title: Primary pulmonary malignant meningioma.
abstract: Fewer than 20 cases of primary pulmonary meningioma have been reported. Most of these cases have been histologically and clinically benign. We report an unusual case of primary pulmonary malignant meningioma with atypical histologic features and malignant behavior. A computed tomography scan of the head did not show evidence of tumor. The right upper lobe mass was resected and showed features of an atypical meningioma with loss of architectural pattern, mild nuclear pleomorphism, increased mitotic counts (up to 15 mitotic figures per 10 high power fields), and focally prominent nucleoli. Focally, cells with rhabdoid features were identified. The tumor's immunohistochemical and ultrastructural profiles were consistent with a meningioma. The tumor stained negative for estrogen and focally positive for progesterone receptors and had a MIB-1 labeling index (marker of cell proliferation) of 9.2%. Approximately 5 months after the initial resection, the patient experienced a tumor recurrence with multiple lymph node metastases, spread to the middle and lower lobes of the right lung, and metastasis to the diaphragm. Rarely, primary pulmonary meningiomas may present as high-grade malignant lesions.
authors.affiliation: Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Prayson
authors.forename: C F
authors.initials: CF
authors.lastname: Farver
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D016190:Carboplatin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003599:Cytoskeleton / Q000648:ultrastructure; D003896:Desmosomes / Q000648:ultrastructure; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007124:Immunoenzyme Techniques; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D008297:Male; D008579:Meningioma / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide; D016190:Carboplatin