Collision tumor of meningioma and malignant astrocytoma

Contiguous Meningioma and B-Cell Lymphoma: A Scoping Review and Case Illustration

BACKGROUND

The diagnosis of a contiguous, synchronous meningioma and central nervous system B-cell lymphoma is rare and associated with paradoxical treatment paradigms. We performed a scoping review of contiguous meningioma and B-cell lymphoma and included an additional illustrative case.

METHODS

The OVID Medline and PubMed databases were systematically searched using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines. Only human clinical reports of contiguous, synchronous meningioma and B-cell lymphoma were included. We concurrently detailed a representative case from our institution.

RESULTS

Nine case reports met our criteria, including the present case. The average age at diagnosis was 67.4 years. Patients showed a female-to-male predominance of 7:2. The diagnosis of synchronous intracranial tumors was not suspected or discovered until after surgical resection in 100% of cases. All meningiomas were grade I on histopathologic diagnosis, while lymphomas were distributed between diffuse large B-cell lymphoma (56%), metastatic lymphoma (22%), Burkitt lymphoma (11%), and follicular lymphoma (11%). All patients underwent surgical resection. Patients (n = 5) treated with adjuvant chemotherapy had evidence of longer progression-free survival (median 12 months; range, 3-18 months) than patients without adjuvant chemotherapy (n = 2; median 2 months; range, 1-3 months).

CONCLUSIONS

Contiguous, synchronous meningioma/B-cell lymphoma is a rare diagnosis that may appear as an inconspicuous solitary intracranial neoplasm on imaging. Based on the limited cases and current treatment of lymphoma, progression-free survival may be contingent on the prompt initiation of chemotherapy targeting the lymphoma rather than surgical resection of the meningeal mass. Providers should prioritize prompt medical management.

A collision tumor of solitary fibrous tumor/hemangiopericytoma and meningioma: A case report with literature review

An intracranial collision tumor is a rare lesion composed of two histologically different neoplasms in the same anatomic location. Even more rare is the collision tumor of a solitary fibrous tumor/hemangiopericytoma (SFT/HPC) and meningioma. The patient was a 46-year-old woman who had a 40 × 35 × 30-mm mass in the vermis of the cerebellum. Histologically, the mass consisted of two different components. One component showed the morphology of meningioma (World Health Organization (WHO) grade I), and the other component exhibited small round cell proliferation with hypercellular density, which was revealed to be SFT/HPC (WHO grade III) based on STAT6 immunohistochemistry. STAT6 showed completely different immunohistochemistry results in these two components (nuclear-negative in meningioma and nuclear-positive in SFT/HPC). Since these two neoplasms are associated with different prognoses, they should be distinguished from each other. When meningioma and an SFT/HPC-like lesion are identified morphologically, it is important to recognize the presence of such a collision tumor composed of meningioma and SFT/HPC, and identify the SFT/HPC component by employing STAT6 immunohistochemistry.

Next-generation sequencing reveals novel mutations in a collision tumor of glioblastoma and meningioma

Primary intracranial collision tumors are rare in patients without predisposing factors. We report such a case in a 42-year-old female who presented with headaches and altered mental status. Imaging revealed a single heterogeneous, rim-enhancing lesion in the left parieto-occipital periventricular region, involving the corpus callosum. Stereotactic biopsy demonstrated glioblastoma. Subsequent tumor resection showed histologic evidence of glioblastoma and meningioma. Next-generation sequencing was performed on both tumor components. The glioblastoma exhibited a CDKN2A homozygous deletion and novel missense mutations in TAF1L and CSMD3, while no definitive genetic alterations were identified in the meningioma. Next-generation sequencing may yield insight into molecular drivers of intracranial collision tumors and aid in identifying future therapeutic targets.

Next-generation sequencing (NGS) reveals novel mutations in a collision tumor of GBM and meningioma. NGS has the potential to yield insight into molecular drivers of intracranial tumors and identify therapeutic targets.

Collision tumor of meningioma and metastatic renal clear cell carcinoma: a case report

Distinct tumors in direct contact with one another are known as collision tumors and collision tumors of meningioma and metastatic renal cell carcinoma have not been previously reported. We report a 71-year-old female with a history of renal cell carcinoma who was presented with slow response and gait imbalance for 4 months. Brain MRI showed a mass in the base of right middle cranial fossa. The mass was completely removed. Histopathologic and radiographic findings provided evidence for a collision composed of meningioma and metastatic renal clear cell carcinoma.

Collision Occurrence of Meningioma and Astrocytoma: A Case Report and Literature Review

A case of collision tumors occurring between two distinct primary brain tumors is reported. A 61-year-old female without history of radiotherapy or phakomatosis presented with progressive ly increasing headache and left hemiparesis. Investigation revealed a meningioma and a Grade II astrocytoma in the right frontal lobe. Simultaneous development of a meningioma and a low-grade glioma at adjacent sites is extremely rare. This is the third case reported in the literature. Some hypotheses are proposed to explain this phenomenon but most likely represent a coincidental event.

