CNS tumor

Meningeal tumors

Papillary meningioma

Topic Completed: 1 March 2014

Minor changes: 17 August 2020

Copyright: 2002-2021,, Inc.

PubMed Search: Papillary meningioma [title]

Jesse L. Kresak, M.D.
Anthony T. Yachnis, M.D.
Page views in 2020: 2,705
Page views in 2021 to date: 2,623
Cite this page: Kresak J, Yachnis A. Papillary meningioma. website. Accessed December 3rd, 2021.
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
  • 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

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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
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

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Meningioma smear

Positive stains
  • EMA (variable), NSE
  • PR (in a subset; helpful if positive, not ruled out if negative), vimentin
Negative stains
Electron microscopy description
Electron microscopy images

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Bundles of intermediate filaments

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