Extracranial meningioma

Abstract

Meningioma can be a diagnostic problem for the head and neck surgeon and the surgical pathologist by reason of extracranial manifestation and the varying histological patterns seen in small biopsy specimens submitted from various extracranial sites. During the thirty year period 405 cases of meningioma were seen at the New York Hospital and the Memorial Hospital and the clinical findings have been reviewed together with recent pertinent literature. Thirty-four cases were spinal in origin: 9 cervical, 22 dorsal, and 2 lumbar. An external mass was present in 20% of the intracranial tumors: the orbit was involved in 30 patients, the outer table and scalp in 25, the paranasal sinuses and nasal cavity in 10, and the parotid and parapharyngeal region in 5. Three cases are documented primary extracranial meningiomas arising is soft parts; one free in the orbit and two in the neck masquerading as deep lobe parotid gland tumors. The pathological features of extracranial meningioma were identical with the intracranial variety and a standard classification of the main histological types is outlined. A variety of differential diagnoses were entertained before the true nature of the neoplasm was established. The necessity for sophisticated radiographic studies and neurosurgical attention to the intracranial component of the tumor is emphasized.

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

“…However, when the scalp, orbit, sinonasal tract, oral cavity, and soft tissues are excluded, the incidence decreases to Ͻ1% (9,35,36,46,51,55,(57)(58)(59). Primary ear and temporal bone meningiomas made up only 2.0% of the benign or malignant primary ear and temporal bone tumors seen in consultation at the AFIP during the period of study.…”

“…Increasing evidence supports the development of meningiomas from arachnoid cap cells, with different mechanisms to suggest how extracranial meningiomas arise. In the ear or mastoid bone specifically, an intracranial meningioma can extend by the path of least resistance and follow the tegmen tympani (through dehiscence), the sulci of the greater and lesser superficial petrosal nerves, the posterior fossa plate (geniculate ganglion area), the internal auditory canal (porus internus, lateral semicircular canal, or perilabyrinthine cell tracts), or the jugular foramen by direction extension, origination from arachnoid cell clusters in the sheaths of cranial nerves or vessels as they exit foramina or suture lines of the skull, or without any apparent demonstrable connection to the CNS (8,10,12,18,23,27,31,35,39,(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56). Arachnoid cells are identified outside the neuraxis, thereby giving rise to meningiomas in the ear and temporal bone.…”

“…Up to 20% of intracranial meningiomas may have extraneuraxial extension (3,36,38,(45)(46)(47)55), including the skull, scalp (all cutaneous sites), orbit, upper airway involvement (nasal cavity, paranasal sinuses, nasopharynx), soft tissues, and ear and temporal bone. However, when the scalp, orbit, sinonasal tract, oral cavity, and soft tissues are excluded, the incidence decreases to Ͻ1% (9,35,36,46,51,55,(57)(58)(59).…”

“…Highresolution scanning is probably requisite for an accurate determination of the extent of the tumor. Meningiomas often show a proclivity for local permeation of crevices, suture lines, and foramina of the skull (25,35,49,55,62). It may be difficult to demonstrate an intracranial component to the meningioma, especially if there is a clinically silent (asymptomatic) or a radiographically obscure en plaque growth, which creates a small dural or intracranial component while the bulk of the tumor grows beyond the cranial vault.…”

Olfactory Groove Meningioma Extension to Paranasal Sinus and Nasal Cavity: Combined Approach by Unilateral Subfrontal and Endoscopic Endonasal

“…Extracranial extension results as direct extension of intracranial meningiomas through pressure necrosis of the underlying bone or natural opening. The pathologic features of extracranial meningiomas are identical to those of more frequent intracranial lesions [5]. Bony erosion was reported to be 8% -16% [3] [6] [7], and L. Bakay and H. L. Cares mentioned in their literature that entire cribriform plate was disappeared in a patient due to the erosion.…”