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Lisowski D, Hartrampf PE, Hasenauer N, Nickl V, Monoranu CM, Tamihardja J. Complete loss of E-cadherin expression in a rare case of metastatic malignant meningioma: a case report. BMC Neurol 2023; 23:398. [PMID: 37925427 PMCID: PMC10625181 DOI: 10.1186/s12883-023-03450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Hematogenous tumor spread of malignant meningiomas occurs very rarely but is associated with very poor prognosis. CASE PRESENTATION We report an unusual case of a patient with a malignant meningioma who developed multiple metastases in bones, lungs and liver after initial complete resection of the primary tumor. After partial hepatic resection, specimens were histologically analyzed, and a complete loss of E-cadherin adhesion molecules was found. No oncogenic target mutations were found. The patient received a combination of conventional radiotherapy and peptide receptor radionuclide therapy (PRRT). Due to aggressive tumor behavior and rapid spread of metastases, the patient deceased after initiation of treatment. CONCLUSIONS E-cadherin downregulation is associated with a higher probability of tumor invasion and distant metastasis formation in malignant meningioma. Up to now, the efficacy of systemic therapy, including PRRT, is very limited in malignant meningioma patients.
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Affiliation(s)
- Dominik Lisowski
- Department of Radiation Oncology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany, Germany.
| | - Philipp E Hartrampf
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Natalie Hasenauer
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Vera Nickl
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Camelia-Maria Monoranu
- Department of Neuropathology, Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Jörg Tamihardja
- Department of Radiation Oncology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany, Germany
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2
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Park KS, Kim KH, Park SH, Hwang JH, Lee DH. Intracranial meningioma with leptomeningeal dissemination : retrospective study with review of the literature. J Korean Neurosurg Soc 2015; 57:258-65. [PMID: 25932292 PMCID: PMC4414769 DOI: 10.3340/jkns.2015.57.4.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/01/2015] [Accepted: 02/09/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purposes of this article are to present 5 cases of intracranial meningioma with leptomeningeal dissemination (LD) and investigate the characteristics of this disease. METHODS We present a retrospective case series of 5 females at our institutions (age ranged 21-72 years, mean 54.6 years) diagnosed with LD of an intracranial meningioma after surgery between 1998 and 2013. A database search revealed 45 cases with LD of meningioma in the English literature. Characteristic features were analyzed and compared. RESULTS The incidence rate at our institutions of LD of meningioma was 0.9% (5/534). World Health Organization (WHO) grade was distributed as follows: I : 2, II : 2, and III : 1. Time to LD ranged from 2.5 months to 6.9 years; the patient with WHO grade III had the shortest interval to LD. The patient with an intraventricular meningioma (WHO grade II) had the second shortest interval to LD (1.7 years), and simultaneously revealed both LD and extraneuronal metastases. Four of 5 patients showed a disease progression, with the survival ranging from 1 month to 3.8 years after LD. Based on the literature, the initial tumor was an intraventricular meningioma in 9 patients, and their time to LD was shorter on average (mean 1.9 years). Histologically, 26 of 45 (58%) were initially diagnosed with a WHO grade II or III meningioma, and 6 of 19 patients (32%) with WHO grade I revealed malignant transformation. CONCLUSION This study shows that intraventricular location and histologically aggressive features seem to increase the chance of LD of meningioma.
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Affiliation(s)
- Ki-Su Park
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ki-Hong Kim
- Department of Neurosurgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong-Hyun Lee
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
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3
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Bollag RJ, Vender JR, Sharma S. Anaplastic meningioma: Progression from atypical and chordoid morphotype with morphologic spectral variation at recurrence. Neuropathology 2009; 30:279-87. [DOI: 10.1111/j.1440-1789.2009.01060.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kuroda H, Kashimura H, Ogasawara K, Sugawara A, Sasoh M, Arai H, Ogawa A. Malignant intracranial meningioma with spinal metastasis--case report. Neurol Med Chir (Tokyo) 2009; 49:258-61. [PMID: 19556736 DOI: 10.2176/nmc.49.258] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 48-year-old woman presented with a left cerebellopontine angle mass. Over a 93-month period, the patient underwent seven surgeries, two radiosurgeries, and one external beam radiotherapy. The tumor was histologically benign at the first operation, but exhibited unusually aggressive behavior after failed radiosurgery and demonstrated clinical characteristics of malignancy such as spinal metastasis. The patient underwent gamma knife radiosurgery (GKR) for recurrence after the first operation, despite the tumor being located in a resectable region. The tumor did not respond. Six months after the sixth surgery, the patient presented with progressive lower extremity paraparesis and sensory disturbance below the T11 dermatome. Magnetic resonance imaging revealed multiple intradural mass lesions located at the T2, T11-T12, and L2 levels. She died 4 months after the diagnosis of spinal metastases. Retrospectively, we speculate that if a tumor is located in a resectable region and Simpson grade I or II tumor resection is possible, direct surgery may be a safer option than GKR.
