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NEUROIMAGES
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 266-267

Multiple extraneural metastases from a benign intracranial meningioma


Department of Neurosurgery, Bethune International Peace Hospital, Shijiazhuang, Hebei, China

Date of Web Publication11-Jan-2018

Correspondence Address:
Dr. Yaxiong Li
Department of Neurosurgery, Bethune International Peace Hospital, 398# Zhong-Shan West Road, Hebei 050082
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.222888

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How to cite this article:
Li Y, Fan F, Qi H. Multiple extraneural metastases from a benign intracranial meningioma. Neurol India 2018;66:266-7

How to cite this URL:
Li Y, Fan F, Qi H. Multiple extraneural metastases from a benign intracranial meningioma. Neurol India [serial online] 2018 [cited 2019 Apr 19];66:266-7. Available from: http://www.neurologyindia.com/text.asp?2018/66/1/266/222888




A 45-year old woman presented with a few months' history of dizziness and right upper limb paraesthesia. Her computed tomography (CT) scan revealed a left temporoparietal dural-based tumor [Figure 1]a and [Figure 1]b. The patient underwent gross total surgical resection of the mass. Histopathological examination revealed a fibroblastic meningioma (World Health Organisation grade I tumor) [Figure 1]c. The patient was disease-free after surgery. After 8 years, she was readmitted with a 5-month history of progressive abdominal swelling and mild upper abdominal discomfort. Her physical examination revealed a massive hepatomegaly and splenomegaly. Chest and abdominal CT scan demonstrated multiple lesions within the left lobe of thyroid gland, liver, and both lungs [Figure 2]a,[Figure 2]b,[Figure 2]c. The pelvic magnetic resonance imaging (MRI) and ultrasound examination revealed tumors in the recto-uterine and vesico-uterine pouches and within the uterine adenexa [Figure 2]d,[Figure 2]e. There was no evidence of residual or recurrent neoplasm seen on brain CT and magnetic resonance imaging (MRI) [Figure 3]a,[Figure 3]b,[Figure 3]c. The biopsy of these pelvic lesions was consistent with the histopathological diagnosis of metastatic meningioma [Figure 4]a and [Figure 4]b. The patient declined surgical intervention. Chemotherapy and radiotherapy were simultaneously administered. She showed no signs of abdominal discomfort during a 2-year follow-up course.
Figure 1: Unenhanced (a) and enhanced (b) axial brain CT scan images showing a left temporoparietal lesion with an intense and homogenous contrast enhancement (white arrow). (c) Pathological examination showed a densely cellular tumor consisting of sheets and whorls of cells, which indicate a fibroblastic meningioma (hematoxylin and eosin staining; original magnification, ×40)

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Figure 2: Extraneural multiple metastases: left thyroid (a), liver (b ), right lung (c), ovary (d), and uterus (e) [white arrow]

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Figure 3: Axial CT (a), MRI axial T1- (b), and T2-weighted images (c) showing that there was no recurrence of tumor at the primary intracranial site

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Figure 4: (a) Histopathological findings of the metastatic tumor tissue revealed features of a fibroblastic meningioma which were similar in appearance to that of the primary meningioma that had been resected 8 years ago. (b) The tumor was positive for epithelial membrane antigen (original magