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Case Reports
. 2021 Oct 18;2(16):CASE21362.
doi: 10.3171/CASE21362.

Primary intraosseous meningioma of the vertebra: illustrative case

Ue-Cheung Ho  1 , Koping Chang  2 , Yen-Heng Lin  3 , Yu-Cheng Huang  3 , Fon-Yih Tsuang  1
Affiliations
Case Reports

Primary intraosseous meningioma of the vertebra: illustrative case

Ue-Cheung Ho et al. J Neurosurg Case Lessons. .

Abstract

Background: Primary intraosseous meningiomas (PIMs) are rare, and PIMs of the vertebrae have not yet been reported. The authors report a case of primary meningioma arising from the vertebrae.

Observations: A 49-year-old man presented with lower back pain and numbness in both lower extremities. Lumbar spine magnetic resonance imaging revealed an L2 pathological fracture with epidural and paraspinal invasion. The patient had undergone a first palliative decompression and fixation surgery, and the diagnosis turned out to be a World Health Organization grade III anaplastic meningioma based on histopathology. The tumor had progressed after first operation and radiation therapy, and the patient was referred to the authors' institute for excision. The patient had an uneventful postoperative course after a revisional total en bloc spondylectomy of L2.

Lessons: The authors present a rare case of PIM of the vertebrae with epidural and paraspinal invasion. Careful preoperative assessment and surgical planning is crucial for successful patient management.

Keywords: CT = computed tomography; MRI = magnetic resonance imaging; PEM = primary extradural meningioma; PIM = primary intraosseous meningioma; WHO = World Health Organization; anaplastic meningioma; primary extradural meningioma; primary intraosseous meningioma; primary spine tumor; total en bloc spondylectomy.

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Conflict of interest statement

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

FIG. 1.
FIG. 1.
Spine MRI before the first operation. Left: Gadolinium-enhanced T1-weighted sagittal image showed a pathological fracture of L2 with soft tissue mass 5.3 cm in diameter. Right: Gadolinium-enhanced T1-weighted axial image revealed L2 tumor with bilateral psoas muscle invasion and epidural extension.
FIG. 2.
FIG. 2.
Spine MRI 4 months after the first palliative decompression surgery. Left: Gadolinium-enhanced T1-weighted sagittal image revealed an enlarged residual tumor. Right: Gadolinium-enhanced T1-weighted axial image revealed an enlarged tumor with more extensive bilateral psoas muscle invasion.
FIG. 3.
FIG. 3.
Left and right: Spine radiographs after excision showed the instrumentation, reconstruction, and embolization coils.
FIG. 4.
FIG. 4.
Spine MRI 1 week after excision. Sagittal and axial T2-weighted images (A and B) and sagittal and axial gadolinium-enhanced T1-weighted images (C and D) show no residual tumor radiologically.
FIG. 5.
FIG. 5.
A and B: Hematoxylin and eosin staining of tumor showed some foci of spindle tumor cells with significant nuclear pleomorphism, increased nucleocytoplasmic ratio, and prominent nucleoli. C and D: Tumor cells stained positive for SSTR2a and E-cadherin. E: The Ki-67 cell proliferation index was approximately 15–20%. F: Tumor cells focally stained positive for D2–40. Original magnifications ×100 (A) and ×400 (B–F).
See this image and copyright information in PMC

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