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Ishida T, Ikeya S, Suzuki Y, Yoshida H, Asano S, Tominaga T. Efficacy of selective transarterial chemoembolization for recurred liver metastases from intracranial meningioma: A case report. Radiol Case Rep 2023; 18:3076-3079. [PMID: 37434615 PMCID: PMC10331007 DOI: 10.1016/j.radcr.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023] Open
Abstract
Extracranial metastases from intracranial meningioma involve multiple organs with repeatedly recurrence. Due to the rarity of these metastases, management remains to be established, especially in cases that are not amenable to surgery, such as postsurgical relapse and multiple metastases. We present the case of a right tentorial meningioma with multiple extracranial metastases, including postsurgical recurrent liver metastases. The intracranial meningioma was surgically resected when the patient was 53 years of age. The patient was 66 years of age when the hepatic lesion was first revealed, for which an extended right posterior sectionectomy was performed. Histopathology demonstrated a metastatic meningioma. Twelve months after liver resection, multiple local recurrences in the right hepatic lobe were revealed. Because additional surgical resection would put the patient at risk of declining residual liver function, we performed selective transarterial chemoembolization, resulting in a reduction in size and good control without relapse. Selective transarterial chemoembolization for incurable liver metastatic meningiomas could be valuable in palliating patients unsuitable for surgery.
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Affiliation(s)
- Tomohisa Ishida
- Department of Neurosurgery, Iwaki City Medical Center, 16 Kusehara, Uchigo Mimaya-cho, Iwaki-shi, Fukushima, 973-8402, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-cho, Aoba-ku, Sendai, Miyagi, 989-8574, Japan
| | - Shinichi Ikeya
- Department of Gastroenterology, Iwaki City Medical Center, 16 Kusehara, Uchigo Mimaya-cho, Iwaki-shi, Fukushima, 973-8402, Japan
| | - Yasuhiro Suzuki
- Department of Neurosurgery, Iwaki City Medical Center, 16 Kusehara, Uchigo Mimaya-cho, Iwaki-shi, Fukushima, 973-8402, Japan
| | - Hiroshi Yoshida
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigo Mimaya-cho, Iwaki-shi, Fukushima, 973-8402, Japan
| | - Shigeyuki Asano
- Department of Pathology, Iwaki City Medical Center, 16 Kusehara, Uchigo Mimaya-cho, Iwaki-shi, Fukushima, 973-8402, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-cho, Aoba-ku, Sendai, Miyagi, 989-8574, Japan
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2
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Feltracco H, Matar AJ, Smith SA, Blair C, Sarmiento JM. Surgical management of a giant hepatic metastasis from a cranial meningioma 10 years after resection. J Surg Case Rep 2023; 2023:rjad238. [PMID: 37153828 PMCID: PMC10156433 DOI: 10.1093/jscr/rjad238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
Meningiomas are the most common type of primary brain tumor; they have a low risk for extracranial metastases, which are primarily associated with increased tumor grade. Hepatic metastases from cranial meningiomas are extremely rare, with only a paucity of cases reported in the literature and no standardized approach to management. Herein, we report a case of an incidentally discovered giant (>20 cm) metastatic meningioma to the liver treated with surgical resection 10 years following resection of a low-grade cranial meningioma. This report also highlights the use of (68Ga) DOTATATE PET/CT as the diagnostic imaging modality of choice when evaluating for meningioma metastases. To our knowledge, this report describes the largest hepatic metastasis from a cranial meningioma to undergo surgical resection in the literature.
