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epithelial neoplasms {814,873,1109, 1781,2019,2221,2599}. They should be distinguished from intracranial menin-giomas with extracranial/extraspinal extension into the sinonasal tract {721, 814,2599}. Any age can be affected, and there is a slight female predilection. Men tend to be younger than women by about a decade.

Localization

Sinonasal tract meningiomas involve both the nasal cavity and paranasal sinuses more frequently than either location alone. Most tumours are left-sided {814,873,1109,1781,2019,2221,2599}.

Clinical features

Symptoms include a mass (often polypoid), nasal obstruction, epistaxis, sinusitis, pain, headache, seizure, exophthalmos, periorbital edema, visual disturbance, ptosis, and facial deformity {814,873,1109,1781,2019,2221,2599}. Symptoms are present for an average of 4 years.

Macroscopy

The tumours range up to 8 cm, with a mean of about 3 cm. They may infiltrate bone and rarely ulcerate the mucosa. The cut surface is grey-white, tan or pink, gritty, firm to rubbery. Calcifications and fragments of bone are frequently visible.

Tumour spread and staging

Primary extra-cranial meningiomas have not been reported to metastasize {814, 873,2019,2599}.

Histopathology

Sinonasal meningiomas can exhibit a variety of histological patterns, most commonly meningotheliomatous, characterized by lobules of cells with whorl formation, indistinct cell borders, and bland nuclei with delicate chromatin {1329,2599}. Intranuclear pseudoinclusions and psammoma bodies are common. Other variants can also occur in the sinonasal tract, such as transitional, metaplastic (lipidized cells within tumour), and psammomatous type {1329}.

Immunoprofile

Meningiomas are immunoreactive for epithelial membrane antigen and vimentin, but usually negative for cytok-eratin, although rare lesions can exhibit focal and weak cytokeratin immunoreac-tivity. They are frequently positive for progesterone receptor (50%) and occasionally for oestrogen receptor (25%). Glial fibrillary acidic protein and smooth muscle actin are negative.

Differential diagnosis

The differential diagnoses include carcinoma, melanoma, aggressive psammo-matoid ossifying fibroma and follicular dendritic cell sarcoma/tumour {2599, 2771}.

Histogenesis

Meningiomas are derived from arachnoid cap cells located extra-cranially within the sheaths of nerves or vessels.

Prognosis and predictive factors

Complete surgical extirpation is sometimes difficult, and accounts for the up to 30% recurrence rate {1109,2019,2599}. The rare deaths are related to compromise of mid-facial structures or complications of surgery, rather than the aggressive nature of the tumour. Histologic features (such as hypercellu-larity, nuclear pleomorphism, necrosis), proliferation index and progesterone receptor status do not influence prognosis {1138,1139,1426,1666,2599}.

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