[Metastatic meningeal neoplasms diagnosed as tuberculosis meningitis].
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Two patients with meningeal neoplasms and nearby vascular anomalies are reported. The lesions were excised and histologically confirmed. One patient had a meningotheliomatous meningioma and an arteriovenous malformation involving the right frontal lobe; the other, a hemangiopericytoma and an arteriovenous malformation in the right parietooccipital region.
Thirty-three meningeal neoplasms were karyotyped, and the results were compared with histologic features. Thirteen neoplasms had no discernible abnormality or sex chromosome loss only; nine had monosomy or structural abnormality involving only chromosome 22; and 11 had other chromosome abnormalities with or without chromosome 22 involvement. Histologic evidence of invasion was not associated with an abnormal karyotype in the three angioblastic tumors examined. All seven fibroblastic meningiomas had abnormal karyotypes, with monosomy 22 the most common change. Abnormal karyotypes were detected in 76% of syncytial and 55% of transitional meningiomas. When these results were combined with those from 259 meningeal tumors reported since 1987, abnormal karyotypes were detected in at least half of all histologic types. Chromosome changes secondary to those involving chromosome 22 may indicate additional areas of the genome that play a role in tumor progression. In the combined series, chromosome losses were most frequently observed in meningiomatous and transitional histologies; chromosomes 1, 6, 14, 18, and Y each were lost in 10 or more meningiomas, whereas only chromosome 20 was gained at the same frequency. Structural abnormalities most frequently involved chromosome 1. These changes are distinctly different from those observed in other common intracranial neoplasms, specifically astrocytic neoplasms.
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Progress in clinical intrathecal chemotherapy has been slow, and a number of new problems have been encountered. The most significant recent developments include the: 1) success of adjunctive intrathecal chemotherapy in the prevention of meningeal leukemia; 2) recognition and characterization of a necrotizing leukoencephalopathic reaction associated with intrathecal methotrexate therapy; 3) demonstration of the efficacy of intraventricular chemotherapy via an Ommaya reservoir; 4) delineation of the clinical pharmacology of intralumbar and intraventricular methotrexate; and 5) identification of an urgent need for new drugs and techniques for intrathecal administration.
The authors present two cases of non-traumatic subdural haematomas associated with a meningioma. Relevant literature is reviewed and the pathogenesis of this rare condition is discussed.
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Desmosomes, gap junctions and tight junctions are intercellular specializations which have been described in human meningiomas. We report, in five of five meningiomas, including a pulmonary metastasis from a malignant intracranial meningioma, a fourth type of intercellular specialization which is similar to but not identical with the hemidesmosome of the epidermis. Idential intercellular specializations have been described between arachnoidal cells, but not between dural fibroblasts. The presence of the junction in human meningeal neoplasms of diverse histologic pattern supports the origin of the meningioma from arachnoidal epithelium. The consistent occurrence of these structures in a pulmonary metastasis as well as benign intracranial tumors suggests that they may be a useful morphologic marker in the differential diagnosis of putative extracranial metastatic meningiomas.
The antitumor agent 3-deazauridine (DAU) was administered rapidly to four patients before surgical removal of intracerebral tumor. Tumor, adjacent brain tissue, and temporalis muscle were assayed for DAU by high-pressure liquid chromatography. DAU penetrated comparably into tumor, brain, and muscle; in one patient, tissue concentrations were higher than concurrent plasma concentrations. The active metabolite 3-deazauridine 5'-triphosphate was quantitated in one tumor sample and greatly exceeded its Ki for cytidine 5'-triphosphate synthetase. DAU was also present in autopsy brain specimens from two patients treated shortly antemortem. Cerebrospinal fluid concentrations were 22.1 and 59.0%, respectively, of concurrent plasma concentrations during continuous infusion of DAU in two patients. Cerebrospinal fluid concentration was 3.1 microgram/ml 2 hr after a 30-min infusion of 1.5 g of drug per sq m and fell to 1.9 microgram/ml at 16 hr. Thus, DAU is capable of penetrating into intracerebral tumor, brain, and cerebrospinal fluid and is worthy of investigation in the treatment of intracerebral and meningeal neoplasms.
Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that has been recognized to occur almost all along the organism. Since its description in 1996 at the meninges, a total of 59 cases of meningeal SFT have been reported. Different authors have emphasized the difficulties in the differential diagnosis with other more frequent meningeal neoplasms such as meningioma or hemangiopericytoma, as the clinico-radiological characteristics of this lesion seem to be non specific and the morphological features on pathological study may resemble other spindle cell neoplasms. The diffuse and strong reactivity for CD34 and the negativity for EMA and S-100 are data allowing the diagnosis of SFT. We report the case of a 50-year-old woman suffering from headache, in whom MRI study showed a tentorial lesion initially thought to be a meningioma. In spite of morphological similarities with a fibrous meningioma, inmunohistochemical study finally led to the diagnosis of SFT. As occurred in previous cases, the findings in our patient reflect the similarities in clinico-radiological and pathological characteristics between meningeal SFT and other spindle cell meningeal neoplasms, mainly fibrous meningioma. When a clear diagnosis cannot be done based on typical findings on conventional hematoxylin-eosin study, inmunohistochemical study should be performed in meningeal spindle cell lesions to exclude SFT.
A case of idiopathic hypertrophic cranial pachymeningitis with an unusual and misleading manifestation is reported. Computed tomography scan, angiographic and magnetic resonance imaging findings were suggestive of multiple meningeal neoplasms and a correct diagnosis was made only after meningeal biopsy. This 44-year-old patient had a previous history of an ill-defined systemic disorder associating episcleritis, erythroderma nodosa and multiple peripheral arthritis. We review previous reports of idiopathic cranial pachymeningitis with emphasis on radiological investigation techniques, histopathology and possible dysimmune mechanisms of pathogenesis.
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