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Case 11/2011
B. LachDepartment 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
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76yo, history of multiple myelomaLytic bone lesionMRI: intracranial/extracranial extra-axial tumour.Total resection
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MIB-1 P53
Recurrent tumour three years later
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SA SA
MSA M SA M SA
M SA SAB
EMA SMA
CD10 MIB-1 P53
SA
SA
M M
B
RETICULIN
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Additional two cases with similar clinical course and histological
features.
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N
Case #2: 55 y.o.only meningioma in the first surgery
Only myofibroblastic sarcoma in two subsequent surgeries.Four year survival.
Recurrent tumour one year later: only sarcoma
SMA +
Reticulin
Fibronexus
Myofilaments
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c
g h
SMA
GFAP SMA
EMA P53CD10
Case #3: 64 yo: first surgery: atypical meningioma
Recurrence, 5 yrs later: Mixed meningioma/sarcoma
MIB: 10%+
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a
b c
Case #3 Myofibroblastic differentiation of tumour cells
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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”)