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Diffuse pulmonary meningotheliomatosis.
Am J Surg Pathol. 2007 Apr;31 (4):624-31
Minute pulmonary
meningothelial nodules are rare lesions histologically composed of
small nests of epithelioid cells located within the interstitium of
the lung. These nodules are generally asymptomatic and are usually
found incidentally at autopsy or in surgical specimens resected for
unrelated causes. The lesions are most often single, although multiple
lesions with unilateral involvement of one or even all lobes of the
same lung have been described. To our knowledge, cases of
meningothelial nodules with disseminated bilateral pulmonary
involvement associated with clinical symptoms of restrictive pulmonary
disease and radiologic evidence of diffuse reticulonodular pulmonary
infiltrates have not been previously documented. We have studied 5
patients presenting with diffuse bilateral pulmonary involvement by
numerous minute pulmonary meningothelial nodules. The patients were 4
women and a man aged 54 to 75 years who presented clinically with
dyspnea and shortness of breath and the lesions were discovered on
open lung biopsies performed for the evaluation of diffuse bilateral
interstitial lung infiltrates found on chest x-rays and computed
tomography scans. In 3 patients, there was a previous history of
malignancy and the radiologic findings were suspected of representing
diffuse metastatic disease. Histologically, the lesions were composed
of small clusters of epithelioid cells with round to oval nuclei
devoid of atypia and surrounded by abundant eosinophilic cytoplasm.
Immunohistochemical studies showed positivity of the tumor cells for
epithelial membrane antigen and vimentin, and negative staining for
cytokeratin, actin, S-100 protein, CD34, chromogranin, and
synaptophysin. Electron microscopic examination in 1 case confirmed
the ultrastructural features of meningothelial cells, including
complex cytoplasmic interdigitations joined by well-developed
desmosomes and abundant intracytoplasmic intermediate filaments. The
diffuse bilateral involvement of lung parenchyma in the present cases
can lead to confusion on clinical and radiologic grounds with a
variety of interstitial pulmonary processes, including idiopathic
interstitial pneumonia and lymphangitis carcinomatosa. Diffuse
pulmonary meningotheliomatosis should be considered in the clinical
differential diagnosis of diffuse interstitial pulmonary infiltrates.
Pulmonary
meningothelial-like nodules: a genotypic comparison with meningiomas. Am
J Surg Pathol. 2004 Feb;28(2):207-14.
BACKGROUND:
Minute pulmonary meningothelial-like nodules (MPMNs) are incidental
interstitial pulmonary nodules. They share histologic, ultrastructural,
and immunohistochemical features with meningiomas (MGs). DESIGN:
Sixteen cases yielding 33 separate MPMNs and 10 cases of benign MG
were studied. Immunohistochemical studies and mutational analyses were
performed on microdissected tissue using 20 polymorphic microsatellite
markers targeting 11 genomic regions in an effort to identify genetic
similarities of MPMN and MG. RESULTS: A total of 96.6% of MPMNs
stained positive for vimentin, 33.3% for epithelial membrane antigen,
3% for S-100, and all were negative for cytokeratin and synaptophysin.
Loss of heterozygosity (LOH) was identified in 25% of single MPMN
affecting 3 genomic loci. No solitary MPMN had more than 1 LOH event.
Multiple LOHs were seen only in MPMN-omatosis syndrome, where 33.3% of
MPMNs showed LOH affecting 7 genomic loci. MG showed the highest
frequency of LOH with major events seen at 22q (60%), 14q (42.8%), and
1p (44.4%) that were not shared by MPMN. CONCLUSION: Isolated MPMN
lacks mutational damage, consistent with a reactive origin.
MPMN-omatosis syndrome might represent the transition between a
reactive and neoplastic proliferation. MPMNs are different from MG
based on the major molecular genetic events seen in their formation
and progression.
Minute
pulmonary meningothelial-like nodules: a case report.Nihon
Kokyuki Gakkai Zasshi. 2002
Jun;40(6):499-502.
The presence
of multiple small nodular shadows on a routine chest radiograph was
noticed in a 56-year-old woman who had undergone a left mastectomy on
the diagnosis of breast cancer 8 years before. Chest CT films revealed
small nodules scattered beneath the pleura mainly in both lower lobes.
A biopsy was performed during video-assisted thoracoscopy to rule out
metastasis from breast cancer. Biopsy specimens showed spindle--or
oval-shaped cells arranged in nests associated with a dedicated
network of capillaries. These findings were compatible with minute
meningothelium-like nodules (MN). The pathogenesis of MN is still
unknown. It is common in elderly women, and the prognosis is excellent
without any treatment. MN is an important disease in the differential
diagnosis of multiple nodular shadows found on chest CT.
Progesterone receptor immunoreactivity in minute meningothelioid
nodules of the lung.Virchows
Arch. 2002 May;440(5):543-6.
