Primary pulmonary meningiomas: report of two cases and review of the literature

Our plain-English summary of Primary pulmonary meningiomas: report of two cases and review of the literature, by D. Han, H. Deng, Y. Liu (Pathology, Research and Practice, 2020).

The study

• Authors: D. Han, H. Deng, Y. Liu
• Journal: Pathology, Research and Practice
• Published: 2020;216(12):153232
• Type of article: Case report, Review
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Meningiomas rarely occur outside the skull, and primary pulmonary meningiomas (PPMs) are more rare. Only a few cases have been reported in the literature. The clinicopathological characteristics are not clear and it is easy to be misdiagnosed, so it is very important to master its diagnosis and differential diagnosis.

Methods: We report two women with primary pulmonary meningioma. At the time of physical examination, the small solitary pulmonary nodules were detected on chest radiograph, and wedge resection was performed by Video-assisted Thoracoscope Surgery(VATS), and histologic evaluation showed that the lesions were benign PPMs. The clinicopathological features, immunophenotype and differential diagnosis of PPMs were analyzed, with a review of the cases published in the literature.

Results: The study group comprised of 40 patients, 14 males and 26 females. The median age was 56.5 years (range 18-108). Thirty patients who underwent routine screening studies were asymptomatic but had a pulmonary nodule detected on chest X-ray. Nine patients had respiratory symptoms. Only 1 patient had non-specific symptoms. Most of the PPMs were benign, only 3 cases were malignant. Benign PPMs ranged from 0.6 cm to 6 cm in diameter (median 2 cm). The 3 malignant PPMs were 5 cm, 6.5 cm and 15 cm in diameter. The prognosis of benign PPM resection is good, with almost no recurrence or metastasis. But the two of three malignant PPMs relapsed.

Conclusions: PPM is very rare. It needs to be diagnosed by combining histology and immunohistochemistry. Diseases that need to be identified include spindle cell mesothelioma, spindle cell thymoma, spindle cell carcinoma, metastatic tumor, etc.

Copyright © 2020 Elsevier GmbH. All rights reserved.

In plain English

This article did not study asbestos. It reported two patients and reviewed published cases of primary pulmonary meningioma, a rare tumor of the type usually found in the membranes around the brain, here arising in the lung. Both patients were women, aged 75 and 64, whose small lung nodules were found on chest X-rays during physical examinations and removed by surgery. Both tumors were benign. The 64-year-old also had a separate lung adenocarcinoma removed and received chemotherapy. Neither had recurrence, after 2 and 28 months of follow-up. The authors reviewed 40 cases, including these two, reported from 1982 to 2019. There were 14 men and 26 women, with a median age of 56.5 years. Thirty had no symptoms. Three tumors were malignant, and two of those relapsed. The authors reported almost no recurrence or spread after removal of benign tumors. They described how to tell this tumor from others, including sarcomatoid mesothelioma. The authors concluded that the tumor is very rare and that diagnosis requires tissue examination with immunohistochemistry.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Report of two cases plus a review of cases published in the literature
• Who was studied: Two women (aged 75 and 64) treated at the authors' hospital in Hebei, China, plus published cases of primary pulmonary meningioma from 1982 to 2019. Of 53 reported cases, 40 (including the two new cases) had brain imaging showing no meningioma and were analyzed: 14 males and 26 females.
• Main results:
  • Case 1 (75-year-old woman): a 0.6 cm benign meningioma was removed. She had no treatment after surgery and no recurrence or metastasis at 2 months of follow-up.
  • Case 2 (64-year-old woman): the right upper lobe nodule was infiltrative adenocarcinoma of the lung, and the right lower lobe nodule was primary pulmonary meningioma. She received chemotherapy and was disease-free after 28 months of follow-up.
  • Of the 40 reviewed cases, median age was 56.5 years (range 18 to 108).
  • Of the 40 reviewed cases, 30 patients had no symptoms and had a nodule found on chest X-ray during routine screening.
  • Of the 40 reviewed cases, 9 patients had respiratory symptoms and 1 had non-specific symptoms.
  • Of the 40 reviewed cases, most tumors were benign and 3 were malignant.
  • Among the reviewed cases, benign tumors measured 0.6 cm to 6 cm in diameter (median 2 cm).
  • The 3 malignant tumors measured 5 cm, 6.5 cm and 15 cm in diameter.
  • Among the reviewed cases, benign tumors showed almost no recurrence or metastasis after removal, while two of the three malignant tumors relapsed.
  • Of the 40 reviewed cases, 37 were diagnosed from surgically removed tissue and 3 at autopsy.
  • The authors listed sarcomatoid mesothelioma among the tumors to be distinguished from pulmonary meningioma, noting that sarcomatoid mesothelioma is consistently positive for cytokeratin.
• The authors' conclusion: The authors concluded that primary pulmonary meningioma is very rare and usually benign, that it must be diagnosed by combining histology and immunohistochemistry, that surgical removal is the main treatment, and that it should be considered when diagnosing lung diseases.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Differential Diagnosis, Chest X-Ray, Video-Assisted Thoracoscopic Surgery (VATS), Prognosis, Metastasis, Histology, Immunohistochemistry, Spindle Cell.

Related studies

• Expression of podoplanin and calretinin in meningioma: an immunohistochemical study — M. Shintaku, T. Honda, et al. (2010)
• Expression of mesothelioma-related markers in meningiomas: an immunohistochemical study — E. Abdelzaher, D.M. Abdallah (2014)
• Expression and prognostic impact of immune modulatory molecule PD-L1 in meningioma — S.J. Han, G. Reis, et al. (2016)
• Primary pleural epithelioid mesothelioma of clear cell type: a case report and review of current literature — C. Gkogkou, K. Samitas, et al. (2011)
• Giant Pediatric Rhabdoid Meningioma Associated with a Germline BAP1 Pathogenic Variation: A Rare Clinical Case — A.C. Ravanpay, A. Barkley, et al. (2018)
• The INTEROCC case-control study: risk of meningioma and occupational exposure to selected combustion products, dusts and other chemical agents — D.M. McElvenny, M. van Tongeren, et al. (2018)

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