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Affiliation(s)
- Haley Feltracco
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Abraham J Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Savannah A Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Catherine Blair
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan M Sarmiento
- Correspondence address. Clinic Building—A, Suite A5039, 1365 Clifton Rd, Atlanta, GA 30322, USA. E-mail:
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Costea CF, Cucu AI, Bogdănici CM, Scripcariu DV, Dumitrescu GF, Sava A, Ghiciuc CM, Tănase DM, Turliuc MD, Nicoară SD, Schmitzer S, Ciocoiu M, Dragomir RA, Turliuc Ş. The Myth of Prometheus in metastatic meningioma to the liver: from craniotomy to hepatectomy. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2021; 62:351-359. [PMID: 35024723 PMCID: PMC8848289 DOI: 10.47162/rjme.62.2.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- Claudia Florida Costea
- Department of Ophthalmology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Andrei Ionuţ Cucu
- Faculty of Medicine and Biological Sciences, Ştefan cel Mare University of Suceava, Romania
- Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
| | - Camelia Margareta Bogdănici
- Department of Ophthalmology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Dragoş Viorel Scripcariu
- Department of General Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | | | - Anca Sava
- Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Anatomy, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Cristina Mihaela Ghiciuc
- Department of Pharmacology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Daniela Maria Tănase
- Department of Internal Medicine, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Mihaela Dana Turliuc
- Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania
- Department of Neurosurgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Simona Delia Nicoară
- Department of Ophthalmology, Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Speranţa Schmitzer
- Department of Ophthalmology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Manuela Ciocoiu
- Department of Pathophysiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Raluca Alina Dragomir
- Department of Anesthesiology and Oral Surgery, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
| | - Şerban Turliuc
- Department of Psychiatry, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
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4
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Dincer A, Chow W, Shah R, Graham RS. Infiltration of Benign Meningioma into Sagittal Sinus and Subsequent Metastasis to Lung: Case Report and Literature Review. World Neurosurg 2019; 136:263-269. [PMID: 31899401 DOI: 10.1016/j.wneu.2019.12.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Meningioma is an intracranial tumor frequently encountered in the neurosurgical setting. Extracranial disease is a rare occurrence, with a reported incidence in 0.1% of cases. Metastasis is associated with previous craniotomy, venous sinus invasion, local recurrence, and World Health Organization (WHO) grade III tumor. Metastasis of a benign, grade I meningioma is extraordinarily rare. CASE DESCRIPTION We report a case of a 41-year-old with a WHO grade I intracranial meningioma that had invaded and occluded the superior sagittal sinus. Chest computed tomography (CT) scan revealed pulmonary nodules, which were biopsied and confirmed benign meningioma. The metastatic meningiomas were found before resection of the primary tumor, suggesting direct seeding through the venous system versus iatrogenic seeding. Thirteen years later, an additional lung mass was found incidentally on abdominal CT scan for workup of a sarcoidosis. Biopsy and subsequent resection confirmed benign meningioma. A retrospective review of earlier chest CT scans revealed a small lesion that corresponded to the larger lesion found 13 years later. CONCLUSIONS This a rare case of a WHO grade I meningioma involving the sagittal sinus with direct seeding of the pulmonary vascular bed leading to multiple meningioma metastases. The report highlights an increased risk of distant metastases for a benign meningioma with invasion of dural sinuses.
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Affiliation(s)
- Alper Dincer
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Woon Chow
- Department of Pathology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rachit Shah
- Division of Cardiothoracic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Robert S Graham
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, USA.
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Incidental Metastatic Meningioma Presenting as a Large Liver Mass. Case Reports Hepatol 2018; 2018:1089394. [PMID: 29854500 PMCID: PMC5964563 DOI: 10.1155/2018/1089394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/14/2017] [Accepted: 04/02/2018] [Indexed: 12/14/2022] Open
Abstract
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.
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Metastatic meningiomas: an unusual clinical and pathological diagnosis with highly variable outcome. J Neurooncol 2014; 120:411-21. [DOI: 10.1007/s11060-014-1567-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
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7
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Aggressive meningiomas involving the parotid gland. Ann Diagn Pathol 2011; 16:85-90. [PMID: 22056040 DOI: 10.1016/j.anndiagpath.2011.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/05/2011] [Accepted: 08/08/2011] [Indexed: 11/22/2022]
Abstract
Parotid masses remain challenging secondary to the great diversity of primary tumors that may arise in the salivary glands and propensity for regional and even distant metastases to occur in this region. Meningioma must also be considered in the differential diagnosis of parotid masses, whether from direct extension, metastases, or as an extracranial primary. We herein report 4 cases of aggressive meningioma involving the parotid gland and the pathologic considerations in evaluating these tumors.
