CNS tumor
Meningeal tumors
Papillary meningioma

Author: Jesse Kresak, M.D. (see Authors page)
Editor: Anthony T. Yachnis, M.D.

Revised: 6 September 2017, last major update March 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Papillary meningioma [title]

Cite this page: Kresak, J. Papillary meningioma. PathologyOutlines.com website. http://pathologyoutlines.com/topic/cnstumorpapillarymeningioma.html. Accessed October 18th, 2017.
Definition / general
  • WHO grade III
  • Aggressive, high rate of recurrence, may metastasize
  • Often occurs in younger patients
  • May be difficult to recognize as meningothelial
  • Helps to refer to imaging or surgeon to verify a dural based lesion
Sites
  • Most often supratentorial
  • However, can occur in posterior fossa and spinal cord
Radiology description
  • MRI may show irregular tumor borders, heterogenous tumoral enhancement and peritumoral edema suggesting a high grade meningioma
Radiology images

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Right frontal papillary meningioma

Large, lobulated, irregular mass

Mass with a broad base

Postoperative shows severe leptomeningeal seeding

Avidly enhancing meningioma

Preoperative
sagittal and axial
gadolinium
enhanced MR images

Prognostic factors
  • Complete surgical resection is the most favorable prognostic indicator (Neurosurgery 2013;73:777)
  • Low MIB1 index and retention of progesterone receptor (PR) have also been reported as markers of improved prognosis
Case reports
Treatment
Gross description
  • Dural based
  • May be well circumscribed or readily adherent to brain parenchyma
  • Size can vary widely
Microscopic (histologic) description
  • Papillary structures are best appreciated at edges of tumor
  • Papillary features may be focal but at least 50% of tumor should have papillary features to call papillary meningioma, WHO grade III
  • Cross sections through papillae may give an ependymoma-like histology with perivascular pseudorosettes
  • May have areas of classic meningioma or may be difficult to appreciate any meningothelial features (whorls, psammoma bodies, nuclear pseudoinclusions)
  • Often has features of atypical meningioma: hypercellularity, brain invasion, increased mitoses, prominent nucleoli
Microscopic (histologic) images

Images hosted on other servers:

Breaks apart more than classic meningioma

Papillary fronds

Edge of papillary meningioma

Ependymoma-like perivascular pseudorosettes

Focal rhabdoid features


Ki67

H&E

EMA, vimentin, AE1 / AE3, Ki67

H&E, EMA, vimentin

Cytology description
  • Not distinct from a classic meningioma smear
  • However, may appreciate papillary clusters from low power
Cytology images

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Meningioma smear

Positive stains
  • EMA (variable), NSE
  • PR (in a subset; helpful if positive, not ruled out if negative), vimentin
Negative stains
Electron microscopy description
Electron microscopy images

Images hosted on other servers:

Bundles of intermediate filaments