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Affiliation(s)
- Hiroki Kuroda
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
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5
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Abboud M, Haddad G, Kattar M, Aburiziq I, Geara FB. Extraneural metastases from cranial meningioma: a case report. Radiat Oncol 2009; 4:20. [PMID: 19580667 PMCID: PMC2717105 DOI: 10.1186/1748-717x-4-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 07/06/2009] [Indexed: 11/22/2022] Open
Abstract
Extracranial metastases from brain meningiomas is a rare, but well-documented entity. Metastases occur mostly in the lungs, pleura and liver, but may also affect lymph nodes and bones. We report here on a patient who was treated for an atypical brain meningioma with multiple surgeries and multiple sessions of stereotactic radiosurgery with good control of his brain disease. Thirteen years after diagnosis, he developed bilateral large sacroiliac and abdominal metastases.
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Affiliation(s)
- Mirna Abboud
- Department of radiation Oncology, The American University of Beirut Medical Center, Beirut, Lebanon.
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6
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Erkutlu I, Buyukhatipoglu H, Alptekin M, Berkyurek E, Tutar E, Gok A. Spinal drop metastases from a papillary meningioma: a case report and review of the literature: utility of CSF sampling. Med Oncol 2008; 26:242-6. [PMID: 18937081 DOI: 10.1007/s12032-008-9101-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 09/29/2008] [Indexed: 11/28/2022]
Abstract
In this paper, we report a rare case of a 29-year-old boy who presented with papillary meningioma originating from the posterior fossa meninges. After a long, disease-free period, however, spinal drop metastases occurred 32 months after resection of the primary tumor. The primary and metastatic lesions had a similar histological appearance, meaning that multiple spinal metastatic lesions occurred through CSF route even after a gross total resection of the tumor. Tumor seeding during surgery is the evident reason for spinal metastasis, although we strictly adhered to the standard precautions for operations for malignant tumors such as obstruction of the cisterna magna with cotton paddies, and changing surgical gloves and instruments during the operation. In this report, we briefly discuss an exceedingly rare variant of meningioma, the papillary variant, and suggest a new approach, a CSF sampling, in the management of both malignant and benign meningiomas. CSF sampling allows for the early detection of metastasis and of tumor cells before metastasis has occurred, thus allowing treatment to begin as soon as possible. This early detection and management is possibly associated with longer survival. Furthermore, we discussed that meningiomas are tumors that are not as benign as initially thought.
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7
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Shintaku M, Hashimoto K, Okamoto SI. Intraventricular meningioma with anaplastic transformation and metastasis via the cerebrospinal fluid. Neuropathology 2007; 27:448-52. [DOI: 10.1111/j.1440-1789.2007.00786.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Chuang HC, Lee HC, Cho DY. Intracranial malignant meningioma with multiple spinal metastases--a case report and literature review: case report. Spine (Phila Pa 1976) 2006; 31:E1006-10. [PMID: 17172988 DOI: 10.1097/01.brs.0000245952.71265.9b] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report a case and review the literature on intracranial malignant meningioma with metastasis to the spine. SUMMARY OF BACKGROUND DATA Because so few cases have been recognized and reported, the radiologic and pathologic assessment, pathway of metastasis, and the concepts of surgical resection and other palliative management of this disease are still controversial. METHODS A big lobulated mass in the left frontal lobe containing calcifications and tumor bleeding was resected. Pathologic findings indicated malignant meningioma due to bone destruction and dura invasion grossly, and tumor cellular atypism with mitotic activity and massive tumor necrosis microscopically. Radiotherapy followed, and brain computed tomography revealed no definite evidence of recurrence. Three months later, spinal magnetic resonance imaging revealed multiple bone metastasis in lower T-L-S1, and pathologic fracture of L1 with compression of the dural sac and spinal cord. Surgical resection was done for decompression, fixation, and pathologic proof. RESULTS Both pathologic and immunohistochemical survey found evidence consistent with malignant meningioma with spinal metastasis. Advanced treatment was refused, and the patient died. CONCLUSION Spinal magnetic resonance imaging should be performed because of the high spinal metastatic rate, especially when spinal symptoms and signs are present. Immunohistochemical study has an important role in the differential diagnosis of primary or metastatic intracranial neoplasms.
