Is primary pulmonary meningioma a giant form of a meningothelial-like nodule? A case report and review of the literature

Primary pulmonary meningioma presenting as a pulmonary ground glass nodule: a case report and review of the literature

BACKGROUND

A primary pulmonary meningioma is an extremely rare entity. Primary pulmonary meningiomas manifested with a ground glass nodule are a very rare occurrence in clinical practice.

CASE PRESENTATION

In this study, we report a case of a primary pulmonary meningioma with atypical computed tomography features. A 59-year-old Han Chinese female came to our hospital for treatment and reported that her physical examination revealed a ground glass nodule in the right lung for over 3 months. The histologic result revealed a primary pulmonary meningioma. The patient underwent a thoracoscopic lung wedge resection of the right upper lobe for a ground glass nodule. After 1 year of follow-up, the patient is still alive without evidence of metastasis or recurrence.

CONCLUSIONS

Primary pulmonary meningiomas could have a variety of radiological findings. As there are no specific radiologic features for the diagnosis of primary pulmonary meningiomas, complete resection of the lesion is required for both diagnosis and treatment. It is necessary to note the imaging features of primary pulmonary meningiomas, presenting as a ground glass nodule; this rare tumor should be considered in differential diagnoses.

Primary pulmonary meningioma: a case report

An asymptomatic 68-year-old woman, with a history of breast cancer 19 years ago, was unexpectedly found to have primary pulmonary meningioma during medical evaluation. This discovery is exceedingly rare, with only about 70 cases reported worldwide. Following uncomplicated surgical removal of the mass, the patient was discharged in good health on the third day after the procedure. Notably, initial analysis of a frozen tissue sample indicated hamartoma, but subsequent immune-histochemical pathological examination confirmed the presence of meningioma. Given the uncommon nature of this tumor, it is essential to report such cases to raise awareness about pulmonary meningioma as a potential cause of solitary lung nodules. This awareness can help prevent unnecessary chemotherapy or surgical interventions.

Rapid growth of primary pulmonary meningioma with hemoptysis

While lung cancer is the predominant neoplasm causing hemoptysis, rare benign neoplasms can also be associated with hemoptysis. A 60-year-old woman presented with cough and hemoptysis. Chest computed tomography revealed an oval-shaped, well-circumscribed solitary mass (10 cm in size) in the right lower lobe, which had grown rapidly over the past year. The presence of intramass air bubbles and a surrounding halo of ground-glass opacities suggested the hemorrhagic rupture of a circumscribed hematoma into the surrounding lung tissue. Subsequent right lower lobectomy revealed a well-demarcated hematoma; its wall consisted of nonatypical spindle tumor cells, which were histologically diagnosed as meningioma. No meningioma was observed in the central nervous system, leading to the diagnosis of primary pulmonary meningioma. This case highlights PPM as a rare benign tumor (World Health Organization grade 1) capable of rapid development due to intratumoral hemorrhage, presenting with hemoptysis.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

In this editorial, we comment on an article by Ruan et al published in a recent issue of the World Journal of Clinical Case. Pulmonary meningothelial proliferative lesions, including primary pulmonary meningiomas, minute pulmonary meningothelial-like nodules, and metastatic pulmonary meningiomas are rare pulmonary lesions. These lesions are difficult to differentiate from lung cancers based on clinical and imaging manifestations. Herein, we briefly introduce the clinical, imaging, and pathological characteristics of these lesions and discuss their pathogenesis to strengthen the current understanding of pulmonary meningothelial proliferative lesions in clinical diagnosis and therapy.

Pulmonary primary meningioma: A report of two cases and review of the literature

Introduction

Primary pulmonary meningioma (PPM) is rare, mostly asymptomatic, and difficult to recognize preoperatively. In this report, we describe two new cases of PPM and provide an updated review of the literature to enhance our understanding of PPM.

