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Case Report
Primary pulmonary meningioma or large meningothelial-like nodule? A clinicopathological dilemma
1 St. Joseph’s Healthcare Hamilton Charlton Campus, Hamilton, Ontario, Canada
2 Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
3 Department of Medical Imaging, McMaster University, Hamilton, Ontario, Canada
4 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
Address correspondence to:
Moaz Alowami
St. Joseph’s Healthcare Hamilton Charlton Campus, Hamilton, Ontario
Canada
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Article ID: 101526Z01MA2025
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Alowami M, Agzarian J, Haider E, Bonert M, Naqvi A. Primary pulmonary meningioma or large meningothelial-like nodule? A clinicopathological dilemma. Int J Case Rep Images 2025;16(2):73–78.ABSTRACT
Introduction: Primary pulmonary meningiomas (PPMs) are rare ectopic tumors that potentially arise from displaced embryonic arachnoid cells that are isolated outside the dura mater. Its presence outside of the central nervous system poses inherent challenges. We report a case of a primary pulmonary meningioma discovered after a 12-year follow-up for a presumed benign lung lesion.
Case Report: A 47-year-old male with a 17-year history of severe, undiagnosed right-sided subxiphoid and periumbilical pain was monitored for a right middle lobe lung mass that grew from 2.2 cm to 3.4 cm over 12 years. Initially, the transthoracic needle biopsy suggested a solitary fibrous tumor. Video-assisted thoracoscopic wedge resection with concomitant biopsy displayed the characteristic histomorphology, including whorling and psammomatous calcification. Positive immunohistochemical staining for epithelial membrane antigen (EMA) and progesterone receptor (PR) supported the diagnosis of clinically confirmed PPM.
Conclusion: This interesting case illustrates that primary pulmonary meningiomas can mimic other tumors and may be associated with atypical symptoms like chronic pain. In this 12-year monitored case, surgery relieved the patient’s debilitating 17-year-long chronic pain. Additionally, a novel nomenclature system was developed to help distinguish between PPMs and large meningothelial-like nodules.
Keywords: Pathology, Pulmonary meningioma, Pulmonary meningothelial-like nodules
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Acknowledgments
Artificial Intelligence (AI) Statement: No AI was utilized in the formulation and drafting of this manuscript.
Author ContributionsMoaz Alowami - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
John Agzarian - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Ehsan Haider - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Michael Bonert - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Asghar Naqvi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionDr. Asghar Naqvi is the guarantor of submission and accepts full responsibility for the integrity of the work, had access to all the data in the study, and controlled the decision to publish.
Source of SupportNone
Consent StatementIn accordance with the research ethics board, patient consent was not required because no patient identifiers were used.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Moaz Alowami et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