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Affiliation(s)
- Hao-Che Chuang
- Department of Neurosurgery, China Medical University Hospital, Taiwan, Republic of China
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9
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Delgado-López PD, Martín-Velasco V, Castilla-Díez JM, Fernández-Arconada O, Corrales-García EM, Galacho-Harnero A, Rodríguez-Salazar A, Pérez-Mies B. Metastatic meningioma to the eleventh dorsal vertebral body: total en bloc spondylectomy. Case report and review of the literature. Neurocirugia (Astur) 2006; 17:240-9. [PMID: 16855782 DOI: 10.1016/s1130-1473(06)70346-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION One in every thousand intracranial meningiomas metastatize extracranially. Lung and intraabdominal organs are most frequently affected. Only 7% involve vertebrae and just a dozen cases have been reported in the literature. To our knowledge, this is the first description of a total en bloc spondylectomy through a posterior approach for the treatment of an intraosseous metastatic meningioma to the eleventh dorsal vertebra. CASE REPORT In March 1996, a 37 year-old male underwent surgical resection for a left occipital intraventricular benign meningioma (WHO I). He was reoperated in February 2002 due to local recurrence. By the end on 2003 he developed progressively invalidating dorsolumbar pain. MRI studies revealed a T11 intraosseous mass. In March 2004, a percutaneous biopsy and vertebroplasty were performed. The pathological specimen was identified as adenocarcinoma and he initiated chemotherapy. Advice from a second pathologist was seeked, who suggested the diagnosis of intraosseous meningioma. Workup studies failed to reveal any primary tumor. In May 2004 the patient was admitted to our department and a new transpedicular biopsy confirmed the diagnosis. In June 2004 he underwent T11 total en bloc spondylectomy (Tomita's procedure), fusion with bone and calcium substitute-filled stackable carbon-fiber cages, and T9 to L1 transpedicular screw fixation. No postoperative complications ocurred and he is, so far, free from primary and secondary disease. Definite pathology: benign meningioma (WHO I). DISCUSSION Distant metastases from intracranial meningiomas are rare entities, arising from benign lesions in, at least, 60% of cases. Enam et al proposed a specific pathological score to differentiate benign, atypic and malignant meningiomas. Such score correlates with the chance of metastatizing: more than 40% in malignant meningiomas compared to 3.8% of brain tumors overall. The ability to metastatize seems to be linked to vascular or lifatic invasiveness. Metastases ocurr more frequently in angioblastic, papillary and meningothelial variants. Hematogenous (especially venous; Batson's perivertebral plexus), linfatic and cerebrospinal fluid are the main routes involved in the spreading of the tumor. Craniotomy itself may also play a role, for the majority of patients have been previously operated on repeatedly. The interval between the onset of the intracranial disease and the appearance of the metastasis varies from months to many years. The value of transpedicular biopsy is widely recognized (efficacy over 80%) and the suitability of the specimen for pathological examination improves when wide inner caliber trephines are used. In the case presented we applied the oncologic concept of vertebral en bloc resection. We believe this case represents a paradigmatic indication of this technique because it respects the concepts of radical resection and spinal stability, and offers an opportunity for the curation of the disease.
