Nonepithelial tumors of the nasal cavity, paranasal sinuses, and nasopharynx. A clinicopathologic study. XIII: Meningiomas

Abstract

Twelve cases of meningiomas involving the nasal cavity and paranasal sinuses are reported. Meningiomas only rarely involve the upper respiratory tract; these 12 cases were found among the 566,000 surgical pathology cases that have been studied in this laboratory. In this series, five meningiomas probably arose in the cranial cavity and secondarily extended into the nasal cavity and paranasal sinuses. Because radiographs demonstrated hyperostosis or bone destruction, three other tumors could have involved the cranial cavity, but this was never proven. In two other cases, the meningiomas appeared to involve only extracranial tissues and thus probably were primary extracranial lesions. (The data available in two other cases were insufficient to assess the possibility of intracranial involvement). These patients clinically had nonspecific signs and symptoms similar to those produced by other types of neoplasms growing in the upper respiratory tract. The tumor involved the sphenoid area in seven cases, the nasal cavity in six, the maxilla in five, the ethmoid sinus in four, and the frontal sinus in one. The diagnosis was first established when biopsy material was examined, although in several cases the presence of meningioma was first suggested on radiographic examination. Treatment depended upon the size and location of the tumor. In some cases, surgical resection appeared to control the lesion. These tumors did not appear to respond well to radiotherapy. The histologic differential diagnosis is discussed.

Update on Select Benign Mesenchymal and Meningothelial Sinonasal Tract Lesions

“…Meningiomas constitute between 20 and 36 % of intracranial neoplasms [76,77], but primary extracranial (ectopic, extracalvarial) meningiomas account for only about 2 % of all meningiomas, with meningiomas of the sinonasal tract comprising \0.1 % of non-epithelial neoplasms [78][79][80]. Extracranial direct extension into the sinonasal tract of meningiomas is much more likely than a primary, ectopic tumor, and thus, by current consensus, a primary diagnosis should not be rendered when there is a detectable intracranial mass or ''dural enhancement'' by imaging [79][80][81].…”

“…While radiation exposure and sex hormones are known to play a role in meningioma development [76,78,80], these factors are unproven in sinonasal tract tumors. There are three grades (as defined by the World Health Organization) and 15 recognized histologic types [76].…”

Skull base chordomas: overview of disease, management options, and outcome

“…56 Chordomas arising from the most rostral notochord extension in the dorsum sellae present as sellar 96 or parasellar tumors. Those arising from the most ventral aspect of the clivus can present as nasopharyngeal chordomas, 16,42,75,80,108 whereas those associated with the body and dorsal aspect of the clivus manifest as sphenooccipital or petrosal lesions. Chordomas related to the lower clivus will present at the ventral portion of the foramen magnum.…”

To study the immunohistochemical profile of sinonasal and nasopharyngeal masses

“…However, primary extracranial (ectopic, extra calvarial) meningiomas of the nasal cavity, paranasal sinuses, and nasopharynx (here in after referred to collectively as the sinonasal tract) are rare. The largest study to date is of 12 cases reported by Perzin et al [18] While a degree of controversy continues to exist around the exact origin of sinonasal tract meningiomas, it seems generally accepted that primary extracranial meningiomas do occur. Histologically, meningiomas of the sinonasal tract are identical to their intracranial counterparts, although diagnostic difficulties are frequently encountered in the differential diagnosis with carcinoma, melanoma, and olfactory neuroblastoma resulting from the rarity of meningiomas in this location.…”