Simultaneous occurrence of right supratentorial meningioma and glioblastoma multiforme. Case report

Is simultaneous occurrence of meningioma and glioblastoma a mere coincidence?

BACKGROUND

It is extremely unusual for multiple tumors to arise from different cell types and occur at the same time inside the brain. It is still unknown whether or not the coexistence of meningioma and glioblastoma is connected in any way or if their simultaneous appearance is merely a coincidence.

OBJECTIVE

We conduct a comprehensive literature review on cases of concurrent meningioma and glioblastoma occurrence to elucidate the underlying concepts that may constitute this coexistence.

METHODS

We searched for articles on the topic of glioblastoma coexisting with meningioma in Google Scholar, PubMed, and Scopus. First, the initial literature searches were conducted for study selection and the data collection processes. After evaluating the title and abstract, the papers were selected.

RESULTS

We analyzed 21 studies describing 23 patients who had both glioblastoma and meningioma. There were ten male patients (47.6 %) and thirteen female patients (61.9 %). The mean age of patients at diagnosis was 61 years old (the range 30 to 86). In 17 cases, both tumors were in the same hemisphere (80.9 %). In 5 cases, they were in the other hemisphere (23.8 %), and in one case, the glioblastoma was in the left hemisphere and the olfactory meningioma was In 5 cases, they were in the other hemisphere (23.8 %), and in one case, the glioblastoma was in the left hemisphere and the olfactory meningioma was in the anterior cranial fossa. In 61.9 % of cases, headache was the predominant symptom.

CONCLUSION

Understanding the unique challenges posed by the coexistence of glioblastoma and meningioma is crucial for developing effective treatment strategies. Further investigation into the underlying molecular mechanisms and genetic factors involved in this rare occurrence could pave the way for personalized therapies tailored to each patient's specific needs.

A collision tumor of solitary fibrous tumor/hemangiopericytoma and meningioma: A case report with literature review

An intracranial collision tumor is a rare lesion composed of two histologically different neoplasms in the same anatomic location. Even more rare is the collision tumor of a solitary fibrous tumor/hemangiopericytoma (SFT/HPC) and meningioma. The patient was a 46-year-old woman who had a 40 × 35 × 30-mm mass in the vermis of the cerebellum. Histologically, the mass consisted of two different components. One component showed the morphology of meningioma (World Health Organization (WHO) grade I), and the other component exhibited small round cell proliferation with hypercellular density, which was revealed to be SFT/HPC (WHO grade III) based on STAT6 immunohistochemistry. STAT6 showed completely different immunohistochemistry results in these two components (nuclear-negative in meningioma and nuclear-positive in SFT/HPC). Since these two neoplasms are associated with different prognoses, they should be distinguished from each other. When meningioma and an SFT/HPC-like lesion are identified morphologically, it is important to recognize the presence of such a collision tumor composed of meningioma and SFT/HPC, and identify the SFT/HPC component by employing STAT6 immunohistochemistry.

Next-generation sequencing reveals novel mutations in a collision tumor of glioblastoma and meningioma

Primary intracranial collision tumors are rare in patients without predisposing factors. We report such a case in a 42-year-old female who presented with headaches and altered mental status. Imaging revealed a single heterogeneous, rim-enhancing lesion in the left parieto-occipital periventricular region, involving the corpus callosum. Stereotactic biopsy demonstrated glioblastoma. Subsequent tumor resection showed histologic evidence of glioblastoma and meningioma. Next-generation sequencing was performed on both tumor components. The glioblastoma exhibited a CDKN2A homozygous deletion and novel missense mutations in TAF1L and CSMD3, while no definitive genetic alterations were identified in the meningioma. Next-generation sequencing may yield insight into molecular drivers of intracranial collision tumors and aid in identifying future therapeutic targets.

Next-generation sequencing (NGS) reveals novel mutations in a collision tumor of GBM and meningioma. NGS has the potential to yield insight into molecular drivers of intracranial tumors and identify therapeutic targets.