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Cerdá-Nicolás M, Lopez-Gines C, Perez-Bacete M, Roldan P, Talamantes F, Barberá J. Histologically benign metastatic meningioma: morphological and cytogenetic study. Case report. J Neurosurg 2003; 98:194-8. [PMID: 12546373 DOI: 10.3171/jns.2003.98.1.0194] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report on a 75-year-old man with histologically benign fibroblastic meningioma metastasizing to the lung, liver, spleen, and kidney. The original tumor exhibited a complex karyotype involving different structural and numerical anomalies associated with monosomy of chromosome 22. The implication of chromosome 1p36 was confirmed by fluorescence in situ hybridization in most interphase nuclei. Metastases occurred 4 months after incomplete resection with prior therapeutic embolization. The recurrent tumor in turn displayed anaplastic features and an increased Ki-67 labeling index. Genetic alterations in such morphologically benign meningiomas have been implicated in the malignant development and progression of these tumors.
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Affiliation(s)
- Miguel Cerdá-Nicolás
- Department of Pathology, University Clinic Hospital of Valencia, University of Valencia, Spain.
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11
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Lüdemann WO, Obler R, Tatagiba M, Samii M. Seeding of malignant meningioma along a surgical trajectory on the scalp. Case report and review of the literature. J Neurosurg 2002; 97:683-6. [PMID: 12296654 DOI: 10.3171/jns.2002.97.3.0683] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of an 11-year-old boy with a malignant meningioma of the right frontal meninges. The tumor was asymptomatic, despite visible exophytic extracranial growth. Neuroimaging demonstrated an en plaque meningioma bulging into the brain. Six months after the tumor had been totally removed by surgery, an isolated subcutaneous metastasis developed at the right preauricular area of the scalp, originating at the scar left by the first surgery. After removal of this metastasis, radiotherapy was conducted. To date the follow-up examinations have not revealed any additional metastases. To the best of the authors' knowledge, this is the first report of a seeding of a subcutaneous metastasis in a child with a malignant meningioma. The authors review the literature with reference to malignant meningiomas and their formation of metastasis. In cases of malignant meningiomas, piecemeal tumor removal carries the risk of iatrogenic cell dissemination even when precautions are taken.
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Abstract
STUDY DESIGN This report describes a 51-year-old woman with a sacral metastatic meningioma that originated from an intracranial meningioma. OBJECTIVES To describe an unusual presentation of a metastatic meningioma in the sacrum. SUMMARY OF BACKGROUND DATA Extracranial metastases of meningioma are very rare. The phenomenon of metastasis may have more to do with the ability to invade the wall of a blood vessel than with the mitotic activity of a tumor. Therefore, metastases of the meningioma can occur even with a benign histologic picture in the original intracranial meningioma. METHODS A 51-year-old woman had experienced low back pain and sciatica of the left leg for several months. Plain radiographs of the lumbosacral spine showed an osteolytic lesion with an irregular margin that occupied the left side of the sacrum. Magnetic resonance imaging revealed a soft mass invading the left sacrum, ilium, and presacral space. RESULTS Surgical removal of the sacral tumor via an anterior-posterior-anterior approach was done. Histopathologic examination revealed a metastatic meningioma with a meningotheliomatous histologic composition. Sixteen months after excision of the metastatic sacral lesion, the patient was ambulating freely and experiencing mild constipation and urine retention. CONCLUSIONS In this case of metastatic meningioma in the sacrum, which is the first such report to the authors' best knowledge, total excision of the tumor was successful.
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Affiliation(s)
- Yan-Yaw Lee
- Colon & Rectal Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan
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13
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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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14
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Abstract
BACKGROUND Spinal metastasis of intracranial meningiomas has rarely been reported. Three out of ten previously reported cases of malignant meningioma metastasizing to the spine had undergone surgical debulking with no neurological improvement. The authors retrospectively reviewed the treatment course of three patients with malignant meningioma metastasizing to the spine who underwent early magnetic resonance imaging (MRI) and radiotherapy without surgical debulking. CASE DESCRIPTION Three patients with intracranial malignant meningiomas underwent multiple resections of intracranial lesions, and developed spinal intradural metastases an average of 64 months (range, 27-102 months) from their initial presentation. All three patients had at least two operations for recurrent intracranial tumors. All had localized back pain with motor weakness, and MRI scans demonstrated spinal involvement. No surgical exploration was performed for the spinal lesions; rather, all patients received steroids and radiotherapy for the spinal lesions. All three patients improved neurologically after the steroid and radiation treatments, and went on to survive from 3 to 18 months. CONCLUSION Early MRI should be performed in patients with spinal symptoms and signs after the treatment of intracranial meningiomas. Radiotherapy is an effective palliative treatment for spinal metastases.