Case presentation

The first patient was a 53-year-old woman with an asymptomatic solitary pulmonary nodule in the right lower lobe on chest computed tomography (CT). Wedge resection of the right lung was performed and histological features of benign PPM were pathologically confirmed, which was further supported by immunohistochemistry. The second patient was a 63-year-old man who had a left pulmonary nodule during routine physical examination. CT revealed a solid nodule in the outer basal segment of the left lower lobe. The patient underwent a wedge resection of the left lower lobe and mediastinal lymph node dissection. Postoperative pathology confirmed the presence of two tumors: one adenocarcinoma and one PPM. Both cases were confirmed to be benign PPM (grade I) by pathological examination, with histological subtypes of fibrous and psammomatous.

Conclusions

Radiological imaging is crucial for the early detection of PPM, while pathological examination is necessary to confirm the diagnosis. Surgical treatment is recommended, and intraoperative frozen sections are essential for determining the extent of the operation.

Primary pulmonary meningioma: A case report

Meningioma is a common benign tumor originating in the brain, but primary pulmonary meningioma is very rare. It is usually benign, slow-growing, and responds well to treatment. The most common manifestation is an isolated pulmonary nodule that radiologically resembles a benign primary lung tumor. Herein, we report a case of a complete thoracoscopic resection of a primary pulmonary meningioma.

Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)?

Pulmonary minute meningothelial-like nodules (MMNs) are common incidental findings in surgical specimens, consisting of tiny proliferation (usually no larger than 5-6 mm) of bland-looking meningothelial cells showing a perivenular and interstitial distribution, sharing morphologic, ultrastructural, and immunohistochemical profiles with meningiomas. The identification of multiple bilateral MMNs leading to an interstitial lung disease characterized by diffuse and micronodular/miliariform patterns radiologically allows the diagnosis of diffuse pulmonary meningotheliomatosis (DPM). Nevertheless, the lung is the most common site of metastatic primary intracranial meningioma, and differential diagnosis with DPM may be impossible without clinic-radiologic integration. Herein, we report four cases (three females; mean age, 57.5 years) fitting the criteria of DPM, all incidentally discovered and histologically evidenced on transbronchial biopsy (2) and surgical resection (2). All cases showed immunohistochemical expression of epithelial membrane antigen (EMA), progesterone receptor, and CD56. Notably, three of these patients had a proven or radiologically suspected intracranial meningioma; in two cases, it was discovered before, and in one case, after the diagnosis of DPM. An extensive literature review (44 patients with DPM) revealed similar cases with imaging studies excluding intracranial meningioma in only 9% (4 of 44 cases studied). The diagnosis of DPM requires close correlation with the clinic-radiologic data since a subset of cases coexist with or follow a previously diagnosed intracranial meningioma and, thus, may represent incidental and indolent metastatic deposits of meningioma.

Primary pulmonary meningioma with associated multiple micronodules: a case report and literature review

Primary pulmonary meningioma (PPM) is a rare and benign slow growing tumor with good prognosis. It often presents as an asymptomatic, well-circumscribed, solitary pulmonary nodule. Wedge resection is the management of choice for both diagnosis and treatment. Here, we report one case of PPM with increased fluorodeoxyglucose (FDG) uptake and associated micronodules, which was clinically suspicious for malignancy. The patient was a 60-year-old female who presented with persistent shortness of breath for 1 year. Chest computed tomography showed a 1.5-cm well-circumscribed homogenous nodule in the left upper lobe with increased FDG uptake and multiple smaller well-circumscribed micronodules scattered in both lungs. Left upper lobe wedge resection confirmed the diagnosis of PPM. PPM can deceptively mimic malignancy, so recognizing this rare entity and including it in the differential diagnoses of pulmonary nodules, especially with avid uptake of FDG, is crucial to avoid misdiagnosis and overtreatment.

Malignant primary pulmonary meningioma with bone metastasis

Primary pulmonary meningioma is extremely rare and only <45 cases have been reported since its first report by Kemnitz and Heinrich (Meningioma of lung: first report with light and electronmicroscopic findings. Ultrastruct. Pathol. 1982;3:359-65). Among these cases, only five cases were malignant or atypical. A 67-year-old female with primary pulmonary meningioma underwent thoracoscopic pulmonary wedge resection of the left lower lobe a year before. She had been aware of left thigh pain for 9 months, then she was referred to our division. Positron emission tomography-computed tomography suspected multiple bone metastasis including frontal bone, mandible, left scapula, rib, vertebra, pubis, left femur and sternum. We performed a needle biopsy of the sternum. Histopathological diagnosis was metastasis of primary pulmonary meningioma, World Health Organization grade III. We treated her with denosumab and radiation therapy targeting the left femur. Two months after the treatment, the pain had decreased and she could walk with no cane. No case of malignant extracranial meningioma with bone metastasis have been reported.

Primary Pulmonary Meningioma With Rhabdoid Features

Only 1% to 2% of meningiomas have primary extrameningeal location, which is mostly head and neck region. Primary pulmonary meningiomas (PPMs) are even more uncommon with up to 50 cases reported in the literature. Only 5 cases of PPM with confirmed or possible malignancy have been previously described. Three-grade classification of meningiomas with the accordingly growing risk of aggressive behavior of the tumor has been proposed by the World Health Organization. As it is based on correlations between morphological and clinical features of intracranial meningiomas, the analogous prediction of ectopic tumors prognosis remains questionable due to scarce number of cases. In this article, we present a rare case of PPM with rhabdoid features (World Health Organization grade III), which lacked other signs of malignancy. The patient is doing well for 2 years after the thoracoscopic wedge resection without evidence of the disease recurrence.

Primary pulmonary meningioma presenting as a micro solid nodule: A rare case report

An ectopic meningioma, such as a primary pulmonary meningioma (PPM), is a rare type of tumor that primarily originates outside of the central nervous system. A 65-year-old female patient underwent a thoracoscopic lung wedge resection of the right lower lobe for a micro solid nodule detected via computed tomography. The histologic result revealed a PPM. PPMs manifested with micro solid nodules are a very rare occurrence in clinical practice. Increased awareness of the clinical and pathological characteristics of this rare disease can assist thoracic surgical teams to apply adequate management.

Computed tomography findings of primary pulmonary meningioma: A case report

RATIONALE

Primary pulmonary meningiomas are extremely rare, and only a few cases have been reported in the medical literature. Imaging findings of primary pulmonary meningiomas have been reported even more rarely.

PATIENT CONCERNS

We present the case of a 54-year-old male patient with cough and sputum lasting for 20 years. This was a case of primary pulmonary meningioma with initial suspicion of a chest wall intercostal neurinoma.

DIAGNOSES

A lung lesion was detected on chest computed tomography (CT) imaging 4 years ago. This case appeared as a solitary well-defined round nodule close to the left chest wall, with heterogeneous enhancement on CT, which inaccurately led to the suspicion of a chest wall intercostal neurinoma.

INTERVENTIONS

A thoracoscopic wedge resection was performed.

OUTCOMES

The postoperative histological diagnosis was primary pulmonary meningioma. After 2 years of follow-up, the patient is still alive without evidence of metastasis or recurrence.

LESSONS

Increased awareness of the CT characteristics of this rare tumor may broaden the radiologist's knowledge base.

Clinicopathologic features of minute pulmonary meningothelial-like nodules

Purpose Minute pulmonary meningothelial-like nodules are incidentally discovered in lung specimens. We analyzed the clinicopathologic features of 14 cases identified in surgically resected lungs. Methods Among patients who underwent lung resection in our hospital from October 2007 to March 2016, 14 were found to have minute pulmonary meningothelial-like nodules. The clinical parameters, radiologic findings, and pathologic features of these patients were retrospectively reviewed using the medical records. Results The patients included 4 men and 10 women, with a mean age of 69 years (range 53-82 years). The coexisting main disease was adenocarcinoma in 8 patients, squamous cell carcinoma in 1, atypical adenomatous hyperplasia in 1, and metastatic pulmonary tumor in 3. In one patient, the minute pulmonary meningothelial-like nodules presented as multiple lung nodules on chest computed tomography. The median size of the nodules was 1.4 mm (range 0.3-6.0 mm). Similar to meningioma, one case had immunoreactivity to progesterone receptor and epithelial membrane antigen, although the minute pulmonary meningothelial-like nodules were not associated with a meningioma. Conclusions The relationship between minute pulmonary meningothelial-like nodules and meningioma should be investigated. If minute pulmonary meningothelial-like nodules are found on preoperative computed tomography, thoracoscopic lung biopsy is helpful for differential diagnosis.

Primary pulmonary meningioma: A case report

RATIONALE

Primary extracranial meningiomas are rare outside the head and neck region.

PATIENT CONCERNS

A 44-year-old female patient had chest pain for more than 1 year.

DIAGNOSES

Preoperative chest computed tomography (CT) scan revealed a nodule in the right lower lobe, 1.8 cm in diameter. Tumor tissues were examined by immunohistochemistry for vimentin and S-100.

INTERVENTIONS

Histopathologically, the tumor was characterized by whorled nests of spindle-shaped cells accompanied by psammoma bodies. Immunohistochemistry demonstrated tumor cell positivity for vimentin and S-100. This case was diagnosed as a primary pulmonary meningioma. The tumor was removed by a thoracoscopic pulmonary wedge resection.

OUTCOMES

Postoperative cranial and spinal CT scan did not show any intracranial or spinal mass. No recurrence of the tumor was reported at the time of writing up this case report.

LESSONS

A primary pulmonary meningioma should be considered in the differential diagnosis workup of pulmonary nodules.

Primary Pulmonary Meningioma Simulating a Pulmonary Metastasis

Primary pulmonary meningiomas represent a rare tumor entity. Few cases have been reported in the English medical literature, and they have almost all been solitary and benign in nature, with the exception of several extremely rare cases. We report herein a case of PPM that raised suspicion of a pulmonary metastatic tumor initially, as it was depicted as a single, round, small, ground-glass opacity pulmonary nodule on a chest computed tomography scan, in a 55-year-old man with a history of buccal cancer. Increased awareness of the clinical and radiologic characteristics of this rare category can assist a multidisciplinary team to perform adequate management.

Primary pulmonary meningioma: an unusual cause of a nodule with strong and homogeneous enhancement

We report a case of a 61-year-old female with atypical chest pain. The chest CT scan revealed a well-circumscribed large intrapulmonary nodule that showed vigorous and homogeneous contrast enhancement. The nodule was diagnosed as a meningioma after surgery. Metastatic meningioma was excluded by brain and spine MRI scans. Primary pulmonary meningioma usually appears as a solitary well-defined round or lobulated nodule with variable enhancement on CT; this case is unique because of the intense and homogeneous enhancement. Although rare, primary pulmonary meningioma should be considered in the differential diagnosis of a well-defined pulmonary nodule with dense and homogeneous enhancement.

Primary pulmonary malignant meningioma with lymph node and liver metastasis in a centenary woman, an autopsy case

Primary meningiomas arising outside the central nervous system are very rare. They have been reported in the head and neck region, in the thorax, the retroperitoneum, and the pelvis. Usually, they behave as slow-growing tumors with a good prognosis. Herein, we report an autopsy case of a 108-year-old woman, known for a right-sided slowly growing lung nodule for 39 years. Death was attributed to cachexia. At post-mortem, a 15-cm mass was present in the right inferior lobe of the lung, associated with an ipsilateral hilar lymphadenopathy, and another 10-cm mass in the liver. Histology revealed a WHO grade III meningioma. No tumor was observed in the cranial cavity. This case illustrates a rare location of meningioma and highlights its biological behavior, with a very slow progression from a most probably benign tumor to a malignant lesion with metastasis over four decades.