1
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Wang YC, Wu KL, Jung SM, Wu CT. Metastasis of World Health Organization Grade II and Grade III Meningiomas: Long-Term Survival and Associated Factor Analysis. World Neurosurg 2024:S1878-8750(24)01555-9. [PMID: 39265944 DOI: 10.1016/j.wneu.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 09/02/2024] [Indexed: 09/14/2024]
Abstract
OBJECTIVE Metastasis of World Health Organization (WHO) grade II or grade II meningiomas are rare. The aim of this study was to investigate their incidence, associated risk factors, and treatment course. METHODS Patients with surgically resected WHO grade II or grade III meningiomas were reviewed based on histopathology with the 2016 WHO criteria. Metastasis was diagnosed through whole body image scan followed by surgical resection or biopsy. Clinical factors were analyzed for their association with metastasis. RESULTS Among the 131 enrolled patients, metastasis was diagnosed after tumor relapse in 7 (incidence rate 3.6%) at a mean 30.9 months after the initial surgery. The metastasis after tumor relapse group had the worst overall survival, followed by tumor relapse without metastasis and nonrelapse groups (P < 0.001). The independent factors associated with metastasis were major vessel compromise by primary tumors (hazard ratio [HR] = 9.9, P = 0.035), tumor relapse time less than 24 months (HR = 7.0, P = 0.036), and subtotal resection without adjuvant radiotherapy to the primary tumor (HR = 3.5, P = 0.047). Neither grading nor histochemical staining was significantly associated with metastasis, whereas higher vascularity seemed to be more common in metastatic lesions than primary tumors. CONCLUSIONS The presence of metastasis contributed to poor outcomes and was related to earlier tumor relapse and major vessel compromise. Subtotal resection should be followed by adjuvant radiotherapy to reduce the risk of metastasis. Further research is warranted to identify circulating or pathologic biomarkers for the early detection of metastasis.
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Affiliation(s)
- Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Lin Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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2
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Watanabe G, Young K, Rauber E, Khan MF, Suzuki R, Riestenberg R, Umana GE, Palmisciano P. A systematic review of extraneural meningioma metastasis: timing, evolution and outlook. J Neurooncol 2024; 168:187-196. [PMID: 38530549 DOI: 10.1007/s11060-024-04659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Extraneural meningioma metastasis is a rare occurrence and may pose a clinical challenge due to its unclear prognosis. In this systematic review, we analyze patient demographics, clinical characteristics, management strategies, and outcomes. METHODS PubMed, EMBASE, Scopus, Cochrane, and Web of Science databases were searched from inception to February 23, 2024 for cases of metastatic meningioma according to PRISMA guidelines. Descriptive statistics, Mann-Whitney U test, Fisher's exact tests, Kaplan-Meier curves, and log-rank tests were used for selected analyses. RESULTS A total of 288 patients (52% male) were included with an average age of 49 years at meningioma diagnosis. Tumors were distributed across WHO grade 1 (38%), 2 (36%), and 3 (26%). Most patients experienced intracranial recurrence (79%) and mean time to first metastasis was approximately 8 years. No change in WHO grade between primary and metastasis was observed for most cases (65%). Treatment of the initial metastasis was most often with surgery (43%), chemotherapy (20%), or no treatment (14%). Half of the patients were alive (50%) with an average follow-up of 3 years following metastasis. Overall median survival was 36 months for the entire cohort. This differed significantly between WHO grade 1 versus 2/3 meningioma primaries (168 vs. 15 months, p < 0.005). CONCLUSION Metastatic meningioma appears to be associated with more positive prognosis than other brain tumor types with extra-neural metastasis or metastasis in general. This is particularly true for cases arising from a WHO grade 1 meningioma.
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Affiliation(s)
- Gina Watanabe
- John A. Burns School of Medicine, University of Hawaii at Manoa, 5080 Likini St #417, Honolulu, HI, 96818, USA.
| | - Kurtis Young
- Department of Otolaryngology, University of Nevada, Las Vegas, NV, USA
| | - Erin Rauber
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | | | - Reannon Suzuki
- John A. Burns School of Medicine, University of Hawaii at Manoa, 5080 Likini St #417, Honolulu, HI, 96818, USA
| | - Robert Riestenberg
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
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3
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Zhou JJ, Farber SH, de Andrada Pereira B, DiDomenico JD, Williams GP, Almefty KK, Kakarla UK, Uribe JS, Turner JD. Metastasis of Intracranial Meningioma to the Osseous Spine: Systematic Literature Review and Case Report. World Neurosurg 2024; 183:192-203. [PMID: 37995989 DOI: 10.1016/j.wneu.2023.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Osseous spinal metastases from intracranial meningiomas are rare but represent a serious disease progression. A literature review was performed on this topic to understand the clinical course of patients with this disease entity. We also present a case of spinal metastasis in a patient with a World Health Organization grade III meningioma. METHODS The PubMed/MEDLINE database was queried on August 15, 2021, using the keywords (meningioma) AND (metastasis) AND (vertebra∗ OR spin∗). All publications reporting outcomes of patients with meningioma metastatic to the spine were included. Disease characteristics, treatment modality, and outcomes were extracted from each study. Because data availability varied widely between studies, no meta-analysis was performed. RESULTS A total of 30 articles with 33 cases were included. Outcome data varied greatly in terms of quality and length of follow-up. Of 28 cases with reported outcomes data, 20 resulted in patient mortality ranging from a few weeks to 5 years after spinal metastasis. Mean (standard deviation) survival time was 5.8 (6.4) years following initial diagnosis, but only 1.4 (3.2) years from spinal metastasis. The longest survivor was noted to have no recurrence of disease 4 years after spinal metastasis. CONCLUSIONS Bony spinal metastasis from intracranial meningioma is an extremely rare occurrence. Within the limits of the available literature, outcomes of patients with this disease appear to be poor. However, data reporting is inconsistent, and several articles did not report any outcome data. Further study is needed to better clarify the course and prognosis of this disease.
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Affiliation(s)
- James J Zhou
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - S Harrison Farber
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Bernardo de Andrada Pereira
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Joseph D DiDomenico
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Gabriella P Williams
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kaith K Almefty
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - U Kumar Kakarla
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jay D Turner
- Department of Neurosurgery, Barrow Neurological Institute. St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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4
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Melocchi L, Rossi G, Valli M, Mengoli MC, Mondoni M, Lazzari-Agli L, Santandrea G, Davoli F, Baldovini C, Cavazza A, Colby TV. Diffuse Pulmonary Meningotheliomatosis: Clinic-Pathologic Entity or Indolent Metastasis from Meningioma (or Both)? Diagnostics (Basel) 2023; 13:diagnostics13040802. [PMID: 36832290 PMCID: PMC9955492 DOI: 10.3390/diagnostics13040802] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
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.
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Affiliation(s)
- Laura Melocchi
- Pathology Unit, Department of Oncology, Fondazione Poliambulanza Hospital Institute, 25124 Brescia, Italy
- Correspondence: ; Tel.: +39-0303518661
| | - Giulio Rossi
- Pathology Unit, Department of Oncology, Fondazione Poliambulanza Hospital Institute, 25124 Brescia, Italy
| | - Mirca Valli
- Operative Unit of Pathologic Anatomy, Ospedale Infermi, Azienda USL Romagna, 47900 Rimini, Italy
| | | | - Michele Mondoni
- Respiratory Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, Università degli Studi di Milano, 20142 Milan, Italy
| | - Luigi Lazzari-Agli
- Pulmonology Unit, Ospedale Infermi, Azienda USL Romagna, 47900 Rimini, Italy
| | - Giacomo Santandrea
- Operative Unit of Pathology, Azienda USL/IRCCS, 42123 Reggio Emilia, Italy
| | - Fabio Davoli
- Department of Thoracic Surgery, Azienda USL Romagna, S. Maria delle Croci Teaching Hospital, 48121 Ravenna, Italy
| | - Chiara Baldovini
- Cardiovascular Pathology Unit, Department of Pathology, IRCCS, St. Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Alberto Cavazza
- Operative Unit of Pathology, Azienda USL/IRCCS, 42123 Reggio Emilia, Italy
| | - Thomas V. Colby
- Department of Laboratory Medicine and Pathology (Emeritus), Mayo Clinic Arizona, Scottsdale, AZ 13400, USA
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5
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Montgomery EY, Sundarrajan C, Pernik MN, Caruso JP, Garzon-Muvdi T. Metastatic Meningioma: A Systematic Review of Incidence and Risk Factors. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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6
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Solitary pulmonary metastasis after meningioma surgery of the head: a case report. Surg Case Rep 2022; 8:26. [PMID: 35122546 PMCID: PMC8818078 DOI: 10.1186/s40792-022-01379-9] [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: 11/04/2021] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Meningioma is the most common type of benign primary brain tumor that is rarely associated with distant metastasis. No established treatment strategy for metastatic meningiomas exists to date. Herein, we report a case of solitary pulmonary metastasis of meningioma detected 2 years after neurosurgical resection of the primary tumor. Case presentation A 75-year-old male patient underwent neurosurgical resection of a convexity meningioma (World Health Organization grade II atypical meningioma), followed by postoperative radiotherapy for the residual tumor. Two postoperative years later, a solitary 10-mm pulmonary nodule in the left lower lung lobe was detected on chest computed tomography. The patient underwent video-assisted thoracoscopic left lower lobectomy for suspected pulmonary metastasis of meningioma. The pathological diagnosis was solitary pulmonary metastasis of meningioma. No sign of further recurrence was noted at 8 months postoperatively. Conclusions We present a rare and unique surgical case of solitary pulmonary metastasis of meningioma. Further investigation is necessary to establish the standardized treatment strategy for metastatic meningiomas.
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7
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Mardani P, Safarian A, Ashari A, Pourjafar S, Anbardar MH, Azarpira N, Vafabin M, Yousefi S. Low-grade intracranial meningioma with bilateral pulmonary metastases incidentally detected postpartum: a case report and review of the literature. J Med Case Rep 2021; 15:509. [PMID: 34645501 PMCID: PMC8515739 DOI: 10.1186/s13256-021-03093-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Meningiomas are the most commonly encountered intracranial tumors, usually showing indolent behavior. Extra-axial spreading and distant metastases are seldom detected in these tumors, and lung metastasis from a low-grade meningioma is a rare event. Case presentation This case report aimed to present the clinical, imaging, and pathological features of a 37-year-old Caucasian pregnant woman with bilateral lung metastases incidentally detected during preoperative workup ahead of surgery for a primary intracranial meningioma. The possible metastatic routes and risk factors of dissemination to the pulmonary circulation were discussed as well. Conclusion Metastasis must be considered in patients with intracranial meningiomas accompanied by venous sinus invasion and extension through the calvarium. Thorough paraclinical investigations are suggested in such cases.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Safarian
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anita Ashari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sarina Pourjafar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Masoud Vafabin
- General Surgery Resident, Shiraz University of Medical Sciences, Shiraz, Iran
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8
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Vuong HG, Ngo TNM, Dunn IF. Incidence, risk factors, and prognosis of meningiomas with distant metastases at presentation. Neurooncol Adv 2021; 3:vdab084. [PMID: 34345819 DOI: 10.1093/noajnl/vdab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Distant metastases (DM) at presentation in meningiomas is a very rare event, and the incidence and factors predicting this are uncertain. This population-based study also aimed to investigate the prognostic implication of DM at presentation and clinical parameters to prognosticate the overall survival (OS) of meningiomas presenting with DM (M1). Methods We accessed the Surveillance, Epidemiology, and End Results program to search for patients who were diagnosed with meningioma between 2004 and 2016. The log-rank test was used to compare Kaplan-Meier survival curves and multivariate Cox regression model was utilized to evaluate the prognostic parameters of meningiomas with DM at presentation. Results The incidence of DM at presentation among all meningiomas was 0.18%. Clinical variables associated with this event were male gender, large tumor size, and WHO grade III. The presence of DM at diagnosis conferred a shorter survival in comparison to those without DM (HR = 2.015; 95% CI = 1.600-2.536). Older patient age, male gender, malignant histology, and the lesser extent of resection were independent prognostic factors that could negatively impact OS of M1 meningiomas. Radiotherapy and chemotherapy were not associated with an improved outcome for these patients. Conclusion Our study highlighted the clinical and prognostic factors of M1 meningiomas. These data suggest that a greater extent of resection is associated with increased OS across a nationwide analysis and emphasize the need to establish the standards of care in these patients.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Tam N M Ngo
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
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9
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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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10
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Natarajan JM, Born DE, Harsh G, Shuer LM, Soltys SG. Intracranial Grade II Meningioma Oligometastatic to the Cervical Spine. Cureus 2021; 13:e12809. [PMID: 33628677 PMCID: PMC7894379 DOI: 10.7759/cureus.12809] [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] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
For intracranial meningiomas that metastasize extracranially, an oligometastatic state exists that is intermediate between incurable, widely metastatic disease and non-metastatic curable disease. Similar to oligometastatic cancer, aggressive local treatment of meningioma oligometastases is warranted, as it may be curable. We present a patient with multiply recurrent intracranial meningiomas over 19 years, with a transformation from grade I to grade II histology, with oligometastatic disease to the C5 vertebral body. Three years following definitive spinal stereotactic radiosurgery, she remains without evidence of other metastatic diseases. Our case highlights the oncologic concept that metastatic meningioma need not be widely disseminated and provides the clinical rationale for aggressive local treatment of an oligometastatic meningioma.
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Affiliation(s)
| | - Donald E Born
- Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Griffith Harsh
- Neurological Surgery, University of California, Davis, Sacramento, USA
| | - Lawrence M Shuer
- Department of Neurosurgery, Stanford University Medical Center, Stanford, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, USA
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11
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Hanna R, Feldman AM, Keller CE, Siddiqui MS. A Grade I Intracranial Meningioma with Metastasis to Multiple Vertebral Bodies: A Case Report and Literature Review. Cureus 2020; 12:e11477. [PMID: 33329973 PMCID: PMC7734695 DOI: 10.7759/cureus.11477] [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] [Indexed: 11/05/2022] Open
Abstract
World Health Organization (WHO) grade I meningiomas are slow-growing and typically benign brain tumors that can often be easily removed by surgery and rarely become malignant. We report the case of a WHO grade I meningioma in a 67-year-old man with multiple extracranial metastases.
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Affiliation(s)
- Renee Hanna
- Radiation Oncology, Henry Ford Health System, Detroit, USA
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12
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Garzon-Muvdi T, Maxwell R, Luksik A, Kessler R, Weingart J, Olivi A, Bettegowda C, Tamargo R, Brem H, Lim M. Scalp Invasion by Atypical or Anaplastic Meningioma Is a Risk Factor for Development of Systemic Metastasis. World Neurosurg 2020; 142:e133-e139. [PMID: 32599198 DOI: 10.1016/j.wneu.2020.06.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atypical and anaplastic meningiomas (AAMs) are rare and comprise approximately 5% of all meningiomas. Extracranial metastases in meningioma patients occur in 0.1% of all cases, but these lesions are difficult to treat and may be a poor prognostic factor. METHODS We conducted a retrospective chart review between 1990 and 2016 of patients who had surgical resection of AAM. In a cohort of 149 patients, 6 had metastatic lesions that were histologically confirmed to be meningioma. We compared baseline characteristics between patients with and without metastasis and performed a multivariate Cox regression analysis to assess risk factors for the development of systemic metastasis. RESULTS Six patients had histologically confirmed meningioma metastasis. We hypothesized that the presence of scalp invasion in patients could be a potential risk factor for the development of systemic meningioma metastasis. Nine out of the 149 patients without metastasis had scalp invasion, whereas 4 out of the 6 patients with metastasis had scalp invasion. Patients with metastasis had a median age of 62 ± 20. Patients without metastasis had a median age of 59 ± 15 years. Gender distribution was similar; approximately 50% of patients in each group were female. Eighty-five percent of patients with metastatic disease were white, and 65% of patients without metastatic disease were white. Among patients without metastatic disease, 77% had World Health Organization II tumors, whereas 50% of patients with metastatic disease had World Health Organization II tumors. In multivariate analysis including age, tumor grade, size, location, extent of resection, sex, and scalp invasion, the only significant predictor of systemic metastasis was scalp invasion (odds ratio = 39.67; 95% confidence interval = 3.74-421.12; P = 0.0023). Median overall survival (OS) with metastasis was 126 months, and median OS without metastasis was 158 months. Having metastatic disease was not significantly associated with worse OS (P = 0.33). CONCLUSIONS Metastasis development from AAM is a rare but serious event. Because scalp invasion is a strongly associated predictive factor for development of systemic metastasis in patients with AAM, it is necessary to consider strategies to prevent and to be vigilant of the development of scalp invasion.
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Affiliation(s)
- Tomas Garzon-Muvdi
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Russell Maxwell
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Andrew Luksik
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Remi Kessler
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Jon Weingart
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Alessandro Olivi
- Department of Neurosurgery, Gemelli University Hospital, Rome, Italy
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rafael Tamargo
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
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13
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Vasudevan HN, Castro MRH, Lee JC, Villanueva-Meyer JE, Bush NAO, McDermott MW, Solomon DA, Perry A, Magill ST, Raleigh DR. DNA methylation profiling demonstrates superior diagnostic classification to RNA-sequencing in a case of metastatic meningioma. Acta Neuropathol Commun 2020; 8:82. [PMID: 32517746 PMCID: PMC7285578 DOI: 10.1186/s40478-020-00952-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/19/2020] [Indexed: 02/04/2023] Open
Abstract
Meningiomas are the most common primary intracranial tumors, but meningioma metastases are rare. Accordingly, the clinical workup, diagnostic testing, and molecular classification of metastatic meningioma is incompletely understood. Here, we present a case report of multiply recurrent meningioma complicated by liver metastasis. We discuss the patient presentation, imaging findings, and conventional histopathologic characterization of both the intracranial lesion and the metastatic focus. Further, we perform multiplatform molecular profiling, comprised of DNA methylation arrays and RNA-sequencing, of six stereotactically-guided samples from the intracranial meningioma and a single ultrasound-guided liver metastasis biopsy. Our results show that DNA methylation clusters distinguish the liver metastasis from the intracranial meningioma samples, and identify a small focus of hepatocyte contamination with the liver biopsy. Nonetheless, DNA methylation-based classification accurately identifies the liver metastasis as a meningioma with high confidence. We also find that clustering of RNA-sequencing results distinguishes the liver metastasis from the intracranial meningiomas samples, but that differential gene expression classification is confounded by hepatocyte-specific gene expression programs in the liver metastasis. In sum, this case report sheds light on the comparative biology of intracranial and metastatic meningioma. Furthermore, our results support methylation-based classification as a robust method of diagnosing metastatic lesions, underscore the broad utility of DNA methylation array profiling in diagnostic pathology, and caution against the routine use of bulk RNA-sequencing for identifying tumor signatures in heterogeneous metastatic lesions.
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Dalle Ore CL, Magill ST, Yen AJ, Shahin MN, Lee DS, Lucas CHG, Chen WC, Viner JA, Aghi MK, Theodosopoulos PV, Raleigh DR, Villanueva-Meyer JE, McDermott MW. Meningioma metastases: incidence and proposed screening paradigm. J Neurosurg 2020; 132:1447-1455. [PMID: 30952122 DOI: 10.3171/2019.1.jns181771] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 01/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Extracranial meningioma metastases are uncommon, occurring in less than 1% of patients diagnosed with meningioma. Due to the rarity of meningioma metastases, patients are not routinely screened for distant disease. In this series, we report their experience with meningioma metastases and results of screening for metastases in select patients with recurrent meningiomas. METHODS All patients undergoing resection or stereotactic radiosurgery for primary or recurrent meningioma from 2009 to 2017 at a single center were retrospectively reviewed to identify patients who were diagnosed with or underwent imaging to evaluate for systemic metastases. Imaging to evaluate for metastases was performed with CT scanning of the chest, abdomen, and pelvis or whole-body PET/CT using either FDG or 68Ga-DOTA-octreotate (DOTATATE) tracers in 28 patients. Indications for imaging were symptomatic lesions concerning for metastasis or asymptomatic screening in patients with greater than 2 recurrences being evaluated for additional treatment. RESULTS Of 1193 patients treated for meningioma, 922 (77.3%) patients had confirmed or presumed WHO grade I tumors, 236 (19.8%) had grade II tumors, and 35 (2.9%) had grade III tumors. Mean follow-up was 4.3 years. A total of 207 patients experienced recurrences (17.4%), with a mean of 1.8 recurrences. Imaging for metastases was performed in 28 patients; 1 metastasis was grade I (3.6%), 16 were grade II (57.1%), and 11 were grade III (39.3%). Five patients (17.9%) underwent imaging because of symptomatic lesions. Of the 28 patients screened, 27 patients had prior recurrent meningioma (96.4%), with a median of 3 recurrences. On imaging, 10 patients had extracranial lesions suspicious for metastasis (35.7%). At biopsy, 8 were meningioma metastases, 1 was a nonmeningioma malignancy, and 1 patient was lost to follow-up prior to biopsy. Biopsy-confirmed metastases occurred in the liver (5), lung (3), mediastinum (1), and bone (1). The observed incidence of metastases was 0.67% (n = 8). Incidence increased to 2% of WHO grade II and 8.6% of grade III meningiomas. Using the proposed indications for screening, the number needed to screen to identify one patient with biopsy-confirmed malignancy was 3.83. CONCLUSIONS Systemic imaging of patients with multiply recurrent meningioma or symptoms concerning for metastasis may identify extracranial metastases in a significant proportion of patients and can inform decision making for additional treatments.
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Enomoto T, Aoki M, Kouzaki Y, Abe H, Imamura N, Iwasaki A, Inoue T, Nabeshima K. WHO Grade I Meningioma Metastasis to the Lung 26 Years after Initial Surgery: A Case Report and Literature Review. NMC Case Rep J 2019; 6:125-129. [PMID: 31592398 PMCID: PMC6776748 DOI: 10.2176/nmccrj.cr.2019-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/07/2019] [Indexed: 02/05/2023] Open
Abstract
Metastases from meningioma grade I are especially rare. We describe a case of a 65-year-old male with meningioma WHO grade I with a history of local recurrence and distant metastasis to the lung 26 years after the initial surgery. The original tumor was localized at the occipital low convex and invaded into the venous sinus and posterior cranial fossa; it was resected. About 15 years later, the tumor recurred in the posterior cranial fossa and γ-knife radiosurgery was performed. About 4 years later, the recurred tumor was resected at our hospital. Another 7 years later, the tumor recurred in the same area and right middle cranial fossa. All tumors except that inside the venous sinus were excised. All specimens obtained were classified as meningioma WHO grade I. Preoperative examination of the third operation revealed a nodule in the lower lobe of the right lung. The nodule grew gradually. Four months after the third surgery, partial resection of the right lung was performed. Histology indicated meningioma WHO grade I. The two lesions in the cranium and lung lesions were subjected to fluorescence in situ hybridization of the NF2 gene, and the three specimens had similar findings, genetically confirming them to be metastases of the intracranial meningioma. A literature review of past cases of meningioma progression revealed that the mean duration to metastasis is 12.5, 6.8, 3.7 years for grades I, II, and III, respectively. The current case therefore has an extended time frame.
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Affiliation(s)
- Toshiyuki Enomoto
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan.,Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Mikiko Aoki
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Yuki Kouzaki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Naoko Imamura
- Department of General Thoracic, Breast, and Pediatric Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Akinori Iwasaki
- Department of General Thoracic, Breast, and Pediatric Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
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16
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Vakil H, Tran L, Lewis GD, Cykowski MD, Butler EB, Teh BS. Biopsy proven metastatic meningioma: A case report and review of the literature. Rep Pract Oncol Radiother 2019; 24:528-532. [PMID: 31516399 DOI: 10.1016/j.rpor.2019.08.002] [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: 01/22/2019] [Revised: 05/21/2019] [Accepted: 08/11/2019] [Indexed: 11/18/2022] Open
Abstract
Meningiomas are the most common type of benign tumor found in the brain and are typically benign, slow-growing lesions. The current standard of care consists of surgical resection and subsequent postoperative radiotherapy to prevent local recurrence. Because of their indolent nature, meningiomas are rarely found to spread extracranially and develop distant metastases. We present the clinical, imaging, and pathologic features of a patient who had meningioma with multiple local recurrences, who was incidentally found to have metastatic disease in the lungs. In addition, we discuss details of this case in the context of the previously reported literature.
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Affiliation(s)
- Haris Vakil
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Lena Tran
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Gary D Lewis
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Edward Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
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17
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Sathirareuangchai S, Kakazu K, Tauchi-Nishi P, Morris P, Sae-Ow W. Low grade intracranial meningioma presenting with pulmonary metastasis: Case report and literature review. Pathol Res Pract 2019; 215:152390. [DOI: 10.1016/j.prp.2019.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/02/2019] [Accepted: 03/18/2019] [Indexed: 12/17/2022]
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18
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Attuati L, Zaed I, Morselli C, Pecchioli G, Fornari M, Picozzi P. Multimodal Management of Metastatic Malignant Meningiomas: The Role of Radiosurgery in Long-Term Local Control. World Neurosurg 2019; 128:562-572. [PMID: 31102770 DOI: 10.1016/j.wneu.2019.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Metastatic meningiomas (MMs) are rare (0.1 of 100 cases). Their treatment requires a multimodal approach, with surgery, radiotherapy, chemotherapy, and radiosurgery, which allows a long-term local control (LC) and an extension of free survival. In this study, the authors performed a review of the literature and reported 2 cases of patients affected by extracranial MMs, with long-term follow-up. CASE DESCRIPTION Case 1: A 48-year-old woman was admitted for resection of an extra-axial falx lesion (meningioma G1). After 2 years, the lesion got a local recurrence, resected with a histologic diagnosis of meningioma G3. During the next 9 years, the patient underwent 5 Gamma Knife radiosurgery (GKRS) procedures for local recurrence. At 56 years, she was readmitted for a surgical local recurrence (histologic definition: anaplastic meningioma G3). At the age of 62, the patient underwent a right lobectomy for a lung mass (histologic diagnosis: anaplastic meningioma G3). After that, multiple lesions at soma L5 and adrenal gland were discovered and then monitored. Case 2: A 48-year-old woman was operated for a lesion involving torcular herophili (meningioma G2). After 3 years, a local recurrence requires GKRS combined with tamoxifen. In the next 7 years, she underwent 5 GKRS procedures for local recurrence. The patient also underwent chemotherapy with octreotide. At the age of 61, she discovered multiple lesions in both lungs, liver, and kidney. A hepatic biopsy showed anaplastic meningioma G3. Also this patient does not suffer from any neurologic or clinical deficits. CONCLUSIONS LC in malignant meningioma is achievable through a multimodal approach; GKRS makes possible LC, but a novel aspect of these lesions is opened to discussion: the metastases. These reports show that multimodal treatment for MMs is an effective approach with good LC and improvement of overall survival. However, a long survival may allow systemic diffusion of the disease, in particular, when sagittal sinus is involved.
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Affiliation(s)
- Luca Attuati
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.
| | - Carlotta Morselli
- Department of Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Guido Pecchioli
- Department of Neurosurgery, Azienda Ospedaliera Careggi, Florence, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Piero Picozzi
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
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Du Y, Lu T, Huang S, Ren F, Cui G, Chen J. Somatic mutation landscape of a meningioma and its pulmonary metastasis. Cancer Commun (Lond) 2018; 38:16. [PMID: 29764516 PMCID: PMC5993143 DOI: 10.1186/s40880-018-0291-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/25/2018] [Indexed: 01/06/2023] Open
Abstract
Background Extracranial metastasis (ENM) of meningiomas is extremely rare, and typically occurs several years after a primary tumor is diagnosed. However, the genetic changes underlying ENM events have not yet been investigated. Case presentation A 58-year-old male patient was sent to the emergency room of our hospital because of a sudden fall. Magnetic resonance imaging detected a mass at the right frontal sagittal sinus. He underwent tumor resection and recovered well, but post-operative computed tomography revealed three lumps on the right side of his chest. Thoracic surgery was performed to remove two of the lumps. Pathological findings revealed that the brain and lung tumors were grade I meningiomas. The patient received no additional radiation or chemotherapy post-surgery, and there was no sign of tumor recurrence in the brain or progression of the remaining lump in the chest 1 year after surgery. We performed whole exome sequencing of the patient’s blood, primary brain tumor, and lung metastatic tumor tissues to identify somatic genetic alterations that had occurred during ENM. This revealed that a frameshift deletion of the neurofibromin 2 gene likely drove formation of the meningioma. Surprisingly, we found that the brain tumor was relatively homogeneous and contained only one dominant clone; both the pulmonary metastasis and the original brain tumor were derived from the same clone, and no obvious additional driver mutations were detected in the metastatic tumor. Conclusion Although ENM of meningiomas is very rare, brain tumor cells appear to be more adaptable to tissue microenvironments outside of the central nervous system than was commonly thought.
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Affiliation(s)
- Yaran Du
- Institute of Functional Nano and Soft Materials (FUNSOM) & Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University, Suzhou, 215123, P. R. China
| | - Ting Lu
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, 215006, P. R. China
| | - Song Huang
- National Institute of Biological Sciences, Beijing, 102206, P. R. China
| | - Fangfang Ren
- Department of Biochemistry and Molecular Biology, Soochow University Medical College, Suzhou, 215123, P. R. China
| | - Gang Cui
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, 215006, P. R. China
| | - Jian Chen
- Institute of Functional Nano and Soft Materials (FUNSOM) & Collaborative Innovation Center of Suzhou Nano Science and Technology, Soochow University, Suzhou, 215123, P. R. China.
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20
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Lung Metastases of Intracranial Atypical Meningioma Diagnosed on Posttherapeutic Imaging After 177Lu-DOTATATE Therapy. Clin Nucl Med 2018; 43:e184-e185. [PMID: 29688946 DOI: 10.1097/rlu.0000000000002077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Meningiomas are typically benign solitary intracranial tumors. Atypical (World Health Organization [WHO] grade II) or malignant/anaplastic (WHO grade III) meningiomas are seldom, and distant metastases occur only in rare exceptions. We present a case of a 54-year-old male patient with atypical (WHO grade II) meningioma who underwent 1 cycle of peptide receptor radionuclide therapy. Previous imaging studies were confined to the head, but posttherapeutic whole-body Lu-DOTATATE scintigraphy revealed thoracic uptake arising from previously undetected pulmonic meningioma metastases. The case highlights the importance of consideration of rare/untypical metastatic sides and the value of radiotracer whole-body imaging in identifying these.
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21
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Pistolesi S, Boldrini L, Gisfredi S, De Ieso K, Camacci T, Caniglia M, Lupi G, Pingitore R, Basolo F, Leocata P, Parenti G, Fontanini G. Immunohistochemical and Molecular Study of Radiation-Induced Multiple Meningiomas with Pleural and Pulmonary Metastasis. TUMORI JOURNAL 2018; 90:328-32. [PMID: 15315314 DOI: 10.1177/030089160409000312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the present study, the telomerase activity and the putative alterations of genes involved in cell-cycle control (p53, Fas and pRb) were investigated in a radiation-induced meningioma with multiple recurrences and pleural-pulmonary metastases (the patient, a 34-year-old male, had a history of carcinoma of the tongue of testicular lymphocytic lymphoma). Expression of VEGF and vasculature pattern were also studied. Expression of VEGF, pRb and p53 were evaluated by immunohistochemistry on formalin-fixed, paraffin-embedded samples of the tumor. VEGFmRNA was determined by competitive PCR. Fas, FasL and hTERT were evaluated by RT-PCR. Telomerase activity was examined by the TRAP assay. An intense vascularization was observed, supported by high expression of VEGFmRNA (isoforms 121 and 165). pRb and p53 were overexpressed. Fas was undectable with PCR, whereas FasL was positive. Furthermore, the lesion showed an elevated telomerase activity (TPG, 22), according to the high expression of hTERT. These findings emphasized that even among generally benign neoplasms, such as meningiomas, some highly malignant tumors may develop, as in our case, in which several mechanisms were activated in the cancer progression to guarantee the immortalization of cellular clones (angiogenic phenomenon, activation of telomerase and of anti-apoptotic mechanisms) and the blood spread. Thus, the data illustrate the importance of searching for genetic aberrations (which are a hallmark of malignancy) in meningiomas, as predictive and reliable factors of the possibility to recur and to metastasize.
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22
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Garcia GA, Choy AE, Hasso AN, Minckler DS. Malignant Orbital Meningioma Originating from the Frontal Lobe. Ocul Oncol Pathol 2018; 4:186-190. [PMID: 29765952 PMCID: PMC5939669 DOI: 10.1159/000481509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/13/2017] [Indexed: 04/05/2024] Open
Abstract
PURPOSE OF THE STUDY Orbital meningiomas are typically benign tumors, most commonly originating from the dura of the sphenoid wing or the optic nerve sheath. PROCEDURES We describe an unusual case of a malignant meningioma originating from the frontal lobe that ultimately produced orbital and distant metastases. RESULTS AND CONCLUSIONS Orbital invasion by the meningioma was preceded by multiple incomplete resections, which may have facilitated access to the orbit. The present case serves to remind clinicians that surgical resection of aggressive, recurrent frontal lobe meningiomas may facilitate subsequent penetration of surrounding structures, particularly by tumors that demonstrate bone-destructive properties.
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Affiliation(s)
- Giancarlo A. Garcia
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, USA
| | - Andrew E. Choy
- Family Eye Medical Group, Long Beach, CA, USA
- Long Beach Memorial Hospital, Long Beach, CA, USA
| | - Anton N. Hasso
- Department of Radiological Sciences, University of California Irvine Medical Center, Orange, CA, USA
| | - Don S. Minckler
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, USA
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23
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Frappaz D, Le Rhun E, Dagain A, Averland B, Bauchet L, Faure A, Guillaume C, Zouaoui S, Provot F, Vachiery F, Taillandier L, Hoang-Xuan K. [Recommendations for the organ donation from patients with brain or medullary primitive tumors on behalf of the Association of the Neuro-oncologists of French Expression (ANOCEF) and the Club of Neuro-oncology of the French Society of Neurosurgery]. Bull Cancer 2017; 104:771-788. [PMID: 28549594 DOI: 10.1016/j.bulcan.2017.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 11/18/2022]
Abstract
Requests of organs to be transplanted increase. As a matter of urgency, it is not always easy to decide if a patient carrier of a brain tumor can be candidate in the donation. After a review of the literature, the members of the Association of the Neuro-oncologists of French Expression (ANOCEF) and the Club of Neuro-oncology of the French Society of Neurosurgery propose consensual recommendations in case of donor carrier of primitive tumor intra-cranial or intra-medullary. A contact with the neuro-oncologist/neurosurgeon will allow to discuss the indication in case of glioma of grade I/II/III, according to the grade, the current status (absence of progressive disease), the number of surgeries and of lines of treatment. The taking is disadvised in case of glioma of grade IV (glioblastoma), of lymphoma or meningioma of grade III. No contraindication for the meningiomas of grade I, and individual discussion for the meningiomas of grade II. It is advisable to remain careful in case of hemangiopericytoma and of meningeal solitary fibrous tumor. The patients in first complete remission of a medulloblastoma or intra-cranial primitive germinoma seem good candidates for the taking of organ if the follow-up is of at least 10 years (3 years for non germinomas). In every case, a multidisciplinary discussion is desirable when it is materially possible.
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Affiliation(s)
- Didier Frappaz
- Centre Léon-Bérard, 28, rue Laennec, 69673 Lyon, France.
| | - Emilie Le Rhun
- University hospital, department of neurosurgery, neuro-oncology, 59037 Lille, France; Oscar-Lambret center, department of medical oncology, Breast unit, 59037 Lille, France; Lille university, Inserm U-1192, laboratoire de protéomique, réponse inflammatoire, spectrométrie de masse (PRISM), 59037 Lille, France
| | - Arnaud Dagain
- HIA Sainte-Anne, 2, boulevard Sainte-Anne, 83800 Toulon, France
| | - Benoît Averland
- Agence de la biomédecine, 1, avenue du Stade de France, 93210 Saint-Denis, France
| | - Luc Bauchet
- CHRU Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | | | | | - Sonia Zouaoui
- CHRU Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | | | - Florence Vachiery
- CHRU Gui-de-Chauliac, CHU de Montpellier, 80, avenue Augustin-Fliche, 34000 Montpellier, France
| | - Luc Taillandier
- CHU de Nancy, 5, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - Khê Hoang-Xuan
- APHP, UMPC-Sorbonne universités, hôpital Pitié-Salpêtrière, 75013 Paris, France
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McCarthy C, Hofer M, Vlychou M, Khundkar R, Critchley P, Cudlip S, Ansorge O, Athanasou NA. Metastatic meningioma presenting as a malignant soft tissue tumour. Clin Sarcoma Res 2016; 6:23. [PMID: 28042470 PMCID: PMC5200959 DOI: 10.1186/s13569-016-0063-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Extracranial metastasis of malignant meningioma to soft tissues is extremely rare and its clinical, radiological and pathological features are not well-characterised. Case presentation We report a case of a 58 year old man who presented with a mobile mass within the left trapezius muscle. The patient had previously undergone surgery for a right frontal lobe high grade anaplastic meningioma. Histology of the soft tissue lesion showed metastatic anaplastic meningioma with clumps of pleomorphic tumour cells which expressed epithelial membrane antigen, cytokeratin and P63 but were negative for other epithelial and mesenchymal markers. A PET-CT scan revealed additional metastatic lesions in the left pleura, liver and iliac bone. Conclusions Metastatic malignant meningioma can very rarely present as a high grade pleomorphic malignant soft tissue tumour and needs to be distinguished from soft tissue sarcomas and metastatic carcinomas that express epithelial antigens.
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Affiliation(s)
- Catherine McCarthy
- Department of Radiology, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7HE UK
| | - Monika Hofer
- Department of Neuropathology, Oxford University Hospitals Oxford, Oxford, OX3 9DU UK
| | - Marianna Vlychou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7HE UK
| | - Robar Khundkar
- Sarcoma Service, Nuffield Orthopedic Centre, Windmill Road, Oxford, OX3 7HE UK
| | - Paul Critchley
- Sarcoma Service, Nuffield Orthopedic Centre, Windmill Road, Oxford, OX3 7HE UK
| | - Simon Cudlip
- Department of Neurosurgery, Oxford University Hospitals, Oxford, OX3 9DU UK
| | - Olaf Ansorge
- Department of Neuropathology, Oxford University Hospitals Oxford, Oxford, OX3 9DU UK
| | - Nick A Athanasou
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7HE UK
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25
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Singh R, Ryan C, Chohan MO, Tisnado J, Hadjigeorgiou GF, Bilsky MH. Intracranial meningioma with vertebral or intraspinal metastasis: report of 2 cases and review of the literature. J Neurosurg Spine 2016; 25:775-781. [DOI: 10.3171/2016.5.spine151457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extracranial meningioma metastases (EMM) occur in 0.1% of intracranial meningioma patients and are more commonly seen in those with atypical and anaplastic histologies. While the lungs and pleura are the most common site of EMM, intraspinal and vertebral EMM also occur and are not well described in the literature. Although the presence of EMM can worsen prognosis, no standard of care has been established for EMM management.
All patients treated for recurrent atypical/anaplastic meningiomas between January 1985 and July 2014 at Memorial Sloan Kettering Cancer Center were screened for intraspinal and vertebral EMM. Of these patients, 2 were identified as having recurrent meningioma complicated by vertebral or intraspinal EMM. A review of the literature was also conducted. The PubMed database was screened for intraspinal and vertebral EMM cases reported in the literature from 1985 to 2015. Nineteen articles were identified from the literature and included 24 individual cases with a total of 34 vertebral or intraspinal EMM. Forty-two percent (10/24) of patients with vertebral or intraspinal EMM had WHO Grade I tumors. Furthermore, 25% (6/24) of vertebral and intraspinal EMM occurred after the primary tumor but prior to any recurrence.
This paper highlights that vertebral and intraspinal EMM can occur in patients with WHO Grade I meningiomas and can occur before tumor recurrence. This challenges the notion that EMM are seen primarily in high-grade atypical and anaplastic meningiomas.
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Affiliation(s)
| | | | - Muhammad O. Chohan
- Departments of 1Neurosurgery and
- 2Department of Neurosurgery, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico; and
| | - Jamie Tisnado
- 3Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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26
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Wang M, Zhan R, Zhang C, Zhou Y. Multiple pulmonary metastases in recurrent intracranial meningioma: Case report and literature review. J Int Med Res 2016; 44:742-52. [PMID: 26944388 PMCID: PMC5536718 DOI: 10.1177/0300060515618053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 10/27/2015] [Indexed: 11/17/2022] Open
Abstract
Multiple pulmonary metastases from meningioma are rare. We report here a 59-year-old man with multiple pulmonary metastases from a recurrent intracranial meningioma. The primary intracranial tumour in the left occiput was totally excised in 2009. Pathological examination confirmed the diagnosis of atypical meningioma and adjuvant radiotherapy was given to help prevent recurrence. However, recurrence occurred in the left occipital region in 2011 and the meningioma was re-excised in 2012. At the same time, multiple metastases in the right pulmonary lobe were found and excised 3 months after the second craniotomy. The patient has not developed any further recurrence or metastases to date. Neurosurgeons should be aware of the occurrence of pulmonary metastases in patients with intracranial meningioma; potential predictive factors include atypical meningioma, venous sinus invasion, recurrence or previous intracranial surgery, and loss of heterozygosity.
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Affiliation(s)
- Ming Wang
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Renya Zhan
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Chong Zhang
- Department of Thoracic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yongqing Zhou
- Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
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27
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Wang KDA, Su YB, Zhang Y. Recurrent intracranial meningioma with multiple pulmonary metastases: A case report. Oncol Lett 2015; 10:2765-2768. [PMID: 26722239 PMCID: PMC4665146 DOI: 10.3892/ol.2015.3670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 08/05/2015] [Indexed: 11/05/2022] Open
Abstract
Meningiomas are slow-growing tumors, which are generally considered to be benign and rarely metastasize. Although cases of extracranial metastatic meningioma have previously been reported, multiple pulmonary metastases from a benign intracranial meningioma is particularly rare. In the present report, a case of recurrent transitional meningioma with multiple lung nodules, which were demonstrated to be metastatic meningioma, is presented. A 54-year-old female patient received surgical resection of the tumor located in the left base of the middle cranial fossa in 2006. Post-surgery pathological examination indicated a transitional meningioma of World Health Organization grade I. The tumor recurred at the original site 1 year and 3 months later and was completely surgically removed once again. Radiotherapy was administered following the second surgery. Gamma Knife was used to remove the recurrent tumor 18 months following the second surgery. Simultaneously, a chest computed tomography scan revealed multiple pulmonary nodules, which were demonstrated to be metastatic meningioma following wedge resection of the superior lobe of the right lung. The clinical behavior of meningioma does not always correlate with the classification of meningioma. A higher rate of cellular proliferation is not essential for extracranial metastasis, and an individual meningioma of any type may metastasize. Comprehensive examinations should be performed for patients with a history of recurrent intracranial meningioma to detect any distant metastases as early as possible, even when the primary tumor is benign.
