Primary pulmonary malignant meningioma with lymph node and liver metastasis in a centenary woman, an autopsy case

PET/CT imaging of giant primary pulmonary meningioma: a case report and literature review

BACKGROUND

An ectopic meningioma, such as a primary pulmonary meningioma (PPM), is a rare type of tumor that primarily originates outside of the central nervous system. The most common presentation of PPM is isolated pulmonary nodules or masses, and most of them are benign. Only sporadic cases have been reported. This case reported a giant primary pulmonary meningioma and systematically reviewed previously reported cases in the literature.

CASE PRESENTATION

A 55-year-old female suffered from asthma after activity, chest tightness, and a persistent dry cough for 2 months. Chest computed tomography (CT) showed a huge mass with calcification in the left lower lobe. And positron emission tomography (PET)/CT revealed mild FDG accumulation of the mass. The mass was finally surgically removed and PPM was confirmed according to histopathologic examinations.

CONCLUSION

PPM is a rare disease with heterogeneity not only in CT features but also in glucose metabolism. FDG uptake levels do not identify benign from malignant, benign PPM may have high FDG uptake and malignant may have low.

Primary pulmonary meningioma with associated multiple micronodules: a case report and literature review

Primary pulmonary meningioma (PPM) is a rare and benign slow growing tumor with good prognosis. It often presents as an asymptomatic, well-circumscribed, solitary pulmonary nodule. Wedge resection is the management of choice for both diagnosis and treatment. Here, we report one case of PPM with increased fluorodeoxyglucose (FDG) uptake and associated micronodules, which was clinically suspicious for malignancy. The patient was a 60-year-old female who presented with persistent shortness of breath for 1 year. Chest computed tomography showed a 1.5-cm well-circumscribed homogenous nodule in the left upper lobe with increased FDG uptake and multiple smaller well-circumscribed micronodules scattered in both lungs. Left upper lobe wedge resection confirmed the diagnosis of PPM. PPM can deceptively mimic malignancy, so recognizing this rare entity and including it in the differential diagnoses of pulmonary nodules, especially with avid uptake of FDG, is crucial to avoid misdiagnosis and overtreatment.

Coexistence of primary pulmonary meningioma and metastatic papillary renal cell carcinoma of the lung: A rare case report with review of the literature

RATIONALE

Primary pulmonary meningioma (PPM) is extremely rare tumor and only a few reports have been reported to date. PPM may be overlooked when it coexists with other types of tumors in the lung. It is essential to have a knowledge of the clinicopathological features of PPM and to recognize this rare coexistence.

PATIENT CONCERNS

A 57-year-old male underwent surgery for papillary renal cell carcinoma, when 2 pulmonary nodules were detected using chest computed tomography.

DIAGNOSIS

The coexistence of benign PPM and metastatic papillary renal cell carcinoma was histologically confirmed.

INTERVENTIONS

A lobectomy was performed.

OUTCOMES

The patient recovered well after surgery and was discharged on postoperative day 4.

LESSONS

Duo to the rarity of PPM, it is easily overlooked, especially when it coexists with other tumors in the lung. The possibility of PPM needs to be taken into account when diagnosing pulmonary nodules in clinical practice.

Multiple primary pulmonary meningioma: A case report and literature review

Lung cancer has become a leading cause of cancer‐related deaths. With the conventional use of low‐dose spiral computed tomography (CT) in physical examinations, an increasing number of small pulmonary nodules are screened. However, primary pulmonary meningiomas (PPMs) are rarely reported. Here, we report the case of a 64‐year‐old woman who had a CT scan during physical examination, which revealed three ground‐glass‐like opacity pulmonary nodules in both lungs. The patient underwent video‐assisted thoracoscopic wedge resection of the right upper and lower lobes. Paraffin sections revealed pulmonary meningothelial‐like and collagenous nodules in the right upper and lower lobes which stained as follows: EMA+, VIM+, SMA‐, S‐100‐, CD34‐, STAT6‐, Ki‐67+ (2%), and CgA‐. Primary pulmonary meningiomas (PPMs) were finally diagnosed. PPM is a kind of rare and benign tumor. Surgery can provide a precise pathological examination, and patients can achieve an excellent prognosis after surgical resection.

Primary pulmonary meningioma: A case report and review of the literature

BACKGROUND

Primary pulmonary meningioma (PPM) is a rare disease that is usually benign. The most common presentation of PPM is isolated pulmonary nodules or masses, so the disease can mimic any other lung tumor on imaging, especially lung cancer or metastasis.

