Abstract
Cutaneous meningiomas are low grade neoplasms that are commonly confused with vascular lesions or other fibrous tumors when they arise in the skin. We describe six cases of cutaneous meningioma and review their clinicopathologic features. The patients (4 females) ranged in age from 1 to 89 years (median 25 years). None had a history of intracranial meningioma. Tumors were located on the scalp (n=5) and the forehead (n=1) and ranged from 0.5cm-2.5cm. Grossly, they were variously described as tan-white (n=3), skin-colored (n=1); smooth (n=3); and fibrous (n=1). Clinical differential diagnoses included: dermoid cyst (1/3), pilar cyst (1/3), and epidermoid inclusion cyst (1/3). One case was available for follow-up, which showed no evidence of recurrence 8 months after surgery. Histologically, two tumors resembled meningothelial meningiomas, two resembled meningothelial tumors with focally prominent psammoma bodies or calcification, and two resembled mixed or transitional meningiomas. One case contained an increased mitotic rate of 5 mitotic figures per 10 high power fields and was hypercellular. Mitoses were otherwise absent. Immunohistochemically, our cases were positive for epithelial membrane antigen (EMA) (6/6), somatostatin receptor 2A (SSTR2A) (1/1), D2-40 (2/3), p63 (3/3), and progesterone (1/2) and negative for vascular markers (ERG, CD31, CD34; 0/4), S-100 protein (0/2), melanocytic markers (HMB-45, SOX10, Melan A; 0/3), smooth muscle markers (SMA, desmin; 0/4) and cytokeratins (AE1/3, pancytokeratin; 4/4). The meningothelial variant, which is the most common intracranial variant, predominated in our cases; however, two additionally contained foci resembling fibrous meningioma and were thus classified as mixed or transitional type. Immunostains that can be useful in helping to confirm a diagnosis of meningioma include EMA and SSTR2a. Overall, we present these six cases to further describe this rare tumors clinical, histologic and immunohistochemical features.
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