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Affiliation(s)
- Ke-DA Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Yi-Bing Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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28
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Frydrychowicz C, Holland H, Hantmann H, Gradistanac T, Hoffmann KT, Mueller W, Meixensberger J, Krupp W. Two cases of atypical meningioma with pulmonary metastases: A comparative cytogenetic analysis of chromosomes 1p and 22 and a review of the literature. Neuropathology 2014; 35:175-83. [DOI: 10.1111/neup.12177] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/24/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Clara Frydrychowicz
- Clinic of Neurosurgery; University Hospital Leipzig; Leipzig Germany
- Department of Neuropathology; University Hospital Leipzig; Leipzig Germany
| | - Heidrun Holland
- Translational Center of Regenerative Medicine; Faculty of Medicine; Leipzig- University; Leipzig Germany
| | - Helene Hantmann
- Translational Center of Regenerative Medicine; Faculty of Medicine; Leipzig- University; Leipzig Germany
| | - Tanja Gradistanac
- Institute of Pathology; University Hospital Leipzig; Leipzig Germany
| | - Karl T. Hoffmann
- Department of Neuroradiology; University Hospital Leipzig; Leipzig Germany
| | - Wolf Mueller
- Department of Neuropathology; University Hospital Leipzig; Leipzig Germany
| | | | - Wolfgang Krupp
- Clinic of Neurosurgery; University Hospital Leipzig; Leipzig Germany
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29
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30
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Detection of Meningioma Metastasis to Liver and Lung Using Somatostatin Receptor Scintigraphy. Clin Nucl Med 2013; 38:668-70. [DOI: 10.1097/rlu.0b013e31829962ac] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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31
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Distant metastases in meningioma: an underestimated problem. J Neurooncol 2013; 112:323-7. [DOI: 10.1007/s11060-013-1074-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 02/06/2013] [Indexed: 11/27/2022]
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32
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Solitary lung meningioma with synchronous brain nodules: clinical and pathological features. Gen Thorac Cardiovasc Surg 2012; 61:648-50. [PMID: 23054620 DOI: 10.1007/s11748-012-0163-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
Meningiomas are tumours arising from the meninges that ensheath the central nervous system. They are benign tumours, but can very rarely metastasize. We report a case of pulmonary meningioma diagnosed incidentally with concurrent brain masses in an ex-smoker and discuss the difficulties in surgical decision making in a mass that may have represented lung cancer with brain metastases. We also review the literature reporting pulmonary meningiomas.
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33
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Saha MK, Hamieh T. An elusive cause of pleural effusion. BMJ Case Rep 2012; 2012:bcr-01-2012-5616. [PMID: 22907848 DOI: 10.1136/bcr-01-2012-5616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 32-year-old man was admitted with cerebrospinal fluid leakage from a right scalp surgical wound after a resection of recurrent meningioma and reconstruction of skull with muscle flap 3 weeks earlier. On day 4 of admission, he was found to be tachycardic and decreased breath sounds on the right side. Chest x-ray revealed a large right pleural effusion which was found to be exudative after thoracocentesis. Infectious work-up and cytology was negative. CT showed both parietal and visceral pleural masses, which was consistent with meningioma on ultrasound-guided biopsy. He underwent right-side decortication and pleurodesis for recurrent pleural effusion. He declined further treatment and opted for hospice care and expired a month later.
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Affiliation(s)
- Manish K Saha
- Department of Internal Medicine, Health Partners, Saint Paul, Minnesota, USA.
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34
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Multiple Pulmonary Metastases following Total Removal of a Bilateral Parasagittal Meningioma with Complete Occlusion of the Superior Sagittal Sinus: Report of a Case. Case Rep Neurol Med 2012; 2012:121470. [PMID: 22934204 PMCID: PMC3420403 DOI: 10.1155/2012/121470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 05/30/2012] [Indexed: 12/21/2022] Open
Abstract
Pulmonary metastases of benign meningiomas are extremely rare. The case of a 34-year-old man with bilateral parasagittal meningioma who developed pulmonary metastases is described. The meningioma was an enormous hypervascular tumor with invasion of the superior sagittal sinus. The tumor was resected completely and histologically diagnosed as transitional meningioma. The Ki-67 labeling index was 5%. Four months after operation, the patient subsequently developed bilateral multiple lung lesions later identified as metastases. The lung lesions were partially removed surgically and histologically diagnosed as meningothelial meningioma WHO grade I. The Ki-67 labeling index was 2%. The histological findings demonstrated that the tumor occupied the arterial lumen and the perivascular space, suggesting that pulmonary tumors might metastasize via the vascular route. The histopathological features and mechanisms of metastasizing meningiomas are reviewed and discussed.
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35
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Baek BJ, Shin JM, Lee CK, Lee JH, Lee KH. Atypical primary meningioma in the nasal septum with malignant transformation and distant metastasis. BMC Cancer 2012; 12:275. [PMID: 22759338 PMCID: PMC3420263 DOI: 10.1186/1471-2407-12-275] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 07/03/2012] [Indexed: 01/27/2023] Open
Abstract
Background Primary extracranial meningiomas (PEMs) originating from the nasal septum are extremely rare, as are extracranial metastases of meningiomas. Case presentation A 44-year-old male presented with a 2-month history of left-side nasal obstruction and frequent episodes of epistaxis. A friable mass originating from the nasal septum was resected completely via an endoscopic endonasal approach. According to WHO criteria, the tumor was diagnosed as an atypical meningioma radiologically and histopathologically. Two years later, a tumor recurred at the primary site with the same histopathological findings, and the patient was given local external radiotherapy (6840 cGy in 38 fractions). Two months after this local recurrence, a left anterior chest wall mass and a left parietal area scalp mass were observed. The subcutaneous mass was resected and showed histological evidence of malignant transformation. Several months after the last operation, the patient died. Conclusions We describe the clinical, radiological, and bio-pathological features of this unique case and review the literature on atypical PEMs originating in the nasal septum. To our knowledge, this is the first reported case of an atypical PEM originating from the nasal septum that recurred with malignant transformation and extracranial metastasis.
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Affiliation(s)
- Byoung Joon Baek
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan Hospital, 23-20 Bongmyung-Dong, Cheonan 330-721, Chungcheongnam-do, South Korea.
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36
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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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37
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Surgical resection of pulmonary metastases from meningioma: Report of a case. Surg Today 2011; 41:995-8. [PMID: 21748620 DOI: 10.1007/s00595-010-4409-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 08/06/2010] [Indexed: 10/18/2022]
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38
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Métastases pulmonaires de méningiome malin. Rev Mal Respir 2010; 27:764-9. [DOI: 10.1016/j.rmr.2010.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 12/27/2009] [Indexed: 11/23/2022]
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39
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Walter J, Kuhn SA, Brodhun M, Reichart R, Kalff R. Pulmonary meningioma and neurinoma associated with multiple CNS tumours in a patient with neurofibromatosis type 2. Clin Neurol Neurosurg 2009; 111:454-9. [DOI: 10.1016/j.clineuro.2008.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 11/22/2008] [Accepted: 11/30/2008] [Indexed: 11/28/2022]
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40
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Doxtader EE, Butts SC, Holsapple JW, Fuller CE. Aggressive pediatric meningioma with soft tissue and lymph node metastases: a case report. Pediatr Dev Pathol 2009; 12:244-8. [PMID: 19086745 DOI: 10.2350/08-07-0501.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 11/26/2008] [Indexed: 11/20/2022]
Abstract
Metastatic meningioma is extremely rare, occurring in an estimated 0.1% of cases. We report a case of pediatric meningioma metastatic to cervical soft tissue and lymph nodes. An 8-year-old boy presented with headaches, dizziness, and involuntary eye flickering. Magnetic resonance imaging (MRI) revealed a 7.5-cm parasagittal, dural-based mass with venous sinus encasement. Therapeutic embolization was followed by bilateral craniotomy, achieving subtotal resection. Histopathologic examination revealed an atypical meningioma with regions of hypercellularity, small cell morphology, sheeting architecture, increased mitoses, and brain invasion. Surveillance MRI studies showed growth of residual tumor and enlarging cervical soft tissue masses with posterior triangle lymphadenopathy. Radiation and surgical resection were employed for the intracranial tumor burden; resection of the soft tissue masses revealed metastatic meningioma, with soft tissue infiltration and metastasis to 8 lymph nodes. This case demonstrates the aggressive biologic potential of pediatric meningiomas, with potential for distant spread via cerebrospinal fluid leakage and lymphatic invasion.