Meningothelioid nodules (MNs) are not uncommon lesions of the
pulmonary interstitium composed of monomorphic round to spindle cells,
likely reactive in nature. Their origin is unsettled, though a
derivation from arachnoid-like cells in conditions of perturbed
perfusion of the pulmonary tissue has been proposed. Here we confirm
the consistent occurrence of intense progesterone-receptor
immunoreactivity in MNs fortuitously detected in surgical specimens of
lung carcinomas. This finding corroborates the view that these
proliferations exhibit arachnoid cell-like differentiation and
suggests a role for sex-steroid hormones in the control of their
growth.
Minute pulmonary
meningothelial-like nodules: thin-section CT appearance.J
Comput Assist Tomogr. 2001 Mar-Apr;25(2):311-3
Minute pulmonary
meningothelial-like nodules are often incidentally discovered during
pathologic evaluation of pulmonary parenchymal specimens. These
lesions were once thought to represent pulmonary chemodectomas, but
pathological studies have shown that they are not of neuroendocrine
origin. Minute pulmonary meningothelial-like nodules are benign,
perhaps reactive in nature, but are occasionally found in association
with lung carcinoma. They may appear as randomly distributed
well-defined micronodules on thin-section chest CT, and thus may
simulate metastatic disease when associated with lung carcinoma.
Immunohistochemical
and clonal analysis of minute pulmonary meningothelial-like nodules.
Hum Pathol.
1999 Apr;30(4):425-9.
The
histogenesis of meningothelial-like nodule or so-called minute
pulmonary chemodectoma remains unclear, with various
immunohistochemical analyses giving inconsistent results. We performed
an immunohistochemical and clonal analysis of minute pulmonary
meningothelial-like nodules. Thirty-one histologically defined
meningothelial-like nodules in 14 cases were stained
immunohistochemically. One case had multiple lesions with brown
pigment granules, which were positively stained with Berlin blue
method, indicating the presence of hemosiderin. All meningothelial-like
nodules were positive for vimentin and epithelial membrane antigen (EMA),
but not for S-100 protein, chromogranin A, or synaptophysin. Five of
13 cases (13 of 28 lesions) were positive for CD68 by KP-1. Ten cases
(24 lesions) stained for CD68 by PG-M1 were weakly positive. All
lesions were negative for lysozyme, myosin, actin, keratin, and
melanoma-associated antigen. Alveolar macrophages were intensely
positive for CD68 and lysozyme in all examined cases. We analyzed the
clonality of 11 minute pulmonary meningothelial-like nodule lesions in
two female cases based on an X-chromosome-linked polymorphic marker,
the human androgen receptor gene (HUMARA). The HUMARA was found to be
amplified with or without prior digestion by the methylation-sensitive
restriction endonuclease HpaII. Six of 11 lesions showed monoclonal
expansion. Five lesions in a multiple case showed different patterns
of monoclonality. Our findings showed that minute pulmonary
meningothelial-like nodules have meningothelial-like and phagocytic
characteristics but no muscular phenotype. Furthermore, some minute
pulmonary meningothelial-like nodules may show monoclonal expansion,
whereas others are polyclonal. Our data indicate that minute pulmonary
meningothelial-like nodules are reactive rather than neoplastic.
Primary pulmonary
malignant meningioma.
Ann Thorac Surg. 2005Oct;80 (4):1523-5.
Primary
pulmonary meningiomas are relatively rare and mostly benign. To
exclude pulmonary metastasis of an intracranial meningioma, imaging
studies of the brain should be performed. We believe that only one
primary pulmonary malignant meningioma in which a metastasis from the
brain was excluded has been reported. In this report we describe a
second case with malignant features.
Primary pulmonary
meningioma; report of a case.Kyobu
Geka. 2005 Jun;58(6):512-5.
Primary pulmonary
meningiomas are quite rare, and their occurrence has been reported
only sporadically. A 49-year-old, asymptomatic female was hospitalized
for the evaluation of a coin lesion in the left lung radiography. She
has no history of previous neoplasm or symptom referable to the
central nervous system. Chest computed tomography (CT) demonstrated a
9 x 14 mm, round, noncalcified, well-demarcated lesion in the left
upper lobe of the lung (S(1+2)). For diagnostic purposes, enucleation
of the tumor was performed. The resected specimen revealed
histologically classical typical meningioma. Because postoperative
magnetic resonance imaging (MRI) of the brain did not show any
intracranial mass, this case was and diagnosed as a primary pulmonary
meningioma. The patient was discharged with no complication, and alive
without recurrence of disease 14 months after surgery.
Primary pulmonary meningioma first
suspected of being a lung metastasis.
Ann Thorac Surg. 2005 Apr;79(4):1407-9.
Primary
extracranial and extraspinal meningiomas are rare tumors. We describe
a primary pulmonary meningioma first suspected of being a metastasis
because it presented as a solitary subpleural pulmonary nodule in a
patient with breast cancer. The absence of radiographic change after 6
months of chemotherapy led to resection of the breast and lung
lesions. A complete central nervous system evaluation eliminated other
locations of meningioma, allowing the diagnosis of primary pulmonary
meningioma. Primary pulmonary
meningioma manifesting as a solitary pulmonary nodule with a
false-positive PET scan.J
Thorac Imaging. 2006;21 (3):225-7.
