Xanthomatous Meningioma: A Case Report

Abstract

Meningioma is a neoplasm derived from meningothelial cells. Grade1 meningiomas consist of 9 different subtypes. One of the rare subtypes is metaplastic meningioma. Metaplastic meningioma could be defined as "xanthomatous meningioma" in the presence of prevalent xanthomatous changes. A 32-year-old male patient presented to the outpatient clinic with complaints of vertigo and tinnitus. Magnetic resonance imaging revealed a large mass lesion of 7.4 cm in the right frontal region with an extra-axial localization. Resection material demonstrated a neoplasm composed of classical meningothelial meningioma areas accompanied with areas of xanthomatous changes, containing cells with clear, vacuolated cytoplasm. Epithelial membrane antigen (EMA), vimentin, and progesterone expression were evident in both xanthomatous and meningothelial meningioma areas. Additionally, CD68 positivity was also observed in xanthomatous areas. EMA positivity is a neoplastic marker for xanthomatous cells and is a critical marker to differentiate these cells from macrophages, which is crucial for pathologists in the differential diagnosis. Xanthomatous meningiomas are quite rare and our case presentation is the 7 < sup > th < /sup > one in the current literature.