Biopsy proven metastatic meningioma: A case report and review of the literature

Metastasis of World Health Organization Grade II and Grade III Meningiomas: Long-Term Survival and Associated Factor Analysis

OBJECTIVE

Metastasis of World Health Organization (WHO) grade II or grade II meningiomas are rare. The aim of this study was to investigate their incidence, associated risk factors, and treatment course.

METHODS

Patients with surgically resected WHO grade II or grade III meningiomas were reviewed based on histopathology with the 2016 WHO criteria. Metastasis was diagnosed through whole body image scan followed by surgical resection or biopsy. Clinical factors were analyzed for their association with metastasis.

RESULTS

Among the 131 enrolled patients, metastasis was diagnosed after tumor relapse in 7 (incidence rate 3.6%) at a mean 30.9 months after the initial surgery. The metastasis after tumor relapse group had the worst overall survival, followed by tumor relapse without metastasis and nonrelapse groups (P < 0.001). The independent factors associated with metastasis were major vessel compromise by primary tumors (hazard ratio [HR] = 9.9, P = 0.035), tumor relapse time less than 24 months (HR = 7.0, P = 0.036), and subtotal resection without adjuvant radiotherapy to the primary tumor (HR = 3.5, P = 0.047). Neither grading nor histochemical staining was significantly associated with metastasis, whereas higher vascularity seemed to be more common in metastatic lesions than primary tumors.

CONCLUSIONS

The presence of metastasis contributed to poor outcomes and was related to earlier tumor relapse and major vessel compromise. Subtotal resection should be followed by adjuvant radiotherapy to reduce the risk of metastasis. Further research is warranted to identify circulating or pathologic biomarkers for the early detection of metastasis.

A rare case report of recurrent atypical meningioma with multiple metastases treated with anti-PD-1 and anti-VEGF therapy

Background

Meningioma is the most common type of primary intracranial tumor with 0.1–1% of all primary meningiomas have been reported to develop into metastases. However, there is no proven therapeutic strategy for multiple metastases of meningiomas.

Case presentation

A 60-year-old female accepted total tumor resection of a right frontal lobe meningioma in September 2018, In October 2021, the patient was admitted to hospital because of cough and shortness of breath and diagnosed with metastatic meningiomas. The computed tomography (CT) scan revealed the presence of large masses in the right thoracic and abdominal cavity. After two cycles of anti-PD-1 and anti-VEGF treatment, the symptoms were relieved and the tumor was necrotic. Follow up to June 21, 2022, the patient has been given eleven cycles of the treatment every 3 weeks without tumor progression.

Conclusions

This case showed combined anti-PD-1 and anti-VEGF treatment stimulates peripheral blood immune cells to kill metastatic meningioma cells. Whether combined immunotherapy is more effective for metastatic meningioma needs further exploration.

Low-grade intracranial meningioma with bilateral pulmonary metastases incidentally detected postpartum: a case report and review of the literature

Introduction

Meningiomas are the most commonly encountered intracranial tumors, usually showing indolent behavior. Extra-axial spreading and distant metastases are seldom detected in these tumors, and lung metastasis from a low-grade meningioma is a rare event.

Case presentation

This case report aimed to present the clinical, imaging, and pathological features of a 37-year-old Caucasian pregnant woman with bilateral lung metastases incidentally detected during preoperative workup ahead of surgery for a primary intracranial meningioma. The possible metastatic routes and risk factors of dissemination to the pulmonary circulation were discussed as well.

Conclusion

Metastasis must be considered in patients with intracranial meningiomas accompanied by venous sinus invasion and extension through the calvarium. Thorough paraclinical investigations are suggested in such cases.

Intracranial Grade II Meningioma Oligometastatic to the Cervical Spine

For intracranial meningiomas that metastasize extracranially, an oligometastatic state exists that is intermediate between incurable, widely metastatic disease and non-metastatic curable disease. Similar to oligometastatic cancer, aggressive local treatment of meningioma oligometastases is warranted, as it may be curable. We present a patient with multiply recurrent intracranial meningiomas over 19 years, with a transformation from grade I to grade II histology, with oligometastatic disease to the C5 vertebral body. Three years following definitive spinal stereotactic radiosurgery, she remains without evidence of other metastatic diseases. Our case highlights the oncologic concept that metastatic meningioma need not be widely disseminated and provides the clinical rationale for aggressive local treatment of an oligometastatic meningioma.