J Korean Soc Spine Surg.  2016 Dec;23(4):227-233. 10.4184/jkss.2016.23.4.227.

Two Case Reports of Calcified Spinal Meningioma and a Literature Review

• Kim JY
• Min WK
• Kim JE
• Park KH
• Mun JU

• KMID: 2365083
• DOI: http://doi.org/10.4184/jkss.2016.23.4.227

Abstract

STUDY DESIGN: Case Report.
OBJECTIVES
The aim of this study was to report 2 cases of calcified spinal meningioma that displayed differences in appearance during resection, and to review the current literature on calcified and ossified spinal meningiomas. SUMMARY OF LITERATURE REVIEW: Calcified and ossified spinal meningiomas are rare, and tumor calcification is a risk factor for poor neurological outcomes resulting from the additional manipulations required to dissect the tumor.
MATERIALS AND METHODS
We describe the clinical course and intraoperative findings of 2 female patients who presented with symptoms of myelopathy. Magnetic resonance imaging showed calcified spinal meningiomas of the thoracic spine. The type of tumor resection performed was dependent on the solidity and texture of the individual tumors.
RESULTS
Pathologic evaluation revealed psammoma bodies, which suggested calcified meningioma. The patients' neurologic symptoms resolved with no neurologic sequelae.
CONCLUSIONS
Although there are a few pathologic differences regarding the main type and pathogenesis of ossified and calcified meningioma, both are thought to have a poor prognosis. For these tumors, adequately accounting for the expected poor prognosis and performing a wide laminectomy in order to ensure an adequate surgical margin are important factors for achieving a favorable outcome.

Keyword

Calcified meningioma; Ossified meningioma; Myelopathy

MeSH Terms

Female
Humans
Laminectomy
Magnetic Resonance Imaging
Meningioma*
Neurologic Manifestations
Prognosis
Risk Factors
Spinal Cord Diseases
Spine

Figure

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  Fig. 1. A sagittal plane T2-weighted magnetic resonance imaging scan exhibited a very low signal (white arrow) in an intradural ex-tramedullary tumor occupying the spinal canal at T4 (A). Computed tomography without enhancement depicted a completely calcified intradural mass (black arrow) occupying the entire spinal canal at the T4 level. The axial view is shown in (B).

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  Fig. 2. Intraoperative image showing a tumor (white arrow) at the T4 level. The tumor had a friable solidity and was dissected in a piecemeal manner.

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  Fig. 3. Postoperative T2-weighted magnetic resonance imaging scan revealing decompression of the flattened cord and recovery of the cord diameter in the thoracic spine. The sagittal view is shown in (A), and the axial view in (B).

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  Fig. 4. Microscopy of the specimen demonstrating a psammomatous subtype that was composed of numerous calcified psammoma bodies, suggestive of a calcified meningioma (hematoxylin and eosin staining, ×200 magnification).

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  Fig. 5. T2-weighted magnetic resonance imaging scan showing an oval-shaped mass (white arrow) clearly demarcated by a hypodense signal. The sagittal view shown in (A). Computed tomography image showing a calcified mass (black arrow) occupying the spinal canal at the level of the T9 vertebra. The axial view is shown in (B).

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  Fig. 6. Gross photography showing en bloc dissection of the firm, solid tumor.

Reference

1. Gamache FW Jr, Wang JC, Deck M, et al. Unusual appearance of an en plaque meningioma of the cervical spinal canal. A case report and literature review. Spine (Phila Pa 1976). 2001; 26:E87–9.

2. Doita M, Harada T, Nishida K, et al. Recurrent calcified spinal meningioma detected by plain radiograph. Spine(Phila Pa 1976). 2001; 26:E249–52.

3. Lee JW, Lee IS, Choi KU, et al. CT and MRI findings of calcified spinal meningiomas: correlation with pathological findings. Skeletal radiology. 2010; 39:345–52.

4. Zhu Q, Qian M, Xiao J, et al. Myelopathy due to calcified meningiomas of the thoracic spine: minimum 3-year follow-up after surgical treatment. J Neurosurg Spine. 2013; 18:436–42.

5. Levy WJ Jr, Bay J, et al. Spinal cord meningioma. J Neurosurg. 1982; 57:804–12.

6. Niijima K, Huang YP, Malis LI, et al. Ossified spinal meningioma en plaque. Spine. 1993; 18:2340–3.

7. Huang TY, Kochi M, Kuratsu J, et al. Intraspinal osteo-genic meningioma: report of a case. J Formos Med Assoc. 1999; 98:218–21.

8. Uchida K, Nakajima H, Yayama T, et al. Immunohisto-chemical findings of multiple ossified en plaque meningiomas in the thoracic spine. J Clin Neurosci. 2009; 16:1660–2.

9. Kubota T, Sato K, Yamamoto S, et al. Ultrastructural study of the formation of psammoma bodies in fibroblastic me-ningioma. J Neurosurg. 1984; 60:512–7.

10. Chotai SP, Mrak RE, Mutgi SA, et al. Ossification in an extra-intradural spinal meningioma-pathologic and surgical vistas. Spine J. 2013; 13:E21–6.