Primary
pulmonary meningioma is very rare, with about 30 cases reported in the
English literature. These lesions are usually benign, grow slowly, and
have an excellent prognosis. However, they can mimic any other
pulmonary tumor, as the most common presentation is as a solitary
pulmonary nodule. We report a case of a primary pulmonary meningioma
manifesting as a solitary lung nodule with a very high metabolic
activity on the positron emission tomography, mimicking a primary lung
cancer.
Primary pulmonary
meningioma: report of a case and review of the literature.Tumori.
2003 Jan-Feb;89(1):102-5.
Primary pulmonary
meningiomas are rare and their occurrence has been reported only
sporadically. The diagnosis of such tumors should be accepted only
after the presence of an intracranial or intraspinal meningioma has
been excluded. The morphological and immunohistochemical features are
similar to those of intracranial meningiomas. A case of primary
pulmonary meningioma along with a review of the literature and
discussion of other lesions in the differential diagnosis of this rare
neoplasm are here presented.
Fine needle aspiration
cytology of primary pulmonary meningioma associated with minute
meningotheliallike nodules. Report of a case with histologic,
immunohistochemical and ultrastructural studies.
Acta Cytol. 2002
Sep-Oct;46(5):899-903.
BACKGROUND:
Pulmonary meningioma is an unusual tumor located in the lung. Minute
pulmonary meningotheliallike nodules are also uncommon tumor-like
lesions found at the pleuropulmonary level as solitary or multiple
nodules. The association of both entities is described in a recent
report. CASE: A 58-year-old, male smoker without pathology underwent
radiologic study before a surgical procedure. A peripheral nodule was
found in the left lower lobe of the lung with benign characteristics.
Fine needle aspiration cytology was performed under computed
tomography guidance. Cytologic examination showed features of
transitional meningioma and other lesions near the tumor. Minute
pulmonary meningotheliallike nodules were also present. CONCLUSION: A
diagnosis of meningioma should be considered when there is a
combination of scanty material, whorls composed of concentrically
arranged cells and isolated cells with intranuclear inclusions. The
simultaneous presence of meningioma and meningothelial-like nodules
corroborates the unifying hypothesis of their common origin and the
nature of these rare pulmonary lesions.
Cytology of primary
pulmonary meningioma. Report of the first multiple case. Acta
Cytol. 1998 Nov-Dec;42(6):1424-30.
BACKGROUND:
Ectopic meningiomas arising in the lung are rare. We report here the
first multiple primary case diagnosed by intraoperative imprint
cytology. CASE: Asymptomatic pulmonary nodules, two in the left and
three in the right lung, were found in a 61-year-old woman, and
video-assisted thoracoscopic surgery was undertaken. Because the
largest tumor was diagnosed as a meningioma by intraoperative imprint
cytology using an excised biopsy specimen, further resection was not
performed immediately. Histopathologically the tumor was characterized
by whorled nests of cells accompanied by psammoma bodies intermingled
with a fibrous pattern. The diagnosis was a transitional meningioma,
positive for vimentin and epithelial membrane antigen and negative for
keratin immunohistochemically. All the nodules were subsequently
surgically resected and showed a similar cytohistologic appearance.
Ultrastructurally the tumor cells demonstrated interdigitation of
adjacent plasma membranes with numerous desmosomes and hemidesmosomes,
typical of meningiomas. We failed to detect another primary tumor in
the nervous system, and at this writing the patient was healthy three
years after the operation. CONCLUSION: Because of the characteristic
cytomorphologic features of primary pulmonary meningioma, the
cytologic approach provides useful information for therapy.
Unsuspected
primary pulmonary meningioma.Eur
J Cardiothorac Surg. 2002 Mar;21(3):553-5.
Primary pulmonary
meningioma is an uncommon, usually benign, soft tissue tumour which
has rarely been reported. We report an additional case of primary
pulmonary meningioma occurring in an asymptomatic 56-year-old man
whose diagnosis was only established after resection. The features of
this lesion together with a review of the previous literature are
described.
Primary pulmonary meningioma may arise from
meningothelial-like nodules.
Adv Clin Path. 2000 Jan;4(1):35-9.
A rare case of
primary pulmonary meningioma, associated with meningothelial-like
nodules in the same lung resection, with preoperative fine needle
aspiration cytological findings and ultrastructural features, is
described. The simultaneous presence of meningioma and meningothelial-like
nodules, never before described, corroborates the unifying hypothesis
of their common origin and nature.
Primary pulmonary malignant meningioma.Am
J Surg Pathol. 1999 Jun;23(6):722-6.
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.
Primary pulmonary meningioma presenting as lung
metastasis.
Scand
Cardiovasc J. 1999;33(2):121-3.
A benign primary
pulmonary meningioma, an extremely rare tumour, was incidentally
detected in a 57-year-old woman in association with a contralateral
pulmonary adenocarcinoma. The meningioma was initially suspected to be
a metastasis. Both tumours were excised, with excellent outcome.
Anatomic features of primary pulmonary meningioma and differential
diagnosis are discussed.
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