[Glioblastoma in the region of previously resected meningioma. Case report and literature review]

Combination of meningioma and glioblastoma within the same anatomical region is casuistry. We found only 13 case reports in the available literature. Some of the authors reported induced nature of the second tumor, i.e. development under the influence of the primary neoplasm. We report a patient with glioblastoma of the right frontoparietotemporal region in 3 years after previous resection of benign right-sided meningioma of sphenoid wings. Mathematical analysis of the discovered pattern resulted conclusion about its random nature, i.e. no causal relationship between both neoplasms.

Glioma Simultaneously Present with Adjacent Meningioma: Case Report and Literature Review

A 51-year-old male patient presented to us with an episode of generalized tonic-clonic seizure. Magnetic resonance imaging revealed a dural-based contrast-enhancing lesion in the right temporal lobe and another heterogeneously contrast-enhancing intra-axial lesion in the right insula adjacent to it. Histopathology confirmed it as a meningioma adjacent to an anaplastic oligodendroglioma. This is only the second such case reported in literature. Literature on "adjacent site" gliomas and meningioma was also reviewed.

Collision Occurrence of Meningioma and Astrocytoma: A Case Report and Literature Review

A case of collision tumors occurring between two distinct primary brain tumors is reported. A 61-year-old female without history of radiotherapy or phakomatosis presented with progressive ly increasing headache and left hemiparesis. Investigation revealed a meningioma and a Grade II astrocytoma in the right frontal lobe. Simultaneous development of a meningioma and a low-grade glioma at adjacent sites is extremely rare. This is the third case reported in the literature. Some hypotheses are proposed to explain this phenomenon but most likely represent a coincidental event.

Collision Tumor of Glioblastoma and Meningioma: Case Report and Literature Review

BACKGROUND

Intracranial primary collision tumors of different histologic types are rare, and their occurrence is still unclear.

CASE DESCRIPTION

We describe a 66-year-old female who presented with headache, nausea, and vomiting. Magnetic resonance imaging scan showed that there were 2 primary intracranial tumors occurring simultaneously at adjacent sites of the right cerebral hemisphere. Tumor pathology showed 2 distinct tumors: meningioma (World Health Organization I) and glioblastoma. This is a rare case in which 2 different intracranial primary tumors occurred at adjacent sites, but the patient had no history of head trauma, neurologic surgery, or radiation therapy.

CONCLUSIONS

According to previous and present reports, the most common type of intracranial primary collision tumor is composed of a benign meningioma and a glioblastoma. During the occurrence of collision tumors, 1 tumor can play a role in the formation and growth of the other.

Unusual coexistence of an epidermoid cyst with an atypical meningioma: Case report and review of the literature

Background:

Coexistence of multiple primary intracranial tumors of different cell types has rarely been documented; the association of a meningioma and a glioma has been reported as the most common combination. Hereby, we report an unusual case of a temporal epidermoid cyst coexisting with an atypical meningioma.

Case Presentation:

A 37-year-old male presented with progressive symptoms of raised intracranial progression with progressive loss of vision without any neurological deficit. On admission, magnetic resonance imaging (MRI) revealed a right frontal lesion appearing hypointense T1, hyperintense T2 slightly enhanced after gadolinium and a second right temporal, isointense T1, hyperintense T2 non-enhancing lesion. A right frontotemporal craniotomy was performed that revealed two distinct lesions: The whitish temporal lesion with the pearl appearance reminding of an epidermoid cyst, the second lesion was extraaxial fibrous lesion arising from the falx. Pathology confirmed an atypical meningioma WHO Grade II and an epidermoid cyst.

Conclusion:

The simultaneous occurrence of primary intracranial tumors of different cell types is rare. Epidermoid cysts are slow growing lesions believed to arise from inclusion of ectodermal elements during neural tube closure, while meningiomas arise from arachnoidal cells; their association has rarely been reported previously.

Analysis of a synchronous gliosarcoma and meningioma with long survival: A case report and review of the literature

Background:

The simultaneous occurrence of multiple intracranial neoplasms has been reported, especially in genetic familial syndromes and after cranial irradiation. In the absence of these etiologic factors, some reports showed simultaneous occurrence of glioblastoma and meningioma but the association between gliosarcoma and meningioma is unknown.