CASE SUMMARY

A 47-year-old asymptomatic woman presented with a well-defined, lobulated pulmonary mass with calcification in the left lower lobe. The mass measured 69 mm × 57 mm × 61 mm and was found during a chest computed tomography (CT) performed for physical examination. Contrast-enhanced CT and positron emission tomography (PET)/CT revealed mild enhancement of the mass, with accumulation of 18-fluoro-2-deoxy-D-glucose (¹⁸F-FDG). Transbronchial biopsy suggested a provisional diagnosis of low-grade neuroendocrine tumor. Subsequent enhanced head magnetic resonance imaging revealed no positive lesions. An open cuff resection of the left lower lobe and wedge resection of the lingual segment were performed. Histopathological and immunohistochemical examination revealed that the mass was a PPM.

CONCLUSION

PPM should be considered in the differential diagnosis of isolated pulmonary masses found incidentally on CT and should be diagnosed based on a combination of radiological and histological features. Surgical resection is currently the main treatment strategy. No recurrence of benign PPMs has been reported after complete resection.

A case report of primary pulmonary meningioma masquerading as lung metastasis in a patient with rectal carcinoma: role of 18F-FDG PET/CT

BACKGROUND

Primary pulmonary meningioma (PPM) is an extremely rare disease, which is often misdiagnosed as lung metastasis. Previous studies indicated that PPM usually showed homogeneous enhancement on enhanced CT and high uptake of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) on positron emission tomography/CT (PET/CT). In this study, we report a case of PPM with atypical enhanced CT and ¹⁸F-FDG PET/CT features in a patient with rectal carcinoma.

CASE PRESENTATION

A 70-year-old male was demonstrated to have rectal carcinoma by biopsy while a solitary pulmonary nodule (SPN) with well-defined edges measuring 13 × 13 × 15 mm was almost simultaneously found in the right lower robe on chest CT scan. Contrast-enhanced CT and PET/CT revealed mild centripetal enhancement of the nodule without accumulation of ¹⁸F-FDG. A thoracoscopic wedge resection of the right lower lobe was finally performed and histopathologic examinations and PET/CT imaging showed that the nodule was a PPM.

CONCLUSION

PPM is a rare disease with heterogeneity not only in blood supply but also in glucose metabolism. ¹⁸F-FDG PET/CT may be an effective method for differentiating benign and malignant SPNs. The diagnosis of PPM depends on pathological and radiological examinations.

The Myth of Prometheus in metastatic meningioma to the liver: from craniotomy to hepatectomy

Metastases from intracranial meningiomas are rare, and among them, meningiomas with hepatic dissemination are extremely rare. Therefore, there are currently no guidelines for staging and treatment of metastatic disease in meningioma, a disease that is a challenge for both the clinician and the pathologist. Our literature review revealed 24 cases of liver metastases originating from intracranial meningiomas. We used them to analyze the pathological patterns of dissemination and to assess the different management strategies available, the most efficient and beneficial being surgery and chemotherapy, especially in the case of meningiomas with hepatic and∕or systemic dissemination.

Primary pulmonary meningiomas: report of two cases and review of the literature

BACKGROUND

Meningiomas rarely occur outside the skull, and primary pulmonary meningiomas (PPMs) are more rare. Only a few cases have been reported in the literature. The clinicopathological characteristics are not clear and it is easy to be misdiagnosed, so it is very important to master its diagnosis and differential diagnosis.

METHODS

We report two women with primary pulmonary meningioma. At the time of physical examination, the small solitary pulmonary nodules were detected on chest radiograph, and wedge resection was performed by Video-assisted Thoracoscope Surgery(VATS), and histologic evaluation showed that the lesions were benign PPMs. The clinicopathological features, immunophenotype and differential diagnosis of PPMs were analyzed, with a review of the cases published in the literature.

RESULTS

The study group comprised of 40 patients, 14 males and 26 females. The median age was 56.5 years (range 18-108). Thirty patients who underwent routine screening studies were asymptomatic but had a pulmonary nodule detected on chest X-ray. Nine patients had respiratory symptoms. Only 1 patient had non-specific symptoms. Most of the PPMs were benign, only 3 cases were malignant. Benign PPMs ranged from 0.6 cm to 6 cm in diameter (median 2 cm). The 3 malignant PPMs were 5 cm, 6.5 cm and 15 cm in diameter. The prognosis of benign PPM resection is good, with almost no recurrence or metastasis. But the two of three malignant PPMs relapsed.

CONCLUSIONS

PPM is very rare. It needs to be diagnosed by combining histology and immunohistochemistry. Diseases that need to be identified include spindle cell mesothelioma, spindle cell thymoma, spindle cell carcinoma, metastatic tumor, etc.

