Multiple meningiomas: case report and review of the literature

Multiple Intracranial Meningiomas: A Case Series and Review of the Literature

OBJECTIVE

To review the published data to create a more comprehensive natural history of multiple meningiomas (MM).

METHODS

A review of MM published until now was carried out through a Medline search up to August 2018. The use of the "multiple meningiomas" keyword returned 278 articles, and the characteristics analyzed in our present cohort were searched on those publications. Articles without detailed description of clinical findings, neuroimaging confirmation of tumor multiplicity, follow-up at least of 5 years, and clear description of clinical findings were excluded. We added series to this review.

RESULTS

293 patients with MM were analyzed: 220 women and 73 men, with a total of 932 tumors (3.1 tumors per patient). The majority of tumors were located in the convexity (653% to 74.5%). The total number of tumors treated was 429 (43.9%): 338 (78.8%) by surgical resection and 91 (21.2%) by radiotherapy. Histopathologic description was available in 303 of 429 cases, being grade I in 272 (90.3%) cases, with a predominance of the meningothelial subtype (30.7%). Tumor recurrence was described in 32 (8.07%) among 397 and only 10 deaths (3.4%) of 281 reported cases, where this characteristic was evaluated.

CONCLUSIONS

World Health Organization grade I predominance was observed among multiple meningiomas in similarity to single meningiomas. Only a fraction of MM patients (43.89%) needed treatment. A benign tumor behavior was corroborated by the observed low frequency of recurrence and mortality.

Multiple Meningioma in a Patient of Bipolar Disorder: The Dilemma of Detecting Structural Brain Lesions in the Backdrop of a Long Standing Psychiatric Illness

Multiple meningioma often can be clinically silent and may present with only psychiatric symptoms. We report a case of 43-year-old, right handed woman with a 23 year history of long standing bipolar affective disorder, who presented with a mixed episode with psychotic symptoms which did not respond to usual treatment and was further complicated with a different set of symptomatology. MRI brain revealed multiple dural based mass lesions identified to be multiple meningiomas. Patient's symptoms improved after gamma knife stereotactic radiosurgery for the multiple meningioma. Our finding illustrates the need to assess for brain lesions in presence of atypical symptoms, along with unresponsiveness to traditional management with psychotropic medications in patients with bipolar affective disorders.

[Morphological characteristics of meningiomas]

INTRODUCTION

Meningiomas are common intracranial neoplasms which originate from the soft meninges, precisely from meningeal arachnoidal cells. The aim of this investigation was to establish the age and sex distribution of the examinees, localization, frequency and histological types of meningiomas.

MATERIAL AND METHODS

The investigation was carried out in the period from January 2001 to June 2006. It included 490 consecutive patients of both sexes with diagnosed intracranial tumors and undergoing surgical treatment at the Neurosurgery Clinic of the Clinical Center of Vojvodina. The surgery samples were analyzed in the Laboratory of the Institute of Pathology and Histology of the Clinical Center of Vojvodina. Out of 490 patients with diagnosed intracranial tumors, 137 (27.96%) were diagnosed to have meningiomas.

RESULTS

Meningiomas were more frequent in females (63%) than in males (37%) and they were most common in the 50-59 year age group (37.2%). The most common localization of meningiomas was the frontal region (36.5%). Meningiomas were more common on the left side (44.5%). In regard to other histological types of intracranial tumors, meningiomas were more frequent in females (36.3%). The most common histological type of meningiomas was transitional meningiomas (59.1%). The commonest histological types of meningiomas were benign meningiomas (93.4%). Malignant histological types of meningiomas were more common in males (83.3%), whereas benign histological types were more common in females (64.1%).

CONCLUSION

A typical patient with meningiomas is a woman 50-59 years old. The tumor is located in the left frontal region. On histology it is benign, transitional type of meningiomas.