Case Description:

We report a case of a 51-year-old woman with synchronous gliosarcoma and meningioma in whom extensive immunohistochemical characterization and molecular profile was performed. The gliosarcoma recurred 21 months after the first resection, reaching 3 years of overall survival. A molecular characterization of all three lesions was performed. None of the lesions showed the presence of mutations in TP53 and BRAF genes. MGMT analysis showed the presence of loss of expression associated with promoter hypermethylation in both gliosarcoma lesions. EGFR overexpression and gene amplification was found only in the recurrent gliosarcoma.

Conclusion:

The immunohistochemistry and molecular data of this unique case, suggest the distinct clonal origin of meningioma and gliosarcoma lesions, and the association of MGMT methylation with the presumable favorable prognosis observed.

Medulloblastoma and juvenile pilocytic astrocytoma presenting as synchronous primary brain tumors in a child: case report

Multiple metastatic brain tumors and multifocal primary brain tumors of a single histological type have been published in the adult and pediatric literature. However, the simultaneous occurrence of multiple primary brain tumors with different cell types is rare. Even more rare is the pediatric presentation of multiple primary brain tumors with different cell types. The authors describe the case of an 8-year-old boy who presented with a 2-week history of progressive headache, nausea and vomiting, and imbalance. Brain MR imaging demonstrated a heterogeneously enhancing mixed solid/cystic mass of the left cerebellar hemisphere and a larger, midline, more homogeneously enhancing lesion of the superior vermis. Spinal MR imaging was unremarkable. The patient underwent a suboccipital craniotomy and subsequent gross-total resection of both mass lesions. Pathological examination revealed the left cerebellar and superior vermian lesions to be a juvenile pilocytic astrocytoma and a medulloblastoma, respectively. The patient did well in the immediate postoperative period, was discharged home, and underwent neurooncological follow-up. To the best of the authors' knowledge, they describe the first known pediatric case in which a medulloblastoma and a juvenile pilocytic astrocytoma presented as synchronous primary brain tumors. They review the literature on multiple primary brain tumors with different histological characteristics and rehash potential mechanisms for their development.

Glioblastoma simultaneously present with adjacent meningioma: case report and review of the literature

The simultaneous occurrence of multiple primary intracranial tumors has been reported previously. However, most of these tumors arise after cranial radiotherapy or in association with familial tumor syndromes. Double tumors of different histologies that are unrelated to radiotherapy or genetic disorders are very rare. We present a case of two primary intracranial tumors occurring simultaneously at adjacent sites. Preoperative gadolinium-enhanced magnetic resonance imaging of these tumors revealed a single continuous lesion. Postoperative histological examination revealed the presence of two distinct tumors, meningioma and glioblastoma multiforme. To elucidate the mechanism of synchronous tumor formation, we performed immunohistochemical analysis of the proteins involved in the receptor tyrosine kinase, Wnt, and Notch signaling pathways. These analyses showed that platelet-derived growth factor (PDGF) receptors-alpha and beta were overexpressed in both tumors, thereby indicating the oncogenic effects of activated signaling of these receptors. The PDGF-mediated paracrine system may induce one tumor from another.

Simultaneous choroid plexus carcinoma and pilocytic astrocytoma in a pediatric patient

Simultaneous primary brain tumors in pediatric patients without prior chemotherapy or radiotherapy, phacomatosis, or known familial history are a rare occurrence. The authors report the case of a 4-year-old boy with simultaneous choroid plexus carcinoma and pilocytic astrocytoma with features of oligodendroglioma. Magnetic resonance imaging studies revealed diffuse heterogeneously enhancing left intraventricular and posterior fossa tumors initially believed most consistent with multicentric choroid plexus carcinomas. A multiple staged resection was carried out for each tumor and gross-total resection was achieved. Upon gross inspection intraoperatively as well as postoperative histological analysis, 2 distinct simultaneous tumors were identified: choroid plexus carcinoma and pilocytic astrocytoma. To the authors' knowledge this is the first case report published identifying 2 distinct tumor types with similar radiological appearances in a pediatric patient with no prior history of radiotherapy, chemotherapy, or phacomatosis.

Acoustic schwannoma and petroclival meningioma occurring as collision tumours: a case report

A case of a collision tumour comprising of an acoustic schwannoma and a petroclival meningioma in a 30-year old male patient is described. Both of these tumours were resected through a retrosigmoid route. The caudal portion of the mass was an acoustic schwannoma while the rostral portion was a distinct well-defined petroclival meningioma. The occurrence of an acoustic schwannoma and a petroclival meningioma in 'collision' has never been reported. The pathogenesis of such a rare entity is discussed and the relevant literature is briefly reviewed.

