Olgu Sunumu
Sekretuar Meningiom: Radyolojik ve Patolojik Olarak Malign Tümörlerle Karıştırılabilen Nadir Bir Antite
Öz
Özet
Meningiomlar, araknoidin meningotelyal hücrelerinden kaynaklanan, yavaş büyüyen, ekstra aksiyal beyin tümörleridir. Meningiomlar en sık görülen beyin tümörleridir, ancak sekretuar meningiomlar son derece nadir bir varyant olup radyolojik ve patolojik olarak kötü huylu tümörlerle karıştırılabilir. Kırk sekiz yaşında erkek hasta sol gözde görme bozukluğu ve baş ağrısı şikayeti ile başvurdu. Manyetik rezonans görüntülemede sol pontoserebellar bölgede 57x48x30 mm boyutlarında ekstra aksiyal kitle lezyonu ve kitle çevresinde belirgin ödem görüldü. Mikroskobik olarak, oval-yuvarlak nükleuslu, ince veziküle kromatinli ve orta derecede eozinofilik sitoplazmalı uniform meningotelyal hücrelerden oluşan tümöral lezyon gözlendi. Tümör hücreleri arasında eozinofilik sekresyon içeren lümenlerin oluşturduğu psödopsammom yapılarıyla karakterize epitel farklılaşmasının varlığı belirlendi. Lümenlerdeki eozinofilik sekresyon histokimyasal periyodik asit schiff (PAS) boyası ile gösterildi. Karsinoembriyonik antijen (CEA), epitelyal membran antijen (EMA) ve pan sitokeratin (Pan- CK) ile psödopsammom yapılarında ve çevreleyen tümör hücrelerinde immün reaksiyon gözlendi. Tümör hücreleri, Vimentin ve progesteron reseptörü (PR) ile immünopozitifti. Ki67 proliferasyon indeksi <%1 olarak belirlendi. Nekroz veya mitoz saptanmadı. Tümör “sekretuar meningiom” olarak rapor edildi. Olguya ek tedavi uygulanmadı ve cerrahi rezeksiyon sonrası 32 aylık takipte nüks saptanmadı. Sekretuar meningiomlar benign seyri nedeniyle klinik olarak önemli olmamakla birlikte radyolojik olarak belirgin beyin ödemi, serum CEA düzeylerinin yükselmesi ve epitel farklılaşması nedeniyle malign tümörlerle karıştırılabildiklerinden ayırıcı tanı önemlidir.
Anahtar Kelimeler
Kaynakça
- Perry A, Louis DN, Budka H, von Deimling A, Sahm F, Rushing EJ et al. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (Eds), WHO Clasification of Tumours of Central Nervous System, Lyon: IARC Press; 2016. P:239-240.
- Probst‐Cousin S, Villagran‐Lillo R, Lahl R, Bergmann M, Schmid KW, Gullotta F. Secretory meningioma: Clinical, histologic, and immunohistochemical findings in 31 cases. Cancer. 1997;79(10):2003-2015.
- Colakoğlu N, Demirtas E, Oktar N, Yuntem N, Iskelek S, Ozdamar N. Secretory Meningiomas. J Neurooncol. 2003;62:233-241.
- Buhl R, Hugo HH, Mihajlovic Z, Maximilian Mehdorn H. Secretory meningiomas: Clinical and immunohistochemical observations. Neurosurgery. 2001;48(2):297-302.
- Mohme M, Emami P, Matschke J, Regelsberger J, Westphal M, Eicker SO. Secretory Meningiomas: Characteristic Features and clinical management of a unique subgroup. Neurosurg Clin N Am. 2016;27(2):181-187.
- Reuss DE, Piro RM, Jones DT, Simon M, Ketter R, Kool M et al. Secretory meningiomas are defined by combined KLF4 K409Q and TRAF7 mutations. Acta neuropathologica. 2013;125(3):351-358.
- Nishio S, Morioka T, Suzuki S, Hirano K, Fukui M. Secretory meningioma: Clinicopathologic features of eight cases. Journal of clinical neuroscience. 2001;8(4):335-339.
- Canda MŞ, Güray M, Acar ÜD. The histopathologic and the immunohistochemical features of secretory meningiomas. Turk J Med Sci. 2001;31:279-282.
- Wang DJ, Xie Q, Gong Y, Wang Y, Cheng HX, Mao Y et al. Secretory meningiomas: Clinical, radiological and pathological findings in 70 consecutive cases at one institution. International journal of clinical and experimental pathology. 2013;6(3):358.
- Csonka T, Murnyák B, Szepesi R, Bencze J, Bognár L, Klekner Á et al. Assessment of candidate immunohistochemical prognostic markers of meningioma recurrence. Folia neuropathologica/Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences. 2016;54(2):114-126.
- Tirakotai W, Mennel HD, Celik I, Hellwig D, Bertalanffy H, Riegel T. Secretory meningioma: Immunohistochemical findings and evaluation of mast cell infiltration. Neurosurgical review. 2006;29(1):41-48.
- Regelsberger J, Hagel C, Emami P, Ries T, Heese O, Westphal M. Secretory meningiomas: A benign subgroup causing life-threatening complications. Neuro-oncology. 2009;11(6):819-824.
Secretory Meningioma: A Rare Entity That Can Be Confused Radiologically and Pathologically with Malignant Tumors
Öz
Abstract
Meningiomas are slow growing, extra axial brain tumors that originating from the meningothelial cells of the arachnoid. Meningiomas are the most common brain tumors, however secretory meningiomas are extremely rare variant and can be confused radiologically and pathologically with malignant tumors. A 48 years old male was presented with a complaint of headache and visual impairment in the left eye. Magnetic resonance imaging revealed an extra axial mass lesion in the left pontocerebellar region, 57x48x30 mm in size, and marked edema around the mass. Microscopically, a tumoral lesion consisting of
uniform meningothelial cells with oval-round nuclei, thin vesiculated chromatin, and moderately eosinophilic cytoplasm was observed. The presence of epithelial differentiation characterized by pseudopsammom structures formed by lumens containing eosinophilic secretion was appointed among the tumor cells. Eosinophilic secretion within the lumens were highlighted with histochemical periodic acid schiff (PAS) stain. Immunoreaction was observed in the pseudopsammom structures and the surrounding tumor cells with carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA) and pan cytokeratin (Pan-CK). Tumor cells were immunopositive with Vimentin and progesterone receptor (PR). Ki67 proliferation index was determined as <1%. No necrosis or mitosis were detected. The tumor was reported as ‘‘secretory meningioma’’. No additional treatment was applied to the case and no recurrence was detected in 32 month follow-up after surgical resection. Although secretory meningiomas are not clinically important due to their benign course, differantial diagnosis is critical, since they can be confused with malign tumors because of marked brain edema radiologically, elevated serum CEA levels and epithelial differentiation.
Anahtar Kelimeler
Kaynakça
- Perry A, Louis DN, Budka H, von Deimling A, Sahm F, Rushing EJ et al. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK (Eds), WHO Clasification of Tumours of Central Nervous System, Lyon: IARC Press; 2016. P:239-240.
- Probst‐Cousin S, Villagran‐Lillo R, Lahl R, Bergmann M, Schmid KW, Gullotta F. Secretory meningioma: Clinical, histologic, and immunohistochemical findings in 31 cases. Cancer. 1997;79(10):2003-2015.
- Colakoğlu N, Demirtas E, Oktar N, Yuntem N, Iskelek S, Ozdamar N. Secretory Meningiomas. J Neurooncol. 2003;62:233-241.
- Buhl R, Hugo HH, Mihajlovic Z, Maximilian Mehdorn H. Secretory meningiomas: Clinical and immunohistochemical observations. Neurosurgery. 2001;48(2):297-302.
- Mohme M, Emami P, Matschke J, Regelsberger J, Westphal M, Eicker SO. Secretory Meningiomas: Characteristic Features and clinical management of a unique subgroup. Neurosurg Clin N Am. 2016;27(2):181-187.
- Reuss DE, Piro RM, Jones DT, Simon M, Ketter R, Kool M et al. Secretory meningiomas are defined by combined KLF4 K409Q and TRAF7 mutations. Acta neuropathologica. 2013;125(3):351-358.
- Nishio S, Morioka T, Suzuki S, Hirano K, Fukui M. Secretory meningioma: Clinicopathologic features of eight cases. Journal of clinical neuroscience. 2001;8(4):335-339.
- Canda MŞ, Güray M, Acar ÜD. The histopathologic and the immunohistochemical features of secretory meningiomas. Turk J Med Sci. 2001;31:279-282.
- Wang DJ, Xie Q, Gong Y, Wang Y, Cheng HX, Mao Y et al. Secretory meningiomas: Clinical, radiological and pathological findings in 70 consecutive cases at one institution. International journal of clinical and experimental pathology. 2013;6(3):358.
- Csonka T, Murnyák B, Szepesi R, Bencze J, Bognár L, Klekner Á et al. Assessment of candidate immunohistochemical prognostic markers of meningioma recurrence. Folia neuropathologica/Association of Polish Neuropathologists and Medical Research Centre, Polish Academy of Sciences. 2016;54(2):114-126.
- Tirakotai W, Mennel HD, Celik I, Hellwig D, Bertalanffy H, Riegel T. Secretory meningioma: Immunohistochemical findings and evaluation of mast cell infiltration. Neurosurgical review. 2006;29(1):41-48.
- Regelsberger J, Hagel C, Emami P, Ries T, Heese O, Westphal M. Secretory meningiomas: A benign subgroup causing life-threatening complications. Neuro-oncology. 2009;11(6):819-824.
Toplam 12 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Erken Görünüm Tarihi | 1 Kasım 2022 |
| Yayımlanma Tarihi | 2 Kasım 2022 |
| Gönderilme Tarihi | 5 Nisan 2021 |
| Kabul Tarihi | 8 Mayıs 2021 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 17 Sayı: 3 |
