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Case 11/2011

Case 11/2011. B. Lach Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ont. CANADA. Abbreviations used: B-brain, M-meningioma, SMA smooth muscle actin, SA-sarcoma, EMA – epithelial membrane antigen. 76yo, history of multiple myeloma Lytic bone lesion

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Case 11/2011

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  1. Case 11/2011 B. Lach Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ont. CANADA Abbreviations used: B-brain, M-meningioma, SMA smooth muscle actin, SA-sarcoma, EMA – epithelial membrane antigen

  2. 76yo, history of multiple myeloma Lytic bone lesion MRI: intracranial/extracranial extra-axial tumour. Total resection

  3. Recurrent tumour three years later P53 MIB-1

  4. B M M SA SA SA SMA EMA RETICULIN M M SA SA M SA P53 MIB-1 CD10 B SA SA SA M

  5. Additional two cases with similar clinical course and histological features.

  6. Case #2: 55 y.o.only meningioma in the first surgery N Reticulin Recurrent tumour one year later: only sarcoma Myofilaments SMA + Fibronexus Only myofibroblastic sarcoma in two subsequent surgeries. Four year survival.

  7. Case #3: 64 yo: first surgery: atypical meningioma c SMA Recurrence, 5 yrs later: Mixed meningioma/sarcoma SMA MIB: 10%+ GFAP g h EMA CD10 P53

  8. a c b Case #3 Myofibroblastic differentiation of tumour cells

  9. MYOFIBROBLASTIC SARCOMA (MFSA) IN ANAPLASTIC MENINGIOMA • Three similar cases in personal collection: all developed in recurrent malignant meningiomas invading brain • Two mixed, myofibroblastic sarcoma/meningioma and one pure myofibroblastic sarcoma: MFSA strongly positive for smooth muscle actin, vimentin and reticulin • All developed on the side of infiltrated brain • All show high MIB-1 and P53 immunoreactivity • All rapid growth of recurrent tumour • DIAGNOSIS: MYOFIBROBLASTIC VARIANT OF ANAPLASTIC MENINGIOMA (“METAPLASTIC”)

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