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Int J Clin Exp Pathol 2013;6(10):2242-2246

Case Report
Xanthomatous meningioma: a case report with review of the literature

Mitsuaki Ishida, Tadateru Fukami, Naoki Nitta, Muneo Iwai, Keiko Yoshida, Akiko Kagotani, Kazuhiko Nozaki, Hidetoshi Okabe

Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Department of Neurosurgery, Shiga University of Medical
Science, Shiga, Japan

Received August 13, 2013; Accepted August 27, 2013; Epub September 15, 2013; Published October 1, 2013

Abstract: Xanthomatous meningioma is an extremely rare variant of meningioma that is characterized histopathologically by the presence of
tumor cells with lipid-filled vacuolated cytoplasm. In this report, we describe the fifth documented case of xanthomatous meningioma and
review its clinicopathological features. A 76-year-old Japanese male presented with dizziness. Magnetic resonance imaging demonstrated a
well-circumscribed tumor in the left parasagittal to frontal region with attachment of the dura mater. Histopathological examination of the
resected specimen revealed proliferation of polygonal to spindle cells with eosinophilic cytoplasm and bland round to oval nuclei. Whorl
formation and psammomas were scattered, and mitotic figures were rarely seen. A peculiar finding was the presence of extensive
xanthomatous change continuing to the above-mentioned typical meningothelial meningioma. These tumor cells had clear vacuolated
cytoplasm and bland round to oval nuclei. Immunohistochemically, xanthomatous cells were positive for epithelial membrane antigen.
Accordingly, an ultimate diagnosis of xanthomatous meningioma was made. Our clinicopathological analysis revealed that xanthomatous
meningioma affects children to young persons or the elderly, and four of five cases were located in the supratentorial region. Although the
detailed mechanism underlying the xanthomatous change has not been clarified, this change is thought to result from a metabolic abnormality
of the neoplastic meningothelial cells. Further, xanthomatous change has also been reported in atypical and anaplastic meningiomas.
Therefore, it is important to recognize that xanthomatous change can occur in meningiomas, and to avoid misidentifying these cells as
macrophages. (IJCEP1308033).

Keywords: Meningioma, metaplastic, xanthomatous, adipophilin

Address correspondence to: Dr. Mitsuaki Ishida, Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology, Shiga
University of Medical Science, Tsukinowa-cho, Seta, Otsu, Shiga, 520-2192, Japan. Tel: +81-77-548-2603; Fax: +81-77-548-2407; E-mail:
mitsuaki@belle.shiga-med.ac.jp