Simultaneous presentation of meningiomas with other intracranial tumours

Fifteen patients with simultaneous presentation of meningiomas with other intracranial tumours are reviewed. The associated tumours included a brain metastasis in six cases, glioma in three, pituitary adenoma in two, craniopharyngioma in one,acoustic schwannoma in two and brain lymphoma in one. A correct preoperative radiological diagnosis was made in 12 patients; in three others the associated tumour was discovered at operation and by histological studies. A one-stage removal of both tumours through the same approach was performed in nine patients, whereas six others underwent two-stage operations with an interval of 1 - 13 months. The literature relating to meningiomas associated with other intracranial tumours is reviewed and the possible pathogenetic correlations are discussed. A diagnostic pitfall may occur for metastasis into a meningioma, glioma surrounding a meningioma and different suprasellar lesions. The surgical indication and management of meningiomas may be significantly influenced by the presence of another different intracranial tumour.

[Collisiontumour composed of glioblastoma and meningioma-a case report]

A 51 year old caucasian male presented with headache, facial nerve paresis and continuing contraction of the visual field. CT scan revealed a singular intracerebral contrast enhancing lesion in the left frontal lobe. Intraoperatively the tumour was well demarcated. Frozen sections showed a high grade glioma. Paraffin sections revealed, in addition to the gliomatous component, some sharply demarcated nests of meningothelial cells. Immunohistochemistry with glial fibrillary acidic protein and epithelial membrane antigen confirmed a collision tumour consisting of a glioblastoma WHO-grade IV and a meningothelial meningioma WHO-grade I. The coincidence of these two different tumours at the same time and the same location leads us to the speculation, that the collision tumour might have been caused by malignant transformation of a reactive astrogliosis surrounding the meningioma.

Oligodendroglioma and juvenile pilocytic astrocytoma presenting as synchronous primary brain tumors

✓ Multiple metastatic brain tumors and multifocal primary brain tumors of a single histological type are well described in the literature. The concurrent presence of multiple primary brain tumors with different histological characteristics, however, is very rare. The authors describe the first known case in which an oligodendroglioma and a juvenile pilocytic astrocytoma (JPA) presented as synchronous primary brain tumors in the same patient.

This 43-year-old man presented with a 2-month history of progressive headaches, nausea, and vomiting. Magnetic resonance imaging demonstrated an enhancing heterogeneous right medial cerebellar lesion and a larger calcified, nonenhancing, heterogeneous right frontal lesion with surrounding edema and a mass effect. The results of a metastatic workup were unremarkable.

The patient underwent an initial right frontotemporal craniotomy and a subsequent suboccipital craniectomy 2 years later for resection of the posterior fossa lesion. Histological examination revealed the frontal and cerebellar lesions to be an oligodendroglioma and JPA, respectively. A molecular analysis detected a deletion of chromosome 1p36 in the oligodendroglioma, but not in the JPA. After the initial operation, the patient received follow-up care for his oligodendroglioma, but eventually required temozolomide for tumor progression. His condition remains stable both neurologically and according to imaging studies.

The authors describe the first known case in which a low-grade oligodendroglioma and a JPA presented as synchronous primary brain tumors. They review the literature on multiple primary brain tumors with different histological characteristics and discuss potential mechanisms for the development of these lesions.

Simultaneous occurrence of meningioma and glioma in brain: report of two cases

Two patients who presented with a simultaneous occurrence of meningioma and glioma are described. The authors describe their neuroradiological findings, best surgical treatment of this association, aspects of pathology and aetiology, along with a review of literature.

Retroorbital hemangiopericytoma and cavernous sinus schwannoma--case report

An 18-year-old male presented with severe proptosis and blindness in the right eye. Neuroimaging revealed a large and hypervascular tumor in the right retrobulbar region and a large tumor in the left cavernous sinus. Angiography showed the right tumor was extensively vascular, fed by a hypertrophic ophthalmic artery, and the left tumor was moderately vascular, fed by a large middle meningeal artery. Following embolization of the feeder vessels, the right retrobulbar hemangiopericytoma and the left cavernous sinus schwannoma were uneventfully and successfully resected. Such combinations of different pathological lesions present unusual therapeutic challenges.

