Malignant meningioma with adenocarcinoma-like metaplasia: demonstration of intestinal phenotype.
Meningiomas show a diverse histopathologic appearance, often referred to as metaplastic changes; however, adenocarcinoma-like metaplasia is an extremely rare condition. Here, we present a novel case. A dura-based bulky mass located in the right frontotemporal region was identified radiologically in an 83-year-old woman. The tumor, yellow to ash-gray in color, was subtotally removed. Histopathological examination revealed robust adenocarcinoma-like structures within a conventional meningothelial neoplasm. Meningioma elements showed a WHO grade I to III histology. Morphological and immunophenotypic transition between meningothelial and columnar epithelial cells was confirmed on detailed observation. It was of note that the adenocarcinomatous components shared an immunophenotype with intestinal epithelium, expressing CDX2, MUC2 and cytokeratin 20. The present case could be differentiated from secretory meningioma based on distinct cellular atypia, lack of intracytoplasmic lumina and pseudosammoma bodies, and the intact status of the KLF4 gene. In addition, the morphological and immunophenotypic transition excluded the possibility of metastatic carcinoma within meningioma. This is the first reported case of meningioma with adenocarcinoma-like metaplasia harboring an intestinal immunophenotype.
Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan; Department of Pathology, Gunma University Hospital, Maebashi, Japan.
Yoshiyasu
Y
Takayama
Sumihito
S
Nobusawa
Ikuo
I
Ochiai
Hitoshi
H
Watanabe
Hiroki
H
Ishigame
Hayato
H
Ikota
Junko
J
Hirato
Jun
J
Nakayama
Hideaki
H
Yokoo
D000230:Adenocarcinoma / Q000473:pathology*; D000369:Aged, 80 and over; D000071616:CDX2 Transcription Factor; D005260:Female; D018398:Homeodomain Proteins / Q000378:metabolism; D006801:Humans; D007413:Intestinal Mucosa; D053554:Keratin-20 / Q000378:metabolism; D000090062:Kruppel-Like Factor 4; D008577:Meningeal Neoplasms / Q000473:pathology*; D008579:Meningioma / Q000473:pathology*; D008679:Metaplasia; D055262:Mucin-2 / Q000378:metabolism; D010641:Phenotype
D000071616:CDX2 Transcription Factor; C491270:CDX2 protein, human; D018398:Homeodomain Proteins; C000715467:KLF4 protein, human; D053554:Keratin-20; D000090062:Kruppel-Like Factor 4; C524625:MUC2 protein, human; D055262:Mucin-2
adenocarcinoma; anaplasia; intestinal phenotype; meningioma; metaplasia