1. Surgical management of extracranial meningioma presenting in the parapharyngeal space in a pediatric patient 
Majestic Tam, Kestutis Paul Boyev, Kondi Wong, Tapan Padhya 
International Journal of Pediatric Otorhinolaryngology Extra 
Volume 7, Issue 2, Pages (March 2012)
DOI: /j.pedex
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2. Fig. 1
T1 coronal image of the right sided parapharyngeal meningioma enveloping the carotid sheath.
International Journal of Pediatric Otorhinolaryngology Extra 2012 7, 79-81DOI: ( /j.pedex )
Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

3. Fig. 2
Axial CT scan shows large R parapharyngeal mass with heavy central calcifications which has obliterated adjacent planes and is displacing the pharyngeal wall. Major vascular structures like the internal jugular vein are completely compressed and thrombosed.
International Journal of Pediatric Otorhinolaryngology Extra 2012 7, 79-81DOI: ( /j.pedex )
Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions

4. Fig. 3
Pathologic microscopic features. (A) Unremarkable appearing, lobular meningioma. H&E 25× obj. (B) Meningioma tumor cells lining clefts and spaces, breaking up into pseudopapillary pattern. 2× obj. (C) Extensive infiltration of perineurium and endoneurium of cranial nerves, cross-section (arrow, psammoma body within endoneurium) 2× obj. (D) Remaining axons (brown, arrow) compressed by infiltrating meningioma tumor cells (red, arrowhead), double labeled immunostain with epithelial membrane antigen (EMA)-red, neurofilament protein (NFP)-brown. 10× obj. (E) Meningioma tumor cells whorling around axons (arrowhead), H&E 25× obj. (F) Red meningioma tumor cells infiltrating through endoneurium wrapping around axons (brown, arrow), EMA-red, NFP-brown. 25× obj. (G) Meningioma, lobular and solid, breaking up into pseudopapillary architecture within lymphovascular spaces. Masson's trichrome, 10× obj. (H) Meningioma tumor cells lining lymphovascular spaces and in lobules and papillae H&E 25× obj. (I) Lymphovascular spaces labeled by CD31 (brown, arrowhead) and two adjacent lymphovascular spaces filled by meningioma tumor cells labeled with EMA (red, arrows). Double labeled immunostain with EMA-red and CD31-brown. 2× obj. Pathologic description. The meningioma has lobular architecture with psammoma bodies and low proliferative activity (MIB-1) typical of transitional meningiomas. However, in adjacent reasons, meningioma tumor cells line clefts, lymphovascular spaces, invades perineurium and extensive involves endoneurium infiltrating collagen and wrapping around clusters and single myelinated axons. The meningioma is solid in areas, breaking up in to pseudopapillary formations, which is a feature of the solid, pseudopapillary form of papillary meningioma. See Fig. 1 for microscopic images and further descriptions.
International Journal of Pediatric Otorhinolaryngology Extra 2012 7, 79-81DOI: ( /j.pedex )
Copyright © 2012 Elsevier Ireland Ltd Terms and Conditions