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Affiliation(s)
- T T Lee
- Department of Neurological Surgery, University of Miami School of Medicine, Florida, USA
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15
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Vinchon M, Ruchoux MM, Lejeune JP, Assaker R, Christiaens JL. Carcinomatous meningitis in a case of anaplastic meningioma. J Neurooncol 1995; 23:239-43. [PMID: 7673986 DOI: 10.1007/bf01059955] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Malignant meningiomas are associated with a high rate of local recurrence, but seldom give remote metastases. Here, we report a case with carcinomatous meningitis occurring 13 months after treatment of the initial tumor. MRI showed no significant abnormalities. CSF contained abnormal cells, and electronic microscopy after cytocentrifugation confirmed their identity with the initial tumor.
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Affiliation(s)
- M Vinchon
- Clinique Neurochirurgicale, CHR de Lille, France
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16
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Ohta M, Iwaki T, Kitamoto T, Takeshita I, Tateishi J, Fukui M. MIB1 staining index and scoring of histologic features in meningioma. Indicators for the prediction of biologic potential and postoperative management. Cancer 1994; 74:3176-89. [PMID: 7982181 DOI: 10.1002/1097-0142(19941215)74:12<3176::aid-cncr2820741217>3.0.co;2-n] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The biology of brain tumors, including cell kinetics, has been studied. Recently, monoclonal antibody to Ki67 (MIB1), a nuclear protein related to cell proliferation, has been analyzed immunohistochemically using tissue prepared from paraffin embedded sections. METHODS The authors assessed the prognostic usefulness of various histologic indicators of the biologic potential of meningiomas in patients who underwent total resection (Simpson's Grade I and II) by evaluating the time to recurrence as an end point. Forty-three patients with a total of 36 meningiomas and 7 hemangiopericytomas were investigated by immunohistochemical analysis using MIB1. RESULTS MIB1 staining index (SI) and histologic score were well correlated with the recurrence-free interval (r = -0.6749, P = 0.002 and r = -0.4939, P = 0.027, respectively) and with each other (r = 0.7909, P < 0.001). The MIB1 SI and histologic score in the nonrecurrence group were significantly lower than those in the recurrence/metastasis group (P < 0.001 and P = 0.001, respectively). The values of these indicators showed that as the value increased, so did the recurrence rate. CONCLUSIONS Evaluation using the MIB1 SI and total histologic score of meningioma is useful in assessing the prognosis as well as postoperative management of these patients.
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Affiliation(s)
- M Ohta
- Department of Neurosurgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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17
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Metastatic Meningioma to the Second Cervical Vertebral Body. Neurosurgery 1994. [DOI: 10.1097/00006123-199403000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Tominaga T, Koshu K, Narita N, Yoshimoto T. Metastatic meningioma to the second cervical vertebral body: a case report. Neurosurgery 1994; 34:538-9; discussion 539-40. [PMID: 8190232 DOI: 10.1227/00006123-199403000-00024] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A rare case of C2 vertebral body metastasis from a parasagittal meningioma is reported. The metastatic lesion was found 13 years after resection of the primary lesion. The primary and the metastatic lesions had a similar and benign histological appearance. Remote metastasis of a meningioma can occur even with a benign histological finding after a variable disease-free period.
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Affiliation(s)
- T Tominaga
- Division of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan
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19
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de Vries J, Graf M, Scheremet R, Troetschler H. Rapid dedifferentiating meningioma with repeated multifocal recurrences and pulmonary metastases. Clin Neurol Neurosurg 1994; 96:58-65. [PMID: 8187384 DOI: 10.1016/0303-8467(94)90031-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 62-year-old woman presented with a convexity meningioma which, after primary surgery, was histopathologically graded as grade II. There followed three more operations due to repeated rapid local recurrences. After each of these three operations histology revealed dedifferentiated grade III tumors. At third recurrence moreover, other multiple tumor masses in the vicinity of the primary tumor site and in the lung were found. These had the same histological appearance as the local recurrences. The patient died 30 months after primary surgery from respiratory failure due to the multiple lung metastases.
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Affiliation(s)
- J de Vries
- Department of General Neurosurgery, University of Freiburg, Germany
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20
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Shuangshoti S. Primary papillary meningioma of the optic nerve sheath: a case of unique location and benign pathology. SURGICAL NEUROLOGY 1993; 39:200-3. [PMID: 8456383 DOI: 10.1016/0090-3019(93)90183-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
I report here a case of primary papillary meningioma of the optic nerve sheath which developed in the left eye of a 54-year-old woman over a period of 20 years. A review of 123 primary papillary meningiomas, including the current instance, disclosed that they tended to occur in young patients of both sexes at an average age of 35 years, with one-fourth of them occurring in the first two decades of life, and with a female/male ratio of 3:2. These meningiomas were most frequent in the supratentorial compartment of the cranial cavity, especially on the cerebral convexity and in the parasagittal region. They were uncommon subtentorially, intraspinally, and outside the central nervous system. Most reported papillary meningiomas were claimed to be malignant, but the tumor of this particular woman was benign pathologically and clinically.
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Affiliation(s)
- S Shuangshoti
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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21
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Akimura T, Orita T, Hayashida O, Nishizaki T, Fudaba H. Malignant meningioma metastasizing through the cerebrospinal pathway. Acta Neurol Scand 1992; 85:368-71. [PMID: 1621502 DOI: 10.1111/j.1600-0404.1992.tb04063.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case of malignant meningioma metastasizing through the cerebrospinal pathway is presented. The primary tumor was a parasagittal malignant meningioma invading into the brain. The tumor seeded to the cerebellopontine angle cistern and thoracic spine after multiple operations. Although this type of tumor borders the CSF, metastasis through the cerebrospinal pathway is rare, and only 18 such cases have been reported (2, 3, 10, 12).
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Affiliation(s)
- T Akimura
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Japan
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22
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Abstract
A patient with an asymptomatic intracranial meningioma was found at autopsy to have multiple pulmonary metastases. Both the meningeal and pulmonary tumors were histologically benign. Only five other patients with apparently benign metastasizing meningiomas have been described.
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Affiliation(s)
- T H Ng
- Department of Pathology, University of Hong Kong, Queen Mary Hospital
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Pasquier B, Gasnier F, Pasquier D, Keddari E, Morens A, Couderc P. Papillary meningioma. Clinicopathologic study of seven cases and review of the literature. Cancer 1986; 58:299-305. [PMID: 3719522 DOI: 10.1002/1097-0142(19860715)58:2<299::aid-cncr2820580215>3.0.co;2-w] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Seven cases of papillary meningioma are reported. The patients, 3 females and 4 males, were aged between 21 and 69 years. Five tumors were supratentorial, 1 was located in the left temporal bone, and 1 in the thoracic spinal canal. Five patients had local recurrences and died within 1.4 to 9 years of the original operation. In Case 2, one small pulmonary metastatic nodule was found at autopsy. Microscopically, these meningiomas showed foci of necrosis, numerous mitotic figures and local invasiveness. Psammoma bodies were occasional or absent. Forty-six papillary meningiomas have been identified in the literature. Certain histologic features (necrosis, high mitotic index, rich peripapillary reticulin network) and evolutive events (high rate of local recurrence, development of distant metastases) suggest that this aggressive variant of meningioma could form a histologic link between syncytial, fibroblastic, and hemangiopericytic meningiomas.
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Pasquier B, Gasnier F, Pasquier D, Keddari E, Morens A, Couderc P. Papillary meningioma: Clinicopathologic study of seven cases and review of the literature. Cancer 1986. [DOI: 10.1002/1097-0142(19860715)58:2%3c299::aid-cncr2820580215%3e3.0.co;2-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Piatt JH, Campbell GA, Oakes WJ. Papillary meningioma involving the oculomotor nerve in an infant. Case report. J Neurosurg 1986; 64:808-12. [PMID: 3701427 DOI: 10.3171/jns.1986.64.5.0808] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A 6-month-old child with an isolated oculomotor nerve palsy was found to have a papillary meningioma infiltrating the nerve along its intracranial course adjacent to the midbrain. The clinical implications of this unusual histological variant are discussed.
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Humphreys DH, Schwartz MR, Jenkins HA. Meningioma: a case of transcranial recurrence managed by base-of-skull technique and a review of the tumor. Otolaryngol Head Neck Surg 1985; 93:563-70. [PMID: 3931034 DOI: 10.1177/019459988509300417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Meningiomas are the most common benign intracranial neoplasms, and although the otolaryngologist rarely sees these lesions, he or she may encounter them in surgery of the skull base. Surgical removal is the primary treatment modality for these meningiomas. To avoid recurrent disease, the best initial therapy is the most extensive procedure that can reasonably be effected. Chemotherapy and irradiation therapy have, at best, only limited roles in treatment.
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Inoue H, Tamura M, Koizumi H, Nakamura M, Naganuma H, Ohye C. Clinical pathology of malignant meningiomas. Acta Neurochir (Wien) 1984; 73:179-91. [PMID: 6516918 DOI: 10.1007/bf01400851] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Nineteen cases of malignant meningiomas-seven haemangiopericytic, two papillary and ten of the anaplastic type-were examined clinicopathologically. These were ten male and nine female patients and eleven of these received reoperation for recurrence. Tumours of the hemangiopericytic type had similar angiographic and macrooscopic features and malignant characteristics were found microscopically in some tumours. There were intratumoral cysts in both cases of the papillary type and these tumours had a high cellularity, an increased number of mitosis, haemorrhage and partially haemangiopericytic patterns. Six cases of the anaplastic type had changed from a benign type at recurrence and those tumours had variable features radiographically and macroscopically. Lack of typical arrangement, a large number of mitoses, increased cellularity, focal necrosis, brain infiltration, pleomorphism and anaplasia were found histologically. Four cases of the anaplastic type were diagnosed at the first operation and these tumours had apparently similar angiographic and macroscopic features, but with variable organoid structures and malignant forms, microscopically. Electron microscopic features are also described. In malignant meningiomas, the recurrence rate was high even in cases of total removal. The outcome for these patients was good in the papillary type, relatively good in the haemangiopericytic type and poor in the anaplastic type. From these results therapeutic indications are also suggested.
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Abstract
The records of 15 patients with a diagnosis of malignant meningioma were reviewed. In one of these patients, in whom invasion of the brain and pituitary gland was the only unusual feature, the tumor was reclassified as benign. Seven tumors, four hemangiopericytomas and two transitional and one syncytial meningioma, were considered to be only borderline-malignant despite necrosis and invasion of the brain, because of few mitoses and regular architecture. Of this group of patients, four men and three women, two are alive and well, three died after incomplete resections, and two succumbed to recurrent tumor that had become inoperable. The other seven patients, six men and one woman, had lesions classified as histologically frankly malignant, on the basis of marked anaplasia and numerous mitoses. These comprised three hemangiopericytomas and three syncytial and one fibrous meningioma. One of these patients is alive and well and the others are dead, three a a result of metastases. The initial clinical course of malignant meningiomas tends to be short but is otherwise indistinguishable from that of benign meningiomas. The chances of recurrence and eventual death are high, and extracranial metastases are not rare. The tumors are most often hemangiopericytomas, but not exclusively so, and men are particularly at risk.
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Abstract
Six cases of papillary meningioma are described. Five patients are still alive 2 months, and 2, 7, 8 and 14 years after the operation respectively. No metastases or recurrences have been noted. One patient died from an intercurrent disease 2 years after operation. In all cases the papillary pattern was associated with one of the typical well known forms of meningioma. One case showed histologic features of anaplasia, i.e.: local high cellularity accompanied by mitotic activity and pleiomorphism. Only one or two features suggestive of a higher growth dynamism were noted in the other cases. The mechanism of the papillary structures is discussed. Vasotropism and a feeble cohesion between the cellular perivascular "crowns" are thought to be responsible for the papillary pattern which should be interpreted as a secondary phenomenon. It appears likely that the papillary pattern of meningioma is not always an expression of anaplasia when no other clinical and histologic signs of malignancy are present.
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Abstract
A series of 17 meningiomas histologically characterized by a papillary pattern is reported. This pattern was invariably associated with other histologic features of malignancy. The tumors often displayed aggressive clinical behavior marked by a high rate of local recurrence or the development of distant metastases. A relatively large proportion occurred in children. It is suggested that this variant of meningioma is sufficiently characteristic to justify its separation as a distinct clinicopathologic entity.
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