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Yoshida D, Sugisaki Y, Tamaki T, Saitoh N, Node Y, Shimura T, Teramoto A. Intracranial malignant meningioma with abdominal metastases associated with hypoglycemic shock: a case report. J Neurooncol 2000; 47:51-8. [PMID: 10930100 DOI: 10.1023/a:1006460827300] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A thirty-year-old male with an intracranial malignant meningioma, first diagnosed 9 years ago, with three recurrences was admitted with a hypoglycemic shock. The blood glucose level was 17 mg/dl, requiring treatment with high doses of intravenous and oral dextrose for improvement. A large metastatic tumor in the liver was noted. All hormones and peptides influencing blood glucose levels were in their normal levels. Chemo-embolization and injection of anti-cancer drugs was employed in the management of the metastatic tumor. Positron emission tomography was performed to measure the glucose metabolism of the abdominal tumor and it indicated that glucose consumption within the tumor was much elevated than the surrounding abdominal organs. Hypoglycemia secondary to primary hepatoma or islet-cell cancer has been frequently described, but a complication of metastatic meningioma is an exceedingly rare event. Elevated glucose consumption within the tumor might be addressed as one of the reasons for hypoglycemia, not due to the elevated serum levels of insulin or IGF, but due to the closely related blood glucose level.
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Affiliation(s)
- D Yoshida
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
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Drummond KJ, Bittar RG, Fearnside MR. Metastatic atypical meningioma: case report and review of the literature. J Clin Neurosci 2000; 7:69-72. [PMID: 10847658 DOI: 10.1054/jocn.1998.0153] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extracranial metastasis of an intracranial meningioma is rare. We discuss the clinical, radiological and histopathological presentation of an elderly man with pulmonary metastases from a recurrent meningioma of atypical histology, and review the literature pertaining to this phenomenon.
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Affiliation(s)
- K J Drummond
- Department of Neurosurgery, The Westmead Centre, Sydney, Australia
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10
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Grunenberger F, Bachellier P, Chenard MP, Massard G, Caraman PL, Perrin E, Zapf J, Jaeck D, Schlienger JL. Hepatic and pulmonary metastases from a meningeal hemangiopericytoma and severe hypoglycemia due to abnormal secretion of insulin-like growth factor: a case report. Cancer 1999; 85:2245-8. [PMID: 10326704 DOI: 10.1002/(sici)1097-0142(19990515)85:10<2245::aid-cncr20>3.0.co;2-k] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 42-year-old woman was hospitalized for severe hypoglycemic coma. She had a voluminous hepatic metastasis and multiple small lung metastases from a meningeal hemangiopericytoma initially operated on 11 years earlier. High blood levels of an abnormal form of insulin-like growth factor type 2 (IGF II) associated with low blood levels of insulin, growth hormone, IGF I, and IGF BP3 were observed. After surgical resection of the liver and pulmonary metastases, serum glucose levels and hormonal abnormalities returned to normal.
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Affiliation(s)
- F Grunenberger
- Service de Médecine Interne, Hôpital de Hautepierre, Centre Hospitalier et Universitaire de Strasbourg, France
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Nabeya Y, Okazaki Y, Watanabe Y, Tohnosu N, Yamazaki M, Matsuda M, Iizuka H, Akutsu N, Kono T, Sato H, Kubosawa H. Metastatic malignant meningioma of the liver with hypoglycemia: report of a case. Surg Today 1998; 28:953-8. [PMID: 9744408 DOI: 10.1007/s005950050260] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We herein present the case of a 68-year-old male who suffered an episode of hypoglycemic shock 2 years after undergoing total removal of a bifrontal parasagittal malignant meningioma. Imaging studies revealed three giant hypervascular tumors with a cystic portion in the right lobe, but no confirmed preoperative diagnosis could be made. At laparotomy, liver tumors were found in the medial segment of the left lobe as well as in the right lobe, and thus an extended right lobectomy was performed. All the resected tumors were histologically diagnosed as metastatic malignant meningiomas of the liver. Despite subsequent transarterial chemoembolization for a recurrence in the residual liver, the patient died 11 months after surgery. To the best of our knowledge, only one other case of a hepatectomy for liver metastases from an intracranial malignant meningioma has been reported in the literature, but there has never been any report of surgical treatment for a metastatic meningeal tumor in the liver associated with hypoglycemia. Although our surgical treatment provided effective palliation, the prognostic significance of a surgical strategy for such patients has yet to be established.
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Affiliation(s)
- Y Nabeya
- Department of Surgery, Funabashi Municipal Medical Center, Chiba, Japan
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