Chordoid Meningioma: A Case Report

Yeon, Je Young; Lee, Jung Il; Kim, Jong Hyun; Suh, Yeon Lim

doi:10.3346/jkms.2003.18.5.768

Cited by 20 publications

(14 citation statements)

References 15 publications

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“…Meta-analysis results of previously reported immunohistochemical findings in chordoid meningioma 6,17,21,22,24,30,35,36,38,40,42,43,45,47– 49,51–54,61,62,70,75,77,80,82,86 (published in English language) are shown in Figure 7. Additional immunohistochemical staining results in chordoid meningioma reported in the literature (which were not included in Fig.…”

Section: Resultsmentioning

confidence: 99%

Distinguishing Chordoid Meningiomas From Their Histologic Mimics

Sangoi

Dulai²,

Beck

et al. 2009

American Journal of Surgical Pathology

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Chordoid meningioma, World Health Organization grade II, is an uncommon variant of meningioma with a propensity for aggressive behavior and increased likelihood of recurrence. As such, recognition of this entity is important in cases that show similar morphologic overlap with other chondroid/myxoid neoplasms that can arise within or near the central nervous system. A formal comparison of the immunohistochemical features of chordoid meningioma versus tumors with significant histologic overlap has not been previously reported. In this study, immunohistochemical staining was performed with antibodies against D2-40, S100, pankeratin, epithelial membrane antigen (EMA), brachyury, and glial fibrillary acidic protein (GFAP) in 4 cases of chordoid glioma, 6 skeletal myxoid chondrosarcomas, 10 chordoid meningiomas, 16 extraskeletal myxoid chondrosarcoma, 18 chordomas, 22 low-grade chondrosarcomas, and 27 enchondromas. Staining extent and intensity were evaluated semiquantitatively and mean values for each parameter were calculated. Immunostaining with D2-40 showed positivity in 100% of skeletal myxoid chondrosarcomas, 96% of enchondromas, 95% of low-grade chondrosarcomas, 80% of chordoid meningiomas, and 75% of chordoid gliomas. Staining with S100 demonstrated diffuse, strong positivity in all (100%) chordoid gliomas, skeletal myxoid chondrosarcomas, low-grade chondrosarcomas, and enchondromas, 94% of chordomas, and 81% of extraskeletal myxoid chondrosarcomas, with focal, moderate staining in 40% of chordoid meningiomas. Pankeratin highlighted 100% of chordoid gliomas and chordomas, 38% of extraskeletal myxoid chondrosarcomas, and 20% of chordoid meningiomas. EMA staining was positive in 100% of chordoid gliomas, 94% of chordomas, 90% of chordoid meningiomas, and 25% of extraskeletal myxoid chondrosarcomas. Brachyury was positive only in the chordomas (100%), whereas GFAP was positive only in the chordoid gliomas (100%). EMA was the most effective antibody for differentiating chordoid meningioma from skeletal myxoid chondrosarcoma, low-grade chondrosarcoma, and enchondroma, whereas D2-40 was the most effective antibody for differentiating chordoid meningioma from extraskeletal myxoid chondrosarcoma and chordoma. Our findings demonstrate that in conjunction with clinical and radiographic findings, immunohistochemical evaluation with a panel of D2-40, EMA, brachyury, and GFAP is most useful in distinguishing chordoid meningioma from chordoid glioma, skeletal myxoid chondrosarcoma, extraskeletal myxoid chondrosarcoma, chordoma, low-grade chondrosarcoma, and enchondroma. A lack of strong, diffuse S100 reactivity may also be useful in excluding chordoid meningioma. Among the neoplasms evaluated, brachyury and GFAP proved to be both sensitive and specific markers for chordoma and chordoid glioma, respectively. Of note, this study is the first to characterize the D2-40 immunoprofile in extraskeletal myxoid chondrosarcoma, results that could be of utility in differential diagnostic assessment.

