A rare cystic lymphoplasmacyte-rich meningioma: A case report and review of the literature

Abstract

Background: Meningiomas are common central nervous system neoplasms, accounts for 30% of all primary intracranial neoplasms; the occurrence of meningiomas with cystic lesions is an exceptionally rare. Lymphoplasmacyte-rich meningioma (LPRM) is a rare pathological entity belong to the World Health Organization Grade I meningiomas. LPRM is characterized by abundant lymphoplasmacytic infiltrates which over-shadow the underlying meningothelial component.

Case description: A 42-year-old male was admitted to our hospital with a chronic headache for about 3 weeks prior to admission. His symptoms worsen, and subsequently, he experienced left extremities weakness about 1 week before admission. His brain magnetic resonance imaging revealed an irregular and heterogeneously enhancing solid lesion with intratumoral cystic changes at the temporal lobe. A gross total resection was performed; pathological examination revealed a cystic LPRM.

Conclusion: This rare variant of meningioma is a benign tumor entity featured with massive inflammatory cell infiltration and often less proportion of meningothelial elements. Surgical resection remains the treatment of choice. This is the first report regarding cystic LPRM from Indonesia; we also summarized relevant literature upto-date, May 2020, reported LPRM cases.

Keywords: Cystic lymphoplasmacyte-rich meningioma; Extremely rare meningioma variant case; Histopathology; Treatment; Up-date literature review.

Figure 1:

Axial (a) and coronal T1-contrast (b) image shows contrast enhancement dural-based tumor with cystic component size 7 × 5 cm resulting in midline shift of approximately 1.6 cm and third ventricular obliteration. Axial T2 image showing hypointense cystic component (c).

Figure 2:

Microscopic examination revealed the proliferation of neoplastic meningothelial cells with pale eosinophilic cytoplasm forming solid nests, associated with a dense chronic inflammatory infiltrate rich in lymphocytes and some plasma cells (a) (H&E, ×20). Both tumor cells and lymphocytes are positive with vimentin (b) (×20). Negative glial fibrillary acidic protein in tumor cells excludes the diagnosis of glioma with xanthomatous changes (c) (×40). CD3 staining in lymphocytes dispersed between tumor cells (d) (×20).

Figure 3:

Immediate postoperative computed tomography scan showing total removal of tumor with some certain extent of midline shift (a). Magnetic resonance imaging axial T1-contrast scan 6 months after operation showing no recurrence (b).