Radiological manifestations, histological features and surgical outcomes of pulmonary meningothelial proliferation: a case series and rethinking

Background

Lung cancer screening with computed tomography (CT) has been adopted worldwide. Consequently, there is an increase of some previously rarely reported lesions, like pleuropulmonary meningothelial proliferation (PMP), which included metastatic pulmonary meningiomas (MPMs), primary pulmonary meningiomas (PPMs) and minute pulmonary meningothelial-like nodules (MPMNs). To date, the understanding of the clinical management of PMP is limited.

Methods

We retrospectively searched PMP (MPMs, PPMs, and MPMNs) on the medical database (May 2005 to April 2019) of our department, and extracted the demographic and perioperative information. The last follow-up was in May 2019.

Results

A total of 78 patients, including 16 (20.5%) males and 62 (79.5%) females, were enrolled, with the median age as 61 (range, 27–78) years. There was 1 case with multiple MPMs, 4 cases with PPMs and 73 cases with MPMNs. On CT, MPMs manifested as round nodules with solid or part-solid components. PPM mainly presented as an isolated, round, solid, and well-circumscribed nodule, with or without lobulation. While MPMNs often showed as multiple, round, randomly-distributed, solid or partly-solid nodules, most of which were in tiny size. Histologically, MPM, PPM, and MPMN had similar morphological and immunohistochemical (IHC) features. As to the surgical outcomes, the case with multiple MPMs had undergone a progression after wedge resection and was in an active monitoring. And the four cases with PPMs and the five cases with MPMNs were all in regular surveillance.

Conclusions

PPM has variable radiological manifestations. But it can be histologically identified by the characteristic features. Although surgery is able to achieve satisfying prognosis, active observation is an alternative in selected cases due to the surgical invasiveness and the indolent nature of the disease.

Primary Pulmonary Meningioma With Rhabdoid Features

Only 1% to 2% of meningiomas have primary extrameningeal location, which is mostly head and neck region. Primary pulmonary meningiomas (PPMs) are even more uncommon with up to 50 cases reported in the literature. Only 5 cases of PPM with confirmed or possible malignancy have been previously described. Three-grade classification of meningiomas with the accordingly growing risk of aggressive behavior of the tumor has been proposed by the World Health Organization. As it is based on correlations between morphological and clinical features of intracranial meningiomas, the analogous prediction of ectopic tumors prognosis remains questionable due to scarce number of cases. In this article, we present a rare case of PPM with rhabdoid features (World Health Organization grade III), which lacked other signs of malignancy. The patient is doing well for 2 years after the thoracoscopic wedge resection without evidence of the disease recurrence.

Primary pulmonary meningioma: A rare case report of aspiration cytological features and immunohistochemical assessment

Ectopic meningioma is a generally rare type of benign tumor that very rarely occurs in the lung. Here, we report the cytological findings of a primary pulmonary meningioma with a particular focus on immunohistochemical (IHC) assessment. A healthy 60‐year‐old woman visited our hospital with an asymptomatic nodule in the right lower lung lobe. She had no particular past‐history and no other tumors in the central nervous system or elsewhere according to an imaging examination. Transbronchial fine‐needle aspiration cytology revealed clusters of spindle cells in a whorled formation and psammoma bodies. The tumor cells exhibited spindle‐shaped cytoplasm, small fusiform or round nuclei and numerous intranuclear cytoplasmic inclusions. IHC staining of the cytological specimen revealed that the tumor cells were positive for epithelial membrane antigen, negative for thyroid transcription factor‐1 and p40, and equivocal for claudin‐1. Progesterone receptor immunoreactivity of cytology specimen resulted negative at first by manual method but retrieved positive by an autostainer. Following segmentectomy, the pathological diagnosis was a meningothelial meningioma. The patient has remained well without recurrence for 36 months postoperatively. Because the cytological preparation exhibited characteristic findings of meningioma, a correct diagnosis based on pre‐operative cytological findings with appropriate IHC would be possible. Here, we report the cytological and IHC features of this case and highlight the importance of IHC‐quality assurance.

Extracranial meningiomas concurrently found in the lung and vertebral bone: a case report

Background

Primary pulmonary meningiomas are very rare, and primary intraosseous meningiomas outside the head and neck region have not yet been reported. We report an extremely unusual case of concurrent meningiomas arising in the pulmonary parenchyma and vertebral bone.

Case presentation

A 40-year-old Asian woman presented with a destructive lesion of the lumbar vertebral bone and a small nodule in the right lung. Five years later, both lesions slightly increased in size. To evaluate both the pulmonary and vertebral lesions, video-assisted thoracic surgery and curettage of the lytic lesion were performed. Both lesions showed similar histopathological findings corresponding to an intracranial meningioma of World Health Organization grade 1. The patient made good postoperative progress and remained free from disease at 41 months after the operation.

