PMC8797451_01
Preoperative magnetic resonance imaging (MRI) and histological findings of KS01 (case 1). Preoperative gadolinium-enhanced MRI (A) and T2-weighted MRI (B) at the initial stage (KS01A) showing a homogenous enhanced tumor in the right parietal lobe. Preoperative gadolinium-enhanced MRI (C) and T2-weighted MRI (D) at the third recurrence (KS01C) showing an en plaque tumor in the right parietal and occipital lobe with skull invasion. Histological findings of the initial tumor (KS01A) (E). Tumor cells were arranged in a sheet with high cellularity and mitotic cells along with focal necrosis and diagnosed as meningothelial meningioma (WHO grade I) (hematoxylin & eosin staining: 200x, scale bar =200 microm). (F) Histological imaging at the third recurrence revealing high cellularity with mitotic cells (atypical meningioma; WHO grade II) (hematoxylin & eosin staining: 200x, scale bar =200 microm).
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Histological diagnosis was meningothelial meningioma (MIB-1 index: 7%) (Figure 4C, Table 1). Histological diagnosis was rhabdoid meningioma (grade III; MIB-1 index: 20%) (Figure 4F, Table 1).
PMC8797451_02
Preoperative magnetic resonance imaging (MRI), computed tomography (CT), and histological findings of KS02 (case 2). Preoperative gadolinium-enhanced MRI (A) and T2-weighted MRI (B) at the initial stage (KS02A) showing an enhanced en plaque tumor with perifocal edema in the left frontal lobe. Histological findings of the initial tumor (KS02A) (C). Tumor cells were arranged in a sheet with an onion-like structure and diagnosed as meningothelial meningioma (WHO grade I (hematoxylin & eosin staining: 200x, scale bar =200 microm). Gadolinium-enhanced MRI (D) and T2-weighted MRI (E) 12 years after total resection (KS02B) showing a large heterogeneously enhanced tumor associated with expanding perifocal edema in the left frontal lobe compressing the corpus callosum. Histological imaging at the third recurrence (KS02C) revealing high cellularity with mitosis and focal necrosis (anaplastic meningioma; WHO grade III) (hematoxylin & eosin staining: 200x, scale bar =200 microm). (F) containing osteoplastic metaplasia (hematoxylin & eosin staining: 200x, scale bar =200 microm) (G, H). Chest CT demonstrating multiple metastatic tumors to the right lung (I), consisting of substantial pleural effusion (J).
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T1- and T2-weighted images with heterogeneous gadolinium enhancement (Figure 2A,B). The tumor including the dura adjacent to the tumor was totally removed, and duraplasty with Gore-Tex was carried out. Histological diagnosis was meningothelial meningioma (MIB-1 index: 5%) (Figure 2C). MRI demonstrated a de novo tumor with two components appearing hyper- and isointense on T1- and T2-weighted images with heterogeneous gadolinium enhancement (Figure 2D,E). Biopsied specimens were taken from three regions: the red-brownish component of the tumor demonstrated homogenous nuclei of cells with sheet-like arranged and high cellularity containing circumscribed collagen fibers (Figure 2F). The yellowish tumor composed marked circumscribed collagen fibers with bone metaplasia (Figure 2G,H). Chest CT revealed substantial pleural effusion in the right lung because the meningioma had metastasized to the lung (Figure 2I,J).
Macroscopic findings of autopsy. Autopsy demonstrated a recurrent tumor in the left frontal lobe invading into the basal ganglia (A) with dissemination of multiple tumors to the cauda equina (B). Metastasized tumors to the lung with multiple whitish nodules beneath the pleural space were observed (C).
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A recurrent tumor was observed in the left frontal lobe (Figure 3A), and the space created in the frontal skull base after left frontal lobectomy was completely filled with the recurrent tumor, which contained ossified tissue. The tumor disseminated into the brain stem and multiple lesions were observed on the pia of the spine and cauda equina (Figure 3B). The tumor had also metastasized to both sides of the lung, which consisted of multiple white nodules (Figure 3C) and was associated with bloody pleural effusion.
PMC8797451_03
Preoperative magnetic resonance imaging (MRI) and histological findings of KS01 (case 1). Preoperative gadolinium-enhanced MRI (A) and T2-weighted MRI (B) at the initial stage (KS01A) showing a homogenous enhanced tumor in the right parietal lobe. Preoperative gadolinium-enhanced MRI (C) and T2-weighted MRI (D) at the third recurrence (KS01C) showing an en plaque tumor in the right parietal and occipital lobe with skull invasion. Histological findings of the initial tumor (KS01A) (E). Tumor cells were arranged in a sheet with high cellularity and mitotic cells along with focal necrosis and diagnosed as meningothelial meningioma (WHO grade I) (hematoxylin & eosin staining: 200x, scale bar =200 microm). (F) Histological imaging at the third recurrence revealing high cellularity with mitotic cells (atypical meningioma; WHO grade II) (hematoxylin & eosin staining: 200x, scale bar =200 microm).
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Histological diagnosis was meningothelial meningioma (MIB-1 index: 7%) (Figure 4C, Table 1). Histological diagnosis was rhabdoid meningioma (grade III; MIB-1 index: 20%) (Figure 4F, Table 1).
Preoperative magnetic resonance imaging (MRI) and histological findings of KS03 (case 3). Preoperative gadolinium-enhanced MRI (A) and T2-weighted MRI (B) at the second recurrence (KS03B) showed a homogenous enhanced tumor in the right frontal lobe. Histological findings of the initial tumor (KS03A) (C). Tumor cells were arranged in a sheet with an onion-like structure and diagnosed as meningothelial meningioma (WHO grade I) (hematoxylin & eosin staining: 200x, scale bar =200 microm). Preoperative diffusion weighted (D) and T2-weighted MRI (E) at the third recurrence (KS03C) showed the low-intensity mass in the right temporal lobe. Histological findings. (F) Histological imaging at the fourth recurrence (KS03D) showing mitotic cells with plump eosinophic cytoplasm diagnosed as rhabdoid meningioma; WHO grade III (hematoxylin & eosin staining: 400x, scale bar =200 microm). Preoperative gadolinium-enhanced MRI (G) and T2-weighted MRI (H) at the fourth recurrence (KS03D) showed a homogenous enhanced tumor with expanding perifocal edema in the right parietal lobe.
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MRI demonstrated a recurrent tumor in the right inferior frontal gyrus with homogenous gadolinium enhancement (Figure 4A,B). Histological diagnosis was meningothelial meningioma (MIB-1 index: 7%) (Figure 4C, Table 1). MRI demonstrated a huge mass in the right temporal convexity with uncal herniation (Figure 4D,E). Histological diagnosis was rhabdoid meningioma (grade III; MIB-1 index: 20%) (Figure 4F, Table 1). Follow-up MRI demonstrated an en plaque tumor attached to the dura and the cystic tumor with nodule in the parietal lobe on the right (Figure 4G,H).