title: Xanthomatous meningioma: a case report with review of the literature.
abstract: Xanthomatous meningioma is an extremely rare variant of meningioma that is characterized histopathologically by the presence of tumor cells with lipid-filled vacuolated cytoplasm. In this report, we describe the fifth documented case of xanthomatous meningioma and review its clinicopathological features. A 76-year-old Japanese male presented with dizziness. Magnetic resonance imaging demonstrated a well-circumscribed tumor in the left parasagittal to frontal region with attachment of the dura mater. Histopathological examination of the resected specimen revealed proliferation of polygonal to spindle cells with eosinophilic cytoplasm and bland round to oval nuclei. Whorl formation and psammomas were scattered, and mitotic figures were rarely seen. A peculiar finding was the presence of extensive xanthomatous change continuing to the above-mentioned typical meningothelial meningioma. These tumor cells had clear vacuolated cytoplasm and bland round to oval nuclei. Immunohistochemically, xanthomatous cells were positive for epithelial membrane antigen. Accordingly, an ultimate diagnosis of xanthomatous meningioma was made. Our clinicopathological analysis revealed that xanthomatous meningioma affects children to young persons or the elderly, and four of five cases were located in the supratentorial region. Although the detailed mechanism underlying the xanthomatous change has not been clarified, this change is thought to result from a metabolic abnormality of the neoplastic meningothelial cells. Further, xanthomatous change has also been reported in atypical and anaplastic meningiomas. Therefore, it is important to recognize that xanthomatous change can occur in meningiomas, and to avoid misidentifying these cells as macrophages.
authors.affiliation: Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga University of Medical Science Shiga, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Ishida
authors.forename: Tadateru
authors.initials: T
authors.lastname: Fukami
authors.forename: Naoki
authors.initials: N
authors.lastname: Nitta
authors.forename: Muneo
authors.initials: M
authors.lastname: Iwai
authors.forename: Keiko
authors.initials: K
authors.lastname: Yoshida
authors.forename: Akiko
authors.initials: A
authors.lastname: Kagotani
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nozaki
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Okabe
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery; D004388:Dura Mater / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000473:pathology* / Q000601:surgery
keywords: Meningioma; adipophilin; metaplastic; xanthomatous