From Imaging to Molecular Pathways: A Comprehensive Narrative Review of the Distinctive Landscape of Secretory Meningioma

BACKGROUND: Secretory meningioma (SM) is an uncommon variety of meningioma, representing about 1-3% of cases. Notwithstanding its benign classification, SM is frequently associated with excessive peritumoral brain edema (PTBE), resulting in considerable morbidity. This study examines the epidemiology, clinical presentation, imaging characteristics, histological features, immunohistochemical profile, and genetic landscape of SM, along with management methods and results. RESULTS: SM is defined by the presence of pseudopsammoma bodies, pronounced immunoreactivity for CEA and EMA, and a unique molecular profile featuring KLF4 K409Q and TRAF7 mutations. Radiologically, PTBE characterized by FLAIR hyperintensity and increased ADC values serves as critical diagnostic indicators. While surgical gross complete resection is the gold standard, significant postoperative tumor bed edema complicates perioperative treatment and may necessitate additional therapies. CONCLUSION: Identifying SM as a unique clinical entity is essential for diagnosis, prognosis, and therapeutic approaches.