Two primary brain tumors, meningioma and glioblastoma multiforme, in opposite hemispheres of the same patient

We report a case with double primary intracranial tumors of different cell types without phacomatosis. The patient was hospitalized due to progressive memory impairment, headaches, dysarthria and right hemiparesis. Initial computed tomographic (CT) examinations revealed a large hyperdense tumor over the right frontal lobe, suggestive of an extra-axial meningioma. Additionally, there was unusual brain edema in the contralateral hemisphere that subsequently proved to originate from an intrinsic tumor. Staged craniotomies were used to treat the patient. Pathological examinations confirmed the two tumors to be a meningioma and a glioblastoma multiforme, respectively. The patient made an uneventful recovery after treatment. Although meningioma and glioma represent two common primary intracranial tumors, the simultaneous development of the two tumors is rare. A randomly occurring event most likely accounted for this linkage in the patient. We suggest that extraordinary brain edema far remote from the primary brain lesion warrants special attention for identifying other potentially undetected lesions.

Concurrent adjacent meningioma and astrocytoma: a report of three cases and review of the literature

Three patients presenting with an adjacent meningioma and astrocytoma are described. A review of the literature discusses several modes of neuroimaging and the difficulties in diagnosing simultaneous adjacent tumors. Aspects of the pathology and etiology of these tumors are also reviewed.

Intracranial meningiomas associated with glial tumours: a review based on 54 selected literature cases from the literature and 3 additional personal cases

The simultaneous occurrence of meningioma and glioma is extremely rare. Three new cases and 54 adequately described in the literature are analyzed. Clinical diagnosis may be difficult due to discrepancy between clinical and radiological findings. Unexpected clinical deterioration following removal of a tumour and relapse simulating recurrence may occur. The introduction of CT technology does not seem to have offered the expected contribution to the early diagnosis of these coincidental lesions, at least before the introduction of the newer generation scanners or MRI. While removal of both tumours in one session yielded the best results, surgery for the sole glioma appeared to be associated with an unacceptably high mortality. Although several aetiopathogenetic hypotheses have been suggested for explaining this curious association, coincidental meningioma and glioma are most likely to be different primary brain tumours occurring randomly in the same individual.

Concurrent primary intracranial tumours of different histogenesis

The occurrence of intracranial tumours of diverse histogenesis can be considered occasional. In a careful survey of the literature we have encountered 63 cases of concurrent intracranial tumours: we report five personal observations, too. This review raises the question as to whether the conjoint occurrence of two intracranial tumours is purely coincidental. The statistical analysis of the cases of concurrent intracranial tumours, and the comparison between the frequency found for each different tumour when it is solitary and when it is coincident in a same patient, suggests that a casual connection can be found between tumours of diverse histogenesis.

Reactive glioma in intracranial sarcoma: a form of mixed sarcoma and glioma ("sarcoglioma"): report of eight cases

The clinicopathologic features of eight new cases of combined intracranial sarcoma and glioma are described. This type of mixed cerebral tumor is histologically characterized by a peripheral distribution of the gliomatous elements in relation to a more centrally situated meningeal or intracerebral sarcoma, and by the frequent presence of gradual transitions from reactive to frankly neoplastic astrocytes. In six of the eight cases, the additional development of either infiltrating astrocytoma or frank glioblastoma in the adjacent brain was demonstrated; this was interpreted as a further expression of malignant glial reaction. It is suggested that these tumors be termed "sarcogliomas" to distinguish them from the type of mixed glioma and sarcoma that has recently been redesignated "gliosarcoma."

Meningeoma e glioblastoma concomitantes: registro de um caso

É relatado um caso com associação de glioblastoma heteromorfo e de meningioma meningotelial, cuja manifestação inicial foi crise convulsiva focal. Por ser infrequente a associação de neoplasias intracranianas, discute-se a forma de expressão clínica, as teorias referentes à presença concomitante de tais associações tumorais e, ainda, o valor do diagnóstico pré-operatório no estabelecimento da conduta cirúrgica e do prognóstico em tais ocasiões.