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Volume 13
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10.3390/diagnostics13040802
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Article

Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)?

by
Laura Melocchi
1,*,
Giulio Rossi
1,
Mirca Valli
2,
Maria Cecilia Mengoli
3,
Michele Mondoni
4,
Luigi Lazzari-Agli
5,
Giacomo Santandrea
3,
Fabio Davoli
6,
Chiara Baldovini
7,
Alberto Cavazza
3 and
Thomas V. Colby
8
1
Pathology Unit, Department of Oncology, Fondazione Poliambulanza Hospital Institute, 25124 Brescia, Italy
2
Operative Unit of Pathologic Anatomy, Ospedale Infermi, Azienda USL Romagna, 47900 Rimini, Italy
3
Operative Unit of Pathology, Azienda USL/IRCCS, 42123 Reggio Emilia, Italy
4
Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy
5
Pulmonology Unit, Ospedale Infermi, Azienda USL Romagna, 47900 Rimini, Italy
6
Department of Thoracic Surgery, Azienda USL Romagna, S. Maria delle Croci Teaching Hospital, 48121 Ravenna, Italy
7
Cardiovascular Pathology Unit, Department of Pathology, IRCCS, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy
8
Department of Laboratory Medicine and Pathology (Emeritus), Mayo Clinic Arizona, Scottsdale, AZ 13400, USA
*
Author to whom correspondence should be addressed.
Diagnostics 2023, 13(4), 802; https://doi.org/10.3390/diagnostics13040802
Submission received: 1 February 2023 / Revised: 14 February 2023 / Accepted: 15 February 2023 / Published: 20 February 2023
(This article belongs to the Special Issue Advances in the Diagnosis and Management of Tumors/Cancers)
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Abstract

Pulmonary minute meningothelial-like nodules (MMNs) are common incidental findings in surgical specimens, consisting of tiny proliferation (usually no larger than 5–6 mm) of bland-looking meningothelial cells showing a perivenular and interstitial distribution, sharing morphologic, ultrastructural, and immunohistochemical profiles with meningiomas. The identification of multiple bilateral MMNs leading to an interstitial lung disease characterized by diffuse and micronodular/miliariform patterns radiologically allows the diagnosis of diffuse pulmonary meningotheliomatosis (DPM). Nevertheless, the lung is the most common site of metastatic primary intracranial meningioma, and differential diagnosis with DPM may be impossible without clinic–radiologic integration. Herein, we report four cases (three females; mean age, 57.5 years) fitting the criteria of DPM, all incidentally discovered and histologically evidenced on transbronchial biopsy (2) and surgical resection (2). All cases showed immunohistochemical expression of epithelial membrane antigen (EMA), progesterone receptor, and CD56. Notably, three of these patients had a proven or radiologically suspected intracranial meningioma; in two cases, it was discovered before, and in one case, after the diagnosis of DPM. An extensive literature review (44 patients with DPM) revealed similar cases with imaging studies excluding intracranial meningioma in only 9% (4 of 44 cases studied). The diagnosis of DPM requires close correlation with the clinic–radiologic data since a subset of cases coexist with or follow a previously diagnosed intracranial meningioma and, thus, may represent incidental and indolent metastatic deposits of meningioma.
Keywords: meningotheliomatosis; lung; computed tomography; meningioma; transbronchial biopsy meningotheliomatosis; lung; computed tomography; meningioma; transbronchial biopsy

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MDPI and ACS Style

Melocchi, L.; Rossi, G.; Valli, M.; Mengoli, M.C.; Mondoni, M.; Lazzari-Agli, L.; Santandrea, G.; Davoli, F.; Baldovini, C.; Cavazza, A.; et al. Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)? Diagnostics 2023, 13, 802. https://doi.org/10.3390/diagnostics13040802

AMA Style

Melocchi L, Rossi G, Valli M, Mengoli MC, Mondoni M, Lazzari-Agli L, Santandrea G, Davoli F, Baldovini C, Cavazza A, et al. Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)? Diagnostics. 2023; 13(4):802. https://doi.org/10.3390/diagnostics13040802

Chicago/Turabian Style

Melocchi, Laura, Giulio Rossi, Mirca Valli, Maria Cecilia Mengoli, Michele Mondoni, Luigi Lazzari-Agli, Giacomo Santandrea, Fabio Davoli, Chiara Baldovini, Alberto Cavazza, and et al. 2023. "Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)?" Diagnostics 13, no. 4: 802. https://doi.org/10.3390/diagnostics13040802

APA Style

Melocchi, L., Rossi, G., Valli, M., Mengoli, M. C., Mondoni, M., Lazzari-Agli, L., Santandrea, G., Davoli, F., Baldovini, C., Cavazza, A., & Colby, T. V. (2023). Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)? Diagnostics, 13(4), 802. https://doi.org/10.3390/diagnostics13040802

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