Secretory meningiomas have gland-like lumina, often containing PAS-positive hyaline globules ("pseudopsammoma bodies"). The lumina are surrounded by one or more layers of thin epithelium-like cells which are positive for a range of cytokeratins and for EMA and CEA4. There may be a pericytic proliferation within vessel walls4.
Meningothelial meningiomas are composed of sheets of cells with abundant, variably eosinophilic, cytoplasm.
Transitional meningiomas have an appearance intermediate between those of meningothelial and fibroblastic meningiomas.
Fibroblastic meningiomas show curving fascicles of spindle cells with abundant collagen. Sparse psammoma bodies are commonly present.
Psammomatous meningiomas contain abundant psammoma bodies, often within a spindle cell meningioma.
Microcystic meningiomas have a porous microcystic pattern with prominent vasculature.
Choroid meningiomas have trabeculae of cells within a myxoid stroma.
Anaplastic meningiomas ware defined as those containing >20 mitoses per 10 HPF or having cytologic features resembling carcinoma or melanoma
Epithelial markers:
|
Meningioma subtype |
CK16 |
CK17 |
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|
Secretory |
14/20 (positivity in a minority of the gland-like elements)1 |
19/20 (positivity in gland-like elements)1, 9/92 |
19/20 (positivity in gland-like elements)1, 9/92 |
6/20 (positivity in a minority of the gland-like elements)1 |
7/20 (positivity in a minority of the gland-like elements)1 |
6/20 (positivity in a minority of the gland-like elements)1 |
19/20 (positivity in gland-like elements in 19 cases, with meningiomatous positivity in 3 cases)1 |
20/20 (positivity in gland-like elements)1 |
20/20 (positivity in gland-like elements)1 |
9/92 |
9/92 (positivity seen around gland-like lumina: reference 1) |
0/92 |
0/92 |
|
|
Meningothelial |
1/601 |
16/601 |
3/601 |
6/601 |
1/601 |
1/601 |
43/60 (in 18 cases, >10% of cells were positive, sometimes forming a zone around meningothelial whorls)1 |
33/60 (only four case showed >10% of cells positive)1 |
5/60 (only trace positivity)1 |
|
|
|
|
|
|
Transitional |
0/2001 |
44/200 (but only one case showed widespread positivity. Other cases showed positive spindle cells around psammoma bodies)1 |
18/2001 |
25/2001 |
0/2001 |
0/2001 |
138/200 (staining >10% of cells in 80 cases)1 |
80/2001 |
17/2001 |
|
|
|
|
|
|
Fibroblastic |
0/1001 |
14/1001 |
5/1001 |
0/1001 |
0/1001 |
0/1001 |
54/100 (the extent of positivity was very variable)1 |
28/1001 |
5/1001 |
|
|
|
|
|
|
Psammomatous |
0/101 |
4/101 |
1/101 |
4/101 |
0/101 |
0/101 |
7/10 (only one case showed extensive positivity)1 |
8/101 |
1/101 |
|
|
|
|
|
|
Microcystic |
0/71 |
2/71 |
1/71 |
0/71 |
0/71 |
0/71 |
7/7 (positivity is often extensive)1 |
2/71 |
0/71 |
|
|
|
|
|
|
Chordoid |
0/21 |
1/2 (few cells)1 |
0/21 |
0/21 |
0/21 |
0/21 |
1/2 (2% of cells)1 |
1/2 (few cells)1 |
0/21 |
|
|
|
|
|
|
Atypical |
0/601 |
26/601 |
22/601 |
19/601 |
0/601 |
0/601 |
52/60 (33 cases showed positivity of >10% of cells)1 |
30/60 (only 5 cases showed positivity of >10% of cells)1 |
12/601 |
|
|
|
|
|
|
Anaplastic |
0/41 |
3/41 |
3/41 |
2/41 |
0/41 |
0/41q |
4/4 (positivity in 20% to 100% of cells)1 |
2/41 |
2/41 |
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NOS |
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|
|
|
100%3 |
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In summary:
CK18 is the most commonly expressed cytokeratin. This parallels the positivity in normal arachnoid1.
CK8 is expressed by secretory, atypical and anaplastic meningiomas
Other marker:
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39%3 |
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|
100%3 |
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The risk of recurrence and aggressive behaviour depends on location, brain invasion, histological subtype and mitotic index. The WHO grading recognises:
benign (grade I)
atypical (grade II
anaplastic (grade III)
metastatic carcinoma: carcinomas and meningiomas are both positive for EMA. The importance of the various specific cytokeratins depends on the site of the putative primary adenocarcinoma.
This page last revised 24.12.2003.
©SMUHT/PW Bishop