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Section: Resultsmentioning

confidence: 99%

Distinguishing Chordoid Meningiomas From Their Histologic Mimics

Sangoi

Dulai²,

Beck

et al. 2009

American Journal of Surgical Pathology

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“…Nine patients were reviewed from 1743 total meningioma patients in a 1995 to 2013 time period at St. Michael's Hospital in Toronto. To the best of our knowledge, 221 cases of CM have been reported in the English literature worldwide in the form of single case reports and/or case series …”

Section: Discussionmentioning

confidence: 99%

Chordoid meningiomas: Incidence and clinicopathological features of a case series over 18 years

et al. 2014

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Chordoid meningioma (CM) is a rare subtype of meningioma, classified as grade II, which exhibits a high rate of recurrence following subtotal resection. We retrospectively examined nine cases of chordoid meningioma over a case series of 1743 meningiomas (0.52%) operated upon at our institution from 1995 to 2013. All the reported clinicopathological findings were analyzed. Two hundred and twenty-one CM cases have been published to date worldwide and few single-center large case series have been issued. Seventy-five percent of the cases that underwent subtotal resection at our institution had recurrence within 1 year. Total resection of the tumor should be the major objective of surgery to reduce the possibility of tumor recurrence. The percentage of chordoid features within the tumor specimen could assist in predicting the pathogenesis of the lesion. The correlation of the index of proliferation to recurrence rate is still controversial. Much debate exists with regard to the role of adjuvant radiotherapy in CM cases. Immunohistochemical, cytological and ultrastructural studies should be used in combination to assure a correct diagnosis of CM. Owing to the rare occurrence of this meningioma subtype, larger case series are required to assist in providing a reference for diagnosis and to improve the therapeutic management of CM.

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“…For diagnostic confirmation, immunohistochemical staining is of great help. Chordoid meningiomas express membranous immunoreactivity for EMA and are mostly negative for S‐100 protein and CAM5.2 1,3–8 . In contrast, chordomas show strong widespread staining for cytokeratin, EMA, and frequently S‐100 protein 14–16 .…”

Section: Discussionmentioning

confidence: 99%

Jugular foramen chordoid meningioma

Takei

Rivera

Suzuki

et al. 2006

Pathology International

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Chordoid meningioma (CM) is a rare histological variant of meningioma and is classified as an atypical meningioma on pattern alone. Herein is described the first case of CM occurring in the jugular foramen. The patient was a 45-year-old woman with a 2 year history of progressive right hearing loss. Magnetic resonance imaging (MRI) demonstrated a large, dumbbell-shaped, homogenously gadolinium-enhanced mass in the right jugular foramen, extending medially to the cerebellopontine angle and caudally into the upper carotid space. Angiographic findings supported a diagnosis of schwannoma. Intraoperatively, the tumor appeared to involve the right glossopharyngeal nerve completely and the vagus nerve incompletely, and was incompletely resected. Microscopically, the tumor consisted predominantly of cords and nests of medium-sized cells with bland cytological features, surrounded by a pale basophilic mucin. Immunohistochemically, the tumor cells demonstrated reactivity for epithelial membrane antigen (membranous) and vimentin, with negative staining for S-100 protein, cytokeratin, CD34, glial fibrillary acidic protein (GFAP), synaptophysin, and chromogranin A. Based on the chordoid histology, an organoid lobular arrangement of the tumor cells, and the location of the tumor (jugular foramen), the differential diagnosis included not only a chordoma but also a paraganglioma (glomus jugulare tumor). Histological identification of typical meningotheliomatous areas, plus selective immunohistochemical panel, is important to establish the correct diagnosis.

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Chordoid Meningioma: A Case Report

Cited by 20 publications

References 15 publications

Distinguishing Chordoid Meningiomas From Their Histologic Mimics

Distinguishing Chordoid Meningiomas From Their Histologic Mimics

Chordoid meningiomas: Incidence and clinicopathological features of a case series over 18 years

Jugular foramen chordoid meningioma

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