Xanthomatous meningioma: A metaplastic or degenerative phenomenon?

Abstract

Xanthomatous changes can be observed in various conditions including primary xanthomatosis that is linked to an underlying hypercholesterolemia and more commonly associated with secondary xanthomatous degenerative processes in neoplasm and chronic inflammation. Meningioma with extensive xanthomatous change is exceedingly rare. The presence of cholesterol clefts within this peculiar meningioma subtype has not been described. Herein, we report an unusual case of xanthomatous meningioma in an 83-year-old normolipidemic woman, who presented to us with worsening lower limb weakness and global aphasia. There was increasing evidence to suggest that the presence of xanthomatous changes in long-standing meningioma is merely a sequela of cellular degeneration rather than true metaplastic change as previously hypothesized. Hence, the diagnosis of "xanthomatous meningioma" in the metaplastic category should be revisited and considered as a distinct histological subtype. The possible histogenesis of such intriguing phenomenon is discussed with a review of the literature.

A rare variant of meningioma: Case report and review of literature

“…[ 10 11 ] The persistence of the meningothelial immunohistochemistry profile suggests that xanthomatous change is not true histiocytic metaplasia but rather a degenerative process which occurs in the central portion of the tumor, which is poorly nourished. [ 12 ] Further studies are required to elucidate which of these competing points of view are correct.…”

Xanthomatous meningioma, a rare histological variant: Case report

“…10 The tumor is reported in a wide range of age group from children to elderly patients and can be localized in supratentorial or infratentorial regions without any specific predilection (6) (Table 1). [2][3][4][5][6][7][8][9][10][11][12][13] On MRIs of the brain, these metasplatic meningiomas are usually iso-to hypointense on T1 and iso-to hyperintense on T2 weighted MRI. Katayama et al reported evidence of hyperintense lobules on both T1 and T2 weighted MRI images, and hypodensity on CT of the brain in xanthomatous meningiomas.…”

“…Meningothelial and transitional variants often show fat accumulation whereas neoplastic cells in xanthomatous meningiomas are filled up with lipids appearing as foamy cell with cholesterol clefts (Figure 2C). 2 Macrophages surround these neoplastic transformed cells, hence it is essential to carefully establish the origin of these xanthomatous cells. Xanthomatous meningioma does not show inflammation and is different from xanthogranulomatous inflammatory changes.…”

“…4 Furthermore, desmosomal and hemidesmosomal junctions, which create a "jigsaw puzzle" between adjacent neoplastic cells is highly suggestive of meningothelial origin of xanthomatous cells. 2,15 In these tumors, xanthomatous areas stain negative for glial fibrillary acidic protein (GFAP) and stain positive for adipophilin, an antibody suggesting the presence of cytoplasmic lipid granules. 9 Although exact pathophysiology behind these tumor is not known, Ishida et al suggested metabolic abnormality in tumor cells resulting in xanthomatous changes.…”

“…1 Currently, 15 different histological subtypes are known, and been categorized into WHO grade I, II and III. 2 Grade I constitute approximately 65-85% of all meningiomas. 3 Metaplastic meningioma is WHO grade I, which includes tumors containing different mesenchymal tissues i.e.…”