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Affiliation(s)
- Erika E Doxtader
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA.
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41
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Fulkerson DH, Horner TG, Hattab EM. Histologically benign intraventricular meningioma with concurrent pulmonary metastasis: Case report and review of the literature. Clin Neurol Neurosurg 2008; 110:416-9. [DOI: 10.1016/j.clineuro.2007.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 12/19/2007] [Accepted: 12/25/2007] [Indexed: 10/22/2022]
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42
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Tournat H, Huchet A, Ouhabrache N, Thomas IC, Roubaud G, Maire JP. Évolution métastatique osseuse d'un méningiome récidivant : à propos d'un cas. Cancer Radiother 2006; 10:590-4. [PMID: 16876455 DOI: 10.1016/j.canrad.2006.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 06/19/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
We report the case of a 57-year-old man who presented with two local recurrences and metastatic dissemination of a papillary meningioma of the sphenoid 3 years after surgery. Treatment consisted in a combination of surgery for the local recurrence in the initial site, radiotherapy and chemotherapy for bone metastases. Evolution of the disease spread over 7.5 years. The literature relating metastatic meningiomas is reviewed; prognostic factors and main therapeutic protocols are discussed.
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Affiliation(s)
- Helène Tournat
- Service d'Oncologie Médicale et de Radiothérapie, Hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
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43
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Restrepo CS, Herrera DA, Lemos JA. Extraforaminal Meningioma with Extrapleural Space Extension. AJR Am J Roentgenol 2006; 186:1314-6. [PMID: 16632724 DOI: 10.2214/ajr.04.1931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., Bldg. HSC-MED, Rm. 625E-4, San Antonio, TX 78229-3900, USA
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44
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Erman T, Hanta I, Haciyakupoğlu S, Zorludemir S, Zeren H, Göçer AI. Huge Bilateral Pulmonary and Pleural Metastasis from Intracranial Meningioma: A Case Report and Review of the Literature. J Neurooncol 2005; 74:179-81. [PMID: 16193389 DOI: 10.1007/s11060-004-3014-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A case of recurrent meningioma with atypical features and extracranial metastases is reported. A 34-year-old female was operated in 1996, 2000, and 2002, and frontal parasagittal meningioma was extirpated. Histological diagnoses of all the resected tumors were meningotheliomatous meningioma, WHO Grade I. However, 2 years later, the tumor recurred in the frontal scalp and was removed again totally. Histological diagnosis was reported as an atypical meningioma; meningotheliomatous type; WHO Grade II. She received radiation therapy. But the tumor had metastasized to the lung and pleura. Transthoracic tru-cut biopsy was performed from large mass of the left lung. Cytopathology was consistent with malignant meningioma, metastasis from the patient's known intracranial meningioma. Ki-67 staining index at the primary and metastatic sites of the present cases were 7 and 5%, respectively. We reviewed and discussed the histopathological features and mechanisms of metastasizing meningioma.
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Affiliation(s)
- Tahsin Erman
- Department of Neurosurgery, Cukurova University School of Medicine, Balcali, 01330 Adana, Turkey.
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45
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D'Aiuto M, Veronesi G, Pelosi G, Presicci PF, Ferraroli GM, Gasparri R, Spaggiari L. Two-Year Survival After Multiple Bilateral Lung Metastasectomies for Cranial Meningioma. Ann Thorac Surg 2005; 80:1129-30. [PMID: 16122512 DOI: 10.1016/j.athoracsur.2004.02.146] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2003] [Revised: 02/11/2004] [Accepted: 02/17/2004] [Indexed: 11/26/2022]
Abstract
The lung represents a common site of metastases from extrathoracic malignancies, and several studies have strengthened the evidence that complete resection of pulmonary metastases is a useful therapeutic treatment for prolonged survival in selected patients. However, fewer data are available in the literature regarding the role of lung metastasectomy in rare malignancy. We present a case of extensive bilateral lung metastases due to recurrent cranial meningioma, which was successfully treated by aggressive, staged metastasectomies.
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46
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Rubin AS, Pellegrin LG, Porto NDS, Geyer G. Múltiplas metástases pulmonares de meningioma benigno. J Bras Pneumol 2005. [DOI: 10.1590/s1806-37132005000200015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os meningiomas representam um sexto de todas as neoplasias primárias do sistema nervoso central e raramente desenvolvem metástases extracranianas. A presença de metástases múltiplas, bem como de sintomas respiratórios, são raros. Relata-se o caso de uma paciente de 67 anos com sintomas respiratórios de início subagudo e sem história de doença pulmonar prévia, que apresentou múltiplas metástases pulmonares originadas de meningioma benigno intracraniano, seis meses após a ressecção do tumor primário.
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47
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Abstract
Meningioma with extracranial metastases is a rare occurrence. However, the lungs are the most common site of extracranial metastases. We describe a case of a patient with recurrent intracranial meningioma and intrapulmonary metastases.
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Affiliation(s)
- Shawn D Teague
- Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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48
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Hutchins EB, Graves A, Shelton B. Meningioma Metastatic to the Lung Detected by FDG Positron Emission Tomography. Clin Nucl Med 2004; 29:587-9. [PMID: 15311135 DOI: 10.1097/01.rlu.0000135270.71585.72] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eric B Hutchins
- Department of Nuclear Medicine Methodist LeBonheur Healthcare, Memphis, Tennessee 38104, USA.
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49
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Travitzky M, Libson E, Nemirovsky I, Hadas I, Gabizon A. Doxil-induced regression of pleuro-pulmonary metastases in a patient with malignant meningioma. Anticancer Drugs 2003; 14:247-50. [PMID: 12634620 DOI: 10.1097/00001813-200303000-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metastatic meningioma is a rare disease, which has no effective chemotherapy. We report on a treatment of this condition with Doxil, a liposomal doxorubicin formulation. A 60-year-old woman with massive pleuro-pulmonary metastases from recurrent cranial meningioma was treated with Doxil (50-37.5 mg/m2) for 18 months with near-complete resolution of metastases and disappearance of pleural fluid. The only significant toxicities observed were stomatitis and hand-foot syndrome, which resolved with dose reduction and increase of dosing intervals. Doxil was cleared very slowly in this patient with a monoexponential half-life of 108 h. The patient remains in near-complete response for 6 months after treatment discontinuation. This is the first report on an effective chemotherapy in a patient with typical metastatic meningioma. The exact mechanism accounting for such an effective drug action is not clear, but may be related to a particularly high microvascular permeability to the liposome carriers in these metastatic lesions.
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Affiliation(s)
- Mila Travitzky
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
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50
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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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