Primary Central Nervous System Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type Colliding with Meningioma

BACKGROUND

Collision tumors are defined as coexistence of 2 histologically different neoplasms occurring in the same anatomic location. Such co-occurrence of tumors in the brain is uncommon. To our knowledge, meningioma colliding with extranodal natural killer/T-cell lymphoma has not been described previously.

CASE DESCRIPTION

A 50-year-old man presented with a 1-year history of progressive memory decline and 2 weeks of drowsiness, bradykinesia, and aphasia. Magnetic resonance imaging revealed a heterogeneously enhanced mass beside the left frontal cerebral falx resulting in midline shift. The left frontal lobe mass was resected. Pathologic examination showed the tumor consisted of whorled spindle cells and diffuse medium-sized lymphoid cells. The spindle cells were positive for epithelial membrane antigen and negative for S-100. The lymphoid cells expressed CD3ε, CD56, TIA-1, and granzyme B. Epstein-Barr virus encoded small RNAs were detected by in situ hybridization. No monoclonal T-cell receptor gamma gene rearrangement was detected. Four weeks after surgery, the patient was treated with polychemotherapy and intrathecal methotrexate, but he died 2 months later.

CONCLUSIONS

This is the first report of a unique brain collision tumor consisting of a meningioma and an extranodal natural killer/T-cell lymphoma. Diagnosis depends on histopathology. Awareness of this entity is important to distinguish it from other intracranial tumors.

Collision Tumor of Glioblastoma and Meningioma: Case Report and Literature Review

BACKGROUND

Intracranial primary collision tumors of different histologic types are rare, and their occurrence is still unclear.

CASE DESCRIPTION

We describe a 66-year-old female who presented with headache, nausea, and vomiting. Magnetic resonance imaging scan showed that there were 2 primary intracranial tumors occurring simultaneously at adjacent sites of the right cerebral hemisphere. Tumor pathology showed 2 distinct tumors: meningioma (World Health Organization I) and glioblastoma. This is a rare case in which 2 different intracranial primary tumors occurred at adjacent sites, but the patient had no history of head trauma, neurologic surgery, or radiation therapy.

CONCLUSIONS

According to previous and present reports, the most common type of intracranial primary collision tumor is composed of a benign meningioma and a glioblastoma. During the occurrence of collision tumors, 1 tumor can play a role in the formation and growth of the other.

A Comparative Report on Intracranial Tumor-to-Tumor Metastasis and Collision Tumors

BACKGROUND

The incidence of 2 distinct tumor types occupying the same anatomic location is rarely observed and may be accounted for by 2 separate mechanisms: tumor-to-tumor metastasis and collision tumors, where 2 adjacent tumors invade one another. These rare phenomena arise from distinct mechanisms, which may affect their preoperative recognition, surgical approach, and postoperative care. We review 2 cases, highlighting their identification and perioperative management.

CASE DESCRIPTIONS

In case 1, a 71-year-old patient with a history of sphenoid wing meningioma presented with headache, nausea, and vomiting and was found to have a mass with meningioma and glioblastoma (GBM) characteristics. In case 2, a 61-year-old man with worsening dysmetria in the setting of unintentional weight loss presented with multiple masses in the pelvis, abdomen, lung, and brain. The brain masses were classified as meningioma with intratumoral metastatic adenocarcinoma foci.

CONCLUSIONS

Preoperative recognition of collision tumor and tumor-to-tumor metastasis is imperative for surgical planning, including selecting regions for tissue biopsy and goals of care. Meticulous evaluation of history and imaging and thorough pathologic analysis allow for effective diagnosis and optimal patient outcomes.

Comprehensive analysis of Iranian reports of pediatric central nervous system tumors

PURPOSE

Iran lacks a national registry reporting the data of central nervous system (CNS) tumors in children. Consequently, treatment success and failure rates are unknown, and a centralized system for disease-management recommendations does not exist.

METHODS

To critically evaluate the current state of pediatric CNS tumor studies and reporting in Iran, we performed an extensive retrospective analysis of all known reports identified with multiple search engines.

RESULTS

Of 409 initially retrieved articles, we evaluated 123 matching our inclusion criteria. We further narrowed these reports to 74 by excluding studies pertaining to adult patients only, non-CNS tumors, or brain metastases. We also excluded studies that were performed outside of Iran or that did not contain relevant data from our analysis. We divided the remaining studies into those describing exclusively pediatric patients (3484 patients) and those describing mixed populations of adults and children (18,641 patients). In total, our analysis included 22,125 patients.

