Primary Extracranial Meningioma Presenting as a Cheek Mass
A 66-year-old woman presented with a non-tender mass of the right cheek, which slowly increased in its size over 3 years. Three years ago, she had visited with the same lesion. However, she had been lost to follow-up after computed tomography (CT), and the mass had gradually expanded over the time. Physical examination revealed a hard, mobile round mass with about 2 cm diameter. The overlying skin and cheek sensation was normal. She had a history of left frontal bone and orbital wall fracture due to traffic accident 7 years ago. Findings of fine needle aspiration biopsy showed clusters of epithelioid cells suggesting benign tumor such as salivary gland tumor or skin adnexal tumor. Nasal cavity was normal on endoscopic examination. Preoperative CT scan revealed a heterogenously enhanced mass in the subcutaneous fat layer of the right cheek, with well defined margin (). Tumor diameter has increased about 2 times compared to that of 3 years ago. There was no evidence of any intracranial mass lesion except encephalomalacia of the frontal lobe.\nUnder general anesthesia, she underwent complete mass excision via lateral rhinotomy incision. Intraoperative frozen biopsy was compatible with benign lesion. The tumor was surrounded by unclear and thin fibrous capsule, and tethered to the surrounding soft tissue. The relationships of the tumor with the infraorbital nerve was not identified. There was no postoperative morbidity such as cheek sensory defect. She was discharged three days after surgery. She had shown no signs of recurrence during a follow-up period of 18 months.\nMicroscopic examination revealed a poorly-defined tumor which is haphazardly admixed with mature adipose tissue and normal skeletal muscle. The tumor was composed of uniform, epithelioid cells showing delicate chromatin pattern, and characteristic meningothelial whorls were frequently observed (). There were several foci of psammoma bodies within meningothelial whorls. Neither mitotic figures nor significant nuclear pleomorphism was identified. Immunohistochemical studies revealed that tumor cells were reactive for epithelial membranous antigen (EMA), focally positive for S-100, but negative for HMB-45, smooth muscle actin, CD31, CD34, and CD68. Additionally, Ki-67 was found to have low expression index. These histological and immunohistochemical findings were compatible with meningothelial meningioma. This case report was approved by Institutional Review Board of Hallym University Sacred Heart Hospital.