A CASE OF PRIMARY INTRAPULMONARY MENINGIOMA
Takashi Oide1, Michiyo Kambe2, Kenzo Hiroshima1, Sou Tamura3, Yasumitsu Moriya3, Hidehisa Hoshino3, Kiyoshi
Shibuya3, Ichiro Yoshino3, Mari Mino-Kenudson4, Eugene J. Mark4, and Yukio Nakatani1, 2
1 Department of Diagnostic pathology, 3 Department of Thoracic Surgery, Graduate School of Medicine, Chiba
University, 2 Department of Pathology, Chiba University Hospital, Chiba, Japan; 4 Department of Pathology,
Massachusetts General Hospital and Harvard Medical School, Boston, USA
Background: Primary intrapulmonary menigioma is extremely rare. We report a case of the tumor. Design: A surgically resected lung tumor was studied clinicopathologically with histopathological,
immunohistochmical and ultrastructural analyses.
Results: A 44-year-old man with hypertension and obesity had a health checkup in 2008. Chest X-ray examination
revealed a solitary round mass in the left upper lobe. He was suspected of having a benign lung tumor and was
referred to our hospital. For diagnostic and therapeutic purpose, wedge resection of the left lung segment 1+2 was
performed by VATS procedure. On gross examination, the tumor was well-circumscribed and located subpleurally,
measuring 2.0x2.0x1.8 cm in size. It was grayish white in color and elastic firm in consistency. Microscopically, the
tumor comprised of plump to spindle cells with round to oval nuclei and indistinct cellular borders. The tumor cells
were arranged in a fascicular fashion or whorls interspersed by collagen bundles and small vessels. Psammoma
bodies were commonly seen. Mitotic figures were scarce. The microscopic findings indicated a mesenchymal tumor,
and the differential diagnosis included meningioma, solitary fibrous tumor, and inflammatory myofibroblastic tumor
among others. Immunohistochemically, the tumor cells were positive for vimentin, EMA, bcl-2, CD99, and
claudin-1; and negative for cytokeratin, SMA, and ALKp80. A small number of tumor cells were weekly positive
for progesterone receptor, S-100, and CD34. Ultrastructurally, the tumor cells had long and slender cytoplasm, often
in parallel arrangement and with interdigitations. Intercellular junctions including desmosomes were commonly
formed between the cell processes. The cytoplasm often contained numerous intermediate filaments. Based on the
histopathological findings including the characteristic meningothelial pattern and immunohisochemical positivity
for EMA and claudin-1 together with the ultrastructural features, the tumor was diagnosed as meningioma. No
central nervous system meningioma which could cause pulmonary metastasis was detected in the patient. He had an
uneventful postoperative course and has no recurrence of the tumor 9 months after tumor resection.
Conclusions: Review of the literature shows favorable prognosis of the primary intrapulmonary meningioma, i.e.,
complete surgical resection is curative. Albeit quite rare, meningioma should be considered as a differential
diagnosis of pulmonary mesenchymal neoplasms.
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