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 SA M
MIB-1
P53
CD10 SA B SA SA M

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

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

7. Case #3: 64 yo: first surgery: atypical meningioma
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”)