Nakajima Hideki, Tsuchiya Takuro, Shimizu Shigetoshi, Murata Tetsuya, Suzuki Hidenori
Department of Neurosurgery, Suzuka General Hospital, Suzuka, Japan.
Department of Pathology, Suzuka General Hospital, Suzuka, Japan.
Surg Neurol Int. 2023 Apr 28;14:159. doi: 10.25259/SNI_54_2023. eCollection 2023.
A special type of meningioma is known to have infiltrated inflammatory cells within the tumor, associated with peritumoral inflammation. However, there have been no reports of meningioma with inflammatory response only around the tumor, without inflammatory cells within the tumor itself.
A 70-year-old woman presented with transient right hemiparesis due to an extra-axial tumor on the left frontal convexity. The tumor appeared hypointense on T1-weighted magnetic resonance images and hyperintense on T2-weighted images without peritumoral edema, and was homogenously enhanced associated with the peritumoral leptomeningeal enhancement. Cerebrospinal fluid examination showed an increase in the number of inflammatory cells with a predominance of mononuclear cells. During the following 1 month, the tumor size was unchanged, but the peritumoral leptomeningeal enhancement was remarkably enlarged with uncontrolled focal seizures. The tumor was subtotally removed and semisolid substances in the subarachnoid space were biopsied. Pathological examination with immunostaining revealed angiomatous meningioma: the tumor had no inflammatory cell infiltration within it, but was associated with the infiltration of immunoglobulin G4-negative lymphocytes into the border zone between the tumor and the dura mater, as well as numerous neutrophils and fibrinous exudates in the peritumoral subarachnoid space. The tumor removal rapidly improved the leptomeningeal enhancement and inflammatory reactions.
The authors reported the first case of angiomatous meningioma associated with massive peritumoral inflammation without inflammatory infiltrates within the tumor itself.
已知有一种特殊类型的脑膜瘤在肿瘤内有浸润性炎性细胞，并伴有瘤周炎症。然而，尚无关于仅在肿瘤周围有炎症反应而肿瘤本身无炎性细胞的脑膜瘤的报道。
一名70岁女性因左侧额部凸面的轴外肿瘤出现短暂性右侧偏瘫。该肿瘤在T1加权磁共振图像上呈低信号，在T2加权图像上呈高信号，无瘤周水肿，且与瘤周软脑膜强化相关，呈均匀强化。脑脊液检查显示炎性细胞数量增加，以单核细胞为主。在接下来的1个月里，肿瘤大小未变，但瘤周软脑膜强化明显扩大，伴有无法控制的局灶性癫痫发作。肿瘤次全切除，并对蛛网膜下腔内的半固体物质进行活检。免疫染色病理检查显示为血管瘤型脑膜瘤：肿瘤内无炎性细胞浸润，但在肿瘤与硬脑膜之间的边界区域有免疫球蛋白G4阴性淋巴细胞浸润，且瘤周蛛网膜下腔内有大量中性粒细胞和纤维蛋白渗出物。肿瘤切除后迅速改善了软脑膜强化和炎症反应。
作者报道了首例血管瘤型脑膜瘤，其伴有大量瘤周炎症，但肿瘤本身无炎性浸润。
