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

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.

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.

Solitary pulmonary metastasis after meningioma surgery of the head: a case report

Background

Meningioma is the most common type of benign primary brain tumor that is rarely associated with distant metastasis. No established treatment strategy for metastatic meningiomas exists to date. Herein, we report a case of solitary pulmonary metastasis of meningioma detected 2 years after neurosurgical resection of the primary tumor.

Case presentation

A 75-year-old male patient underwent neurosurgical resection of a convexity meningioma (World Health Organization grade II atypical meningioma), followed by postoperative radiotherapy for the residual tumor. Two postoperative years later, a solitary 10-mm pulmonary nodule in the left lower lung lobe was detected on chest computed tomography. The patient underwent video-assisted thoracoscopic left lower lobectomy for suspected pulmonary metastasis of meningioma. The pathological diagnosis was solitary pulmonary metastasis of meningioma. No sign of further recurrence was noted at 8 months postoperatively.

Conclusions

We present a rare and unique surgical case of solitary pulmonary metastasis of meningioma. Further investigation is necessary to establish the standardized treatment strategy for metastatic meningiomas.

Primary pulmonary meningioma presenting as multiple lung nodules: A case report

Primary pulmonary meningioma (PPM) is a very rare and mostly benign disease. Although PPM is incidentally detected as a solitary pulmonary nodule on X-ray or chest computed tomography, it does not have unique radiological characteristics; thus, it is difficult to differentiate it from other lung tumors. A healthy 54-year-old man visited our hospital because of multiple variable-sized lung nodules. He had no contributive medical history and no abnormality that was suggestive of extrapulmonary malignancy. Video-assisted thoracoscopic wedge resection was undertaken for diagnosis, and the tumor cells were histopathologically confirmed as PPM. Brain magnetic resonance imaging revealed no intracranial tumor. The patient has been well and without any progression of the remaining lesions over 24 months. Here, we present the clinicopathological features of this case in which the patient's nodules were mistaken for multiple metastatic lung nodules.

Diagnostic and Management Considerations in a Patient With Primary Pulmonary Meningioma With Associated Micro-Solid Nodules

Primary pulmonary meningiomas (PPMs) are rare mesodermal tumors that arise in the lung and are most often incidentally identified as single pulmonary nodules. Most cases of PPM are benign, and surgical resection remains the primary curative treatment. We describe the case of a 65-year-old asymptomatic female who presented with an incidentally identified 2.5 x 1.7-cm lobulated, non-calcified mass in the right lower lobe of the lung, which was diagnosed as PPM that had low fluorodeoxyglucose (FDG)-avidity and associated sub-centimeter nodules present in the same lobe. The patient was closely monitored and the nodules showed essentially no interval enlargement over several months. Given the disparate locations and small sizes of the nodules, no surgical resection was planned. The patient remained clinically stable, and close medical monitoring was determined to be the best course of action. Our case highlights the viability of medical monitoring as an alternative to surgery in asymptomatic patients with benign PPMs that have associated micronodules.

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.