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Secretory meningiomas are an uncommon histological subtype of meningiomas whose claim to fame is a predilection for causing significant peritumoral edema 1,2.
It is not clear that epidemiology, clinical presentation, treatment or prognosis differ substantially from more common 'typical' meningiomas, and this information is not repeated here.
Secretory meningiomas histologically are seen to contain glandular lumina with periodic acid-schiff (PAS)-positive, eosinophilic secretory globules (also known as pseudopsammoma bodies), which may be the cause of the frequently encountered peritumoural edema 1,2. These pseudopsammoma body inclusions are cytokeratin (CK) and carcinoembryonic antigen (CEA) positive 2. Of note in at least some patients, elevated levels of CEA are detectable in peripheral blood 2.
Secretory meningiomas are similar to other more common types of meningioma in morphology (e.g. they usually have a discernable dural tail). They do, however, differ from meningothelial meningiomas and fibrous meningiomas (the most common histological variants) in their signal intensity 2, and in the fact that secretory meningiomas very frequently have prominent adjacent parenchymal edema.
The typical MRI signal intensity of secretory meningiomas is 2:
- T1: iso- to hypointense to grey matter
- T2 / FLAIR: hyperintense to grey matter
- T1 C+: vivid homogeneous enhancement
Treatment and prognosis
Disproportionate edema associated with this type of meningioma can results in unexpected postoperative complication so extended sedation, aggressive treatment of peritumoural cerebral edema, and a lower threshold for postoperative imaging are required for this type of meningioma; hence, it is very important to recognize the imaging pattern and warn clinicians before operation so intra-operative frozen sections can be performed and subtype of the tumor determined prior to the transfer of the patient to the ICU for early and more aggressive initiation of the post-op treatments.