Conclusions

Our patient presented with almost synchronous pulmonary and lumbar vertebral intraosseous meningiomas. Regarding the relationship between the two lesions, there are two possibilities: Independent tumors occurred coincidentally or the primary pulmonary meningioma metastasized to the vertebral bone despite its bland morphology. It is important to keep in mind the exceptionally rare condition of extracranial meningioma.

Incidental Metastatic Meningioma Presenting as a Large Liver Mass

Meningiomas are slow growing neoplasms of the central nervous system (CNS). Most of the tumors are benign and distant metastasis from a benign meningioma is rare. Metastasis to the liver, although rare, usually presents with hypoglycemia or occurs in conjunction with a clinical history of an intracranial meningioma or following the resection of a prior CNS meningioma, thus making clinical diagnosis relatively easy. Here we present an unusual case of metastatic meningioma to the liver in a 54-year-old female who presented with an incidental liver mass by ultrasound. Her clinical history and physical examination were unremarkable. A partial hepatectomy revealed a meningioma on histology. Further investigation by imaging studies showed a frontal parasagittal dural mass which was confirmed to be a World Health Organization (WHO) grade 1 meningioma. To our knowledge, this is the first report of a clinically silent metastatic meningioma to the liver without either a concurrent or a previous history of meningioma. Precise diagnosis of this challenging case requires high clinical suspicion, histopathology, and immunohistochemistry.

Computed tomography findings of primary pulmonary meningioma: A case report

RATIONALE

Primary pulmonary meningiomas are extremely rare, and only a few cases have been reported in the medical literature. Imaging findings of primary pulmonary meningiomas have been reported even more rarely.

PATIENT CONCERNS

We present the case of a 54-year-old male patient with cough and sputum lasting for 20 years. This was a case of primary pulmonary meningioma with initial suspicion of a chest wall intercostal neurinoma.

DIAGNOSES

A lung lesion was detected on chest computed tomography (CT) imaging 4 years ago. This case appeared as a solitary well-defined round nodule close to the left chest wall, with heterogeneous enhancement on CT, which inaccurately led to the suspicion of a chest wall intercostal neurinoma.

INTERVENTIONS

A thoracoscopic wedge resection was performed.

OUTCOMES

The postoperative histological diagnosis was primary pulmonary meningioma. After 2 years of follow-up, the patient is still alive without evidence of metastasis or recurrence.

LESSONS

Increased awareness of the CT characteristics of this rare tumor may broaden the radiologist's knowledge base.

Multiple primary pulmonary meningiomas: 20-year follow-up findings for a first reported case confirming a benign biological nature

INTRODUCTION

Primary pulmonary meningiomas (PPMs) are very rare neoplasms, and we reported the first multiple case of PPMs in 1998. Usually, PPMs are slow-growing tumors with a good prognosis. Herein, we reported a rare multiple case of PPMs with an extremely long clinical course.

PRESENTATION OF THE CASE

An 84-year-old Japanese woman with a history of multiple PPMs histologically confirmed as having a right-sided slowly growing lung nodule for 20 years. In 2010, we also reported the additional clinical course in the initial case 10 years after surgery implying a benign biological nature. Subsequent to that report, new lesions appeared in the bilateral lung fields with quite a slow growth rate. She was asymptomatic, and no tumor was observed in the cranial cavity during the course of her disease.

DISCUSSION AND CONCLUSION

This case illustrates rare multiple PPMs and highlights their biological behavior with very slow progression from a most likely benign tumor over a 20-year period.

Primary Pulmonary Meningioma Simulating a Pulmonary Metastasis

Primary pulmonary meningiomas represent a rare tumor entity. Few cases have been reported in the English medical literature, and they have almost all been solitary and benign in nature, with the exception of several extremely rare cases. We report herein a case of PPM that raised suspicion of a pulmonary metastatic tumor initially, as it was depicted as a single, round, small, ground-glass opacity pulmonary nodule on a chest computed tomography scan, in a 55-year-old man with a history of buccal cancer. Increased awareness of the clinical and radiologic characteristics of this rare category can assist a multidisciplinary team to perform adequate management.

Primary pulmonary meningioma: an unusual cause of a nodule with strong and homogeneous enhancement

We report a case of a 61-year-old female with atypical chest pain. The chest CT scan revealed a well-circumscribed large intrapulmonary nodule that showed vigorous and homogeneous contrast enhancement. The nodule was diagnosed as a meningioma after surgery. Metastatic meningioma was excluded by brain and spine MRI scans. Primary pulmonary meningioma usually appears as a solitary well-defined round or lobulated nodule with variable enhancement on CT; this case is unique because of the intense and homogeneous enhancement. Although rare, primary pulmonary meningioma should be considered in the differential diagnosis of a well-defined pulmonary nodule with dense and homogeneous enhancement.