CONCLUSIONS

We identified many limitations in the reporting of studies describing the treatment or prevalence of CNS tumors in children in Iran. Our results may guide future efforts in Iran to improve the care for children with CNS tumors and may provide a valuable template for other comprehensive country- and disease-specific retrospective analyses.

Sarcoma-like tumor originating from oligodendroglioma

We present a case of sarcoma occurring at a site of resected oligodendroglioma without preceding radiotherapy or chemotherapy. Oligosarcoma occurring at sites of resected oligodendroglioma or anaplastic oligodendroglioma with sarcomatous components are rare. Although meningioma or sarcoma-like lesions are sometimes reported after glioma-targeted radiotherapy, those without preceding radiotherapy are quite rare. Moreover, cases of sarcoma without oligodendroglial components occurring at a site of resected oligodendroglioma have never been reported. In this case, fluorescent in situ hybridization analysis revealed 1p/19q co-deletion in both the first tumor and second tumors. Additionally, immunohistochemistry revealed mutated isocitrate dehydrogenase 1 in both tumors. Taken together, these findings suggest a monoclonal tumor origin. Consequently, this case may indicate a new mechanism of development of sarcomatous lesions occurring at the site of a resected glioma.

A rare intracranial tumor consisting of malignant anaplastic and papillary meningioma subtypes

Background:

Intracranial tumors with heterogeneous histopathology are a well-described pathologic entity. Pathologically, distinct tumors in direct contact with one another, also known as collision tumors are exceptionally rare, and collision between meningioma subtypes has not been previously described in the literature.

Case Description:

A 79-year-old female with a history of breast carcinoma presenting with visual and motor deficits and imaging/intraoperative findings consistent with separate, distinct lesions. Histopathologic findings provided evidence for a collision between World Health Organization Grade III anaplastic and papillary meningioma.

Conclusion:

We report a possible collision tumor between two separate meningioma subtypes based on the unique radiologic, intraoperative, and histopathologic findings. Submission of multiple pathologic specimens during surgical resection is key for accurate histopathologic diagnosis.

Coexisting differentiated neuroblastoma and ossifying renal tumor of infancy in a patient

We presented a 5-month-old boy with differentiated neuroblastoma and ossifying renal tumor of infancy (ORTI) arising at the left adrenal gland and upper pole of the ipsilateral kidney, respectively. They were located in the adjacent organs with different morphology and immunohistochemistry characteristics. To our best knowledge, coexistence of differentiated neuroblastoma and ORTI in a patient has never been reported. In our report, two contiguous lesions might be represented collision tumor, originated from the same clusters of immature cells and triggered by different mechanism.

Malignant trigeminal nerve sheath tumor and anaplastic astrocytoma collision tumor with high proliferative activity and tumor suppressor p53 expression

Background. The synchronous development of two primary brain tumors of distinct cell of origin in close proximity or in contact with each other is extremely rare. We present the first case of collision tumor with two histological distinct tumors. Case Presentation. A 54-year-old woman presented with progressive atypical left facial pain and numbness for 8 months. MRI of the brain showed left middle cranial fossa heterogeneous mass extending into the infratemporal fossa. At surgery, a distinct but intermingled intra- and extradural tumor was demonstrated which was completely removed through left orbitozygomatic-temporal craniotomy. Histopathological examination showed that the tumor had two distinct components: malignant nerve sheath tumor of the trigeminal nerve and temporal lobe anaplastic astrocytoma. Proliferative activity and expressed tumor protein 53 (TP53) gene mutations were demonstrated in both tumors. Conclusions. We describe the first case of malignant trigeminal nerve sheath tumor (MTNST) and anaplastic astrocytoma in collision and discuss the possible hypothesis of this rare occurrence. We propose that MTNST, with TP53 mutation, have participated in the formation of anaplastic astrocytoma, or vice versa.

Concomitant intraventricular colloid cyst and low-grade astrocytoma of the brainstem in a 16-year-old boy

Multiple primary brain tumors are commonly observed in patients with a history of brain radiation therapy or neurofibromatosis. The concomitant presence of 2 different types of brain tumors in a single location or chamber is a very rare clinical presentation in the absence of such a predisposing factor. The authors report on the case of a 16-year-old boy presenting with different types of brain tumors in 2 ventricular chambers concomitantly. This boy had a medium-sized colloid cyst of the third ventricle and a large fibrillary astrocytoma fungating from the brainstem into the floor of the fourth ventricle. The lesions were successfully excised in 2 separate surgeries. Radiotherapy was used as the adjuvant mode of therapy. There has been no sign of tumor recurrence after 16 months of follow-up. Clinical awareness and recognition of such a combination of tumors is important because they will dictate special treatment strategies depending on the individual biological aggressiveness of each tumor.