Meningiomas

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Meningiomas

Last updated on Friday, February 13 2009 by jdmiles

In this section, there are dozens of images of meningiomas and their subtypes.

There is also an excellent video, by Dr. Mark Cohen, providing an overview of meningiomas. Enjoy!

Related videos:

Meningiomas
A highly informative presentation on the pathology meningiomas, from Dr. Mark Cohen, professor of pathology at Case Western Reserve University.

Related images:

Anaplastic meningioma, coronal section of brain at level of thalamic nuclei.
Anaplastic meningiomas are aggressive tumors with poor prognosis

Anaplastic, brain invasive meningioma, ventral surface of brain.
On the accompanying coronal photograph, brain invasion is readily identified.

Anaplastic meningioma, H&E stained section
Anaplastic meningiomas are characterized by patternless growth and abundant mitotic figures (greater than 12.5 per square millimeter)

Atypical meningioma, H&E stained section.
Atypical meningiomas often demonstrate architectural loss and small cell differentiation as shown here

Atypical meningioma invading bone
Although bone invasion is not automatically upgrade meningioma to atypical, invasion of adjacent structures is commonly seen in these lesions.

Meningioma (WHO GRADE I), H&E stain x40
At low magnification, meningioma cells tend to form whorls as demonstrated here

Meningioma, WHO grade I, H&E stain x 100
Whorl formation is characteristic of meningothelial tumors.

Chordoid Meningioma (WHO Grade II), H&E stained section, high power view.
As implied, chordoid meningiomas demonstrate areas resembling chordomas. This meningioma subtype is classified as a grade II tumor.

Clear Cell Menigioma, H&E
Clear Cell Menigioma is characterized by cells with abundant clear cytoplasm in a collagenous matrix, and is classified as a WHO grade II neoplasm. These benign appearing, but biologically aggressive tumors tend to affect young women with their most commonly...

Meningioma containing adenocarcinoma, intraoperative frozen section.
Meningiomas are the most common tumor of the nervous system to contain metastatic carcinoma. This is a result of the slow flowing arborizing vasculature which characterizes meningiomas.

Microcystic meningioma, high power H&E stain.
These meningioma variants contain abundant extracellular matrix and very little collagen (distinguishing them from clear-cell meningiomas). On frozen section, these tumors are often mistaken for astrocytic neoplasms. There classified as WHO grade 1 (benign) meningiomas.

Papillary meningioma, high power H&E stained section.
Papillary meningiomas tend to occur in younger patients and behave very aggressively (WHO grade 3).

Papillary meningioma, low power H&E stained section
Papillary formations surrounding fibrovascular cores characterize this aggressive meningioma subtype.

Rhabdoid meningioma, intraoperative smear preparation x 400
Rhabdoid meningioma are characterized by cells with abundant eosinophilic cytoplasm and large nuclei often containing nucleoli.

Rhabdoid meningioma, H&E stain x200
Rhabdoid differentiation may be seen focally within meningiomas, and signify aggressive behavior.

Rhabdoid meningioma, H&E stain x400
Rhabdoid differentiation comprises enlarged discohesive epithelioid cells with abundant cytoplasm, large nuclei, and often prominent nucleoli.

Rhabdoid Meningioma, high power H&E stained slide
Rhabdoid differentiation within meningiomas signifies aggressive (who grade 3) behavior.

Secretory meningioma, H&E stain x200
Secretory meningiomas are characterized by intercellular glycoprotein accumulations. They are classified with the other meningiomas as WHO grade 1. However, they may incite disproportionate edema in adjacent brain producing symptoms and radiographic appearance is suggestive of aggressive behavior.

Secretory meningioma, H&E stain x400
Accumulations of glycoproteins within secretory meningiomas have been referred to as pseudo-psammoma bodies. Although they appear to be extracellular, careful examination discloses they are actually within the cytoplasm of tumor cells.

Meningioma - Contrast CT
This is a contrast-enhanced CT of the head, showing a large meningioma in the left hemisphere.

Atypical Meningioma (WHO Grade II)
Atypical meningiomas demonstrate architectural loss, increased mitotic activity, and often coagulative necrosis, as seen on the right side of the photograph

Chordoid Meningioma (WHO Grade II), H&E stained section, medium power
This section demonstrates the interface between typical appearing meningioma differentiation and chordoid differentiation (at right).

Clear Cell Meningioma, high power H&E stained section
In clear cell meningiomas, the clearing occurs within the cytoplasm of tumor cells (distinguishing this variant from the less aggressive microcystic meningioma).

Meningioma, status post embolization, H&E stained section.
Embolization may produce several features associated with aggressive behavior. Therefore in order to ovoid over diagnosis, the pathologist should be apprised of the preoperative embolization.

Meningioma invading brain, H&E stain.
Brain invasion by meningioma signifies aggressive behavior and therefore caries and automatic WHO grade 2 classification.

Muscle invasion by meningioma, H&E stained section
Meningioma invasion into non-brain parenchymal tissues does not carry an automatic up grade, although it may make total resection more difficult.

Metapastic meningioma with bone formation, H&E stain.
The abundance of woven bone within this tumor favors metaplasia over invasion of pre-existing bony structures

Metaplastic meningioma, myxoid type
This tumor was resected from the falx cerebri of a young boy. Although it looks nothing like meningioma, immunohistochemical stains and radiographic appearances both supported a meningioma diagnosis.

Microcystic meningioma, high power H&E stained section
Microcystic meningioma demonstrates abundant vacuolization of both cells and matrix, perhaps explaining wide they appear as astrocytomas on frozen section.

Papillary meningioma, high power H&E stained section.
Papillary differentiation with fibrovascular cores is readily apparent on this high powered H&E stained section. Meningiomas with significant papillary differentiation are classified as WHO grade 3 neoplasms.

Psammomatous meningioma, H&E stain.
Psammomatous meningiomas may be encountered as minute gritty meningeal excrescences in patients undergoing spinal ependymoma resection in neurofibromatosis type II

Rhabdoid Meningioma, H&E stained section
Rhabdoid differentiation, characterized by enlarged epithelioid cells with large nuclei and prominent nucleoli, signify aggressive behavior and classification as WHO grade 3.

Microcystic meningioma with adherent brain parenchymal tissue
Microcystic meningiomas are nearly always grade 1 tumors, and therefore do not show invasion into brain parenchymal tissue

Meningeal hemangiopericytoma
Characterized by dense hypercellularity, dilated vasculature, and a tendency towards leptomeningeal and extramural dissemination; the hemangiopericytoma is no longer considered a meningioma subtype, but instead is felt to represent an aggressive an aggressive mesenchymal tumor involving the meninges.

Meningioma, H&E stain x 200
In this photomicrographs, the tumor cells can be seen recapitulating their lepidic function, wrapping around both blood vessels as well as other tumor cells (forming whorls).

MRI ADC meningioma
This is an ADC sequence MRI of the brain, showing a left frontal meningioma.

MRI DWI meningioma
This is a DWI sequence MRI of the brain, showing a left frontal meningioma.

MRI FLAIR meningioma
This is a FLAIR sequence MRI of the brain, showing a left frontal meningioma.

MRI GRE left frontal meningioma
This is a GRE sequence MRI of the brain, showing a left frontal meningioma.

MRI T1 Gad meningioma
This is a gadolinium contrasted T1-weighted MRI of the brain, showing a left frontal meningioma.

MRI T1 meningioma
This is a non-contrasted T1-weighted MRI of the brain, showing a left frontal meningioma.

MRI T2 meningioma
This is a T2-weighted MRI of the brain, showing a left frontal meningioma.

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