CNS & pituitary tumors
Meningeal tumors
Papillary meningioma
Last author update: 1 March 2014
Last staff update: 17 August 2020
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PubMed Search: Papillary meningioma [title]
Table of Contents
Definition / general | Sites | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Gross description | Microscopic (histologic) description | Cytology description | Cytology images | Positive stains | Negative stains | Electron microscopy description | Electron microscopy images | Differential diagnosisCite this page: Kresak J, Yachnis A. Papillary meningioma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cnstumorpapillarymeningioma.html. Accessed March 22nd, 2023.
Definition / general
- WHO grade III
- Aggressive, high rate of recurrence, may metastasize
- Often occurs in younger patients
- May be difficult to recognize as meningothelial
- Helps to refer to imaging or surgeon to verify a dural based lesion
Sites
- Most often supratentorial
- However, can occur in posterior fossa and spinal cord
Radiology description
- MRI may show irregular tumor borders, heterogenous tumoral enhancement and peritumoral edema suggesting a high grade meningioma
Radiology images
Images hosted on other servers:
Right frontal papillary meningioma
Large, lobulated, irregular mass
Mass with a broad base
Postoperative shows severe leptomeningeal seeding
Avidly enhancing meningioma
Preoperative sagittal and axial adolinium enhanced MR images
Prognostic factors
- Complete surgical resection is the most favorable prognostic indicator (Neurosurgery 2013;73:777)
- Low MIB1 index and retention of progesterone receptor (PR) have also been reported as markers of improved prognosis
Case reports
- 3 year old boy with cerebellar papillary meningioma (Am J Surg Pathol 1999;23:844)
- 13 year old boy with papillary meningioma with pleural metastasis (Acta Neurol Scand 2000;102:200)
- 15 year old girl with cystic papillary meningioma (Childs Nerv Syst 2005;21:322)
- 19 year old man with spinal papillary meningioma (Acta Neurochir (Wien) 2000;142:703)
- 25 year old woman with jugular foramen papillary meningioma (Brain Tumor Pathol 2004;21:143)
- 29 year old woman with meningioma with rhabdoid, papillary and clear cell features (Clin Neuropathol 2011;30:291)
- 43 year old man with papillary meningioma with leptomeningeal seeding (J Korean Neurosurg Soc 2011;49:124)
Treatment
- Gross total resection
- Postsurgical radiotherapy (Front Oncol 2013;3:227)
- Radiosurgery (Radiat Oncol 2014;9:38)
Gross description
- Dural based
- May be well circumscribed or readily adherent to brain parenchyma
- Size can vary widely
Microscopic (histologic) description
- Papillary structures are best appreciated at edges of tumor
- Papillary features may be focal but at least 50% of tumor should have papillary features to call papillary meningioma, WHO grade III
- Cross sections through papillae may give an ependymoma-like histology with perivascular pseudorosettes
- May have areas of classic meningioma or may be difficult to appreciate any meningothelial features (whorls, psammoma bodies, nuclear pseudoinclusions)
- Often has features of atypical meningioma: hypercellularity, brain invasion, increased mitoses, prominent nucleoli
Cytology description
- Not distinct from a classic meningioma smear
- However, may appreciate papillary clusters from low power
Cytology images
Images hosted on other servers:
Meningioma smear
Positive stains
Electron microscopy description
- Meningioma features of interdigitating cell processes, desmosomes and intermediate filaments (Histopathology 2001;38:318)
Electron microscopy images
Images hosted on other servers:
Bundles of intermediate filaments
Differential diagnosis
