To investigate the clinicopathological features, immunophenotype, differential diagnosis, treatment and prognosis of secretory meningioma (SM). The clinical and pathological data of 5 patients with SM were retrospectively analyzed, and their pathomorphological features, PAS histochemical staining and immunophenotypic features were observed. Among the 5 patients, 3 were male and 2 were female, aged from 30 to 74 (51.4 on average) years old. There was 1 case that occurred in cerebellar vermis, 1 case in the right frontotemporal region, 1 case in multiple lesions at the bottom of anterior cranial fossa and in the right cerebral falx, and 1 case in the left and right cerebral falx respectively. Under the light microscope, the tumor cells were round or oval, arranged in a spiral shape, with relatively consistent cell sizes, rich and lightly stained cytoplasm, and unclear boundaries; the tumor cell nucleus was large, round or oval, with clear nuclear membrane, some nuclear chromatin on the edge and rare mitotic figures. In some areas, eosinophilic inclusions of varying sizes, single or cluster distributed could be seen in the cytoplasm of tumor cells, and there was a clear halo around the eosinophilic inclusions. The eosinophilic inclusions were positive for PAS staining. Immunohistochemical staining showed that all cases were positive of EMA, Vimentin, and PR in the tumor cells; CK-pan (AE1/AE3) and CEA showed positivity in eosinophilic inclusions and some tumor cells around them; S-100, CD34, GFAP, Oligo-2 were all negative and Ki-67 proliferation index was about 1%–3%. The pathological diagnosis of all these 5 cases was SM, grade I, based on the 2016 World Health Organization criteria of Central Nervous System Tumor. After follow-up for 20 to 120 months (67.8 months on average), there was no recurrence or metastasis. SM is very rare, with unique pathological morphological features and immunophenotype, low clinical stage, and good prognosis.