Meningioma, Meningeal Hemangiopericytoma (Angioblastic Meningioma), Peripheral Hemangiopericytoma, and Acoustic Schwannoma

Abstract

The relationship between meningeal hemangiopericytoma (angioblastic meningioma), meningiomas of meningothelial derivation, and peripheral hemangiopericytoma is controversial; and immunohistochemical studies have yielded conflicting results. Likewise, immunohistochemistry has been touted as a reliable means of differentiating fibrous meningioma from acoustic schwannoma. By the immunoperoxidase method, we studied 40 meningiomas (11 meningotheliomatous, four transitional, 11 fibrous, three secretory, four metaplastic, one xanthomatous, one papillary, four atypical, one malignant), five arachnoid granulations, 13 angioblastic meningiomas, nine peripheral hemangiopericytomas, and seven acoustic schwannomas. Antisera to vimentin, epithelial membrane antigen (EMA), keratin, S-100 protein, carcinoembryonic antigen (CEA), desmin, factor VIII, Ulex europeaus, and glial fibrillary acidic protein (GFAP) were utilized. All meningiomas and arachnoid granulations stained for vimentin and EMA; 15% and 12% of meningiomas were S-100 and keratin positive, respectively. The latter was noted primarily in areas of secretory (pseudopsammomatous) differentiation. In contrast, all angioblastic meningiomas stained for only vimentin. This profile of immunoreactivity was also seen in the peripheral hemangiopericytomas, with the exception of single cases that stained focally for EMA and S-100 protein, respectively. Acoustic schwannomas all stained positively for S-100 protein, vimentin, and were variably reactive for EMA, a pattern not distinct from meningioma. We conclude that (a) meningiomas express both epithelial and mesenchymal markers as do arachnoid granulations, (b) that angioblastic meningiomas demonstrate only mesenchymal markers, (c) that angioblastic meningiomas express identical markers to peripheral hemangiopericytoma and should thus be considered a variant thereof, (d) among meningiomas, CEA and keratin appear to be relatively specific markers for the "secretory" variant, and (e) because of overlap in S-100 and EMA reactivity, these markers are unreliable in differentiating meningioma from acoustic schwannoma.