or xanthomatous components singly or in combination. Lipomatous meningiomas account for 0.3% of all meningiomas; as regards their frequency among metaplastic meningiomas, 2 of the 15 metaplastic meningiomas reported by Tang et al. contained fat-like tissue. Microscopically, lipomatous meningiomas represent meningothelial or transitional meningiomas containing variable proportions of mature adipocytes or lipoblasts. Lipomatous meningioma has also been observed in association with secretory, microcystic, and chondroid meningiomas and this entity may be confused with pure microcystic meningiomas containing mucinous fluid and glycogen-rich clear cell meningiomas.
The adipocyte-like cells/mature adipocytes of lipomatous meningioma are thought to result from true metaplastic change since the cap arachnoid-derived cells retain pluripotential capacity of differentiation; but alternatively, it has been suggested that they result from lipid accumulation in meningothelial cells. According to Matyja et al., a secretory meningioma with extensive lipomatous component had whorls of meningothelial cells with numerous periodic acid–Schiff-positive hyaline inclusions (pseudopsammoma bodies) and numerous mature adipocyte-like cells which shared the features of meningothelial cells and adipocytes; the coexistence of these two components reflects the multipotency of phenotypic transformation of primary meningothelial cells. Even the nonmeningothelial mesenchymal tumor of central nervous system such as meningeal osteochondroma which simulates osseous metaplastic menigioma is considered to have origin in the multipotent primitive mesenchymal stem cells of the dura. In a study of 18 xanthomatous meningiomas, Roncaroli et al. observed an admixture of xanthomatous meningothelial cells (with vacuolated lipid-filled cytoplasm) and adipocytes in six cases, and a transition between the two components in some cases, these authors suggested that these changes may result from a metabolic abnormality of the neoplastic meningothelial cells. The expression of epithelial membrane antigen (EMA) and progesterone receptor in meningothelial cells, adipocyte/adipocyte-like and lipoblast-like cells, suggests that lipid accumulation in meningioma should be considered a transformation of meningothelial cells rather than a true metaplasia. Although both the components of lipomatous meningiomas retain reactivity for EMA, there is a variable expression of S100 protein and differences in expression of progesterone receptors (40% in meningothelial cells and rarely in adipocytic cells) and Ki67 levels (5% of meningothelial cells and negligible in the adipocytic component)., The differences in progesterone receptor expression and Ki67 labeling between the two components of lipomatous meningioma suggest that the adipocyte-like cells may represent some quiescent form of meningothelial neoplastic cell, characterized by metabolic abnormalities, leading to lipid accumulation, and very low proliferative activity. This is supported by the lack of calretinin expression (a sensitive marker for adipocytic tumors) and ultrastructural findings indicating the presence of desmosomes and interdigitating cell membranes and the absence of lipid droplet binding to cell membranes.
As per the report on lipomatous meningioma by Yüksel et al. published in this issue of “Journal of Neurosciences in Rural Practice,” the case under consideration had not only morphological features of lipomatous meningioma with a mixture of typical meningothelial cells including those with fat vacuoles and mature adipose tissue, but immunohistochemical support in the form of coexpression of EMA, vimentin, and progesterone receptor as well as low proliferation activity (1–2% Ki67 positivity). The review of literature by the authors highlights a panel of fat containing tumors under differential diagnoses which include lipoma, liposarcoma, teratoma, chordomas, and metastatic mucinous carcinomas and require further immunohistochemical parameters for their separation from lipomatous meningiomas.
| References|| |
Matyja E, Naganska E, Zabek M, Jagielski J. Meningioma with the unique coexistence of secretory and lipomatous components: A case report with immunohistochemical and ultrastructural study. Clin Neuropathol 2005;24:257-61.
Perry A, Louis DN, Scheithuer BW, Budka H, von Deimling A. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. World Health Organization Classification of Tumors of the Central Nervous System. Lyon: IARC Press; 2007. p. 164-72.
Buccoliero AM, Caldarella A, Taddei A, Di Lorenzo N, Gallina P, Mennonna P, et al.
Atypical, aplastic, and unusual meningiomas. Morphology and incidence in 300 consecutive cases. Pathologica 2003;95:83-7.
Roncaroli F, Scheithauer BW, Laeng RH, Cenacchi G, Abell-Aleff P, Moschopulos M. Lipomatous meningioma: A clinicopathologic study of 18 cases with special reference to the issue of metaplasia. Am J Surg Pathol 2001;25:769-75.
Tang H, Sun H, Chen H, Gong Y, Mao Y, Xie Q, et al.
Clinicopathological analysis of metaplastic meningioma: Report of 15 cases in Huashan Hospital. Chin J Cancer Res 2013;25:112-8.
Harmouch T, Colombat M, El Amri A, Feydy A, Kalamarides M, Redondo A, et al.
Lipomatous meningioma: Two case reports. Ann Pathol 2005;25:389-92.
Gasparinho MG, Ferreira M, Lavrador JP, Livraghi S. Revisiting lipomatous meningioma: A case report and review of an unusual entity. Int J Surg Pathol 2015;23:399-403.
Majumdar K, Mandal S, Thakkar R, Saran RK, Srivastava AK. Meningeal osteochondroma simulating meningioma with metaplastic change: A rare golf-ball-like lesion of non-meningothelial mesenchymal origin. Brain Tumor Pathol 2014;31:62-7.
Colnat-Coulbois S, Kremer S, Weinbreck N, Pinelli C, Auque J. Lipomatous meningioma: Report of 2 cases and review of the literature. Surg Neurol 2008;69:398-402.
Yüksel MO, Gürbüz MS, Tanrıverdi O, Özmen SA. Lipomatous meningioma: A rare subtype of benign metaplastic meningiomas. J Neurosci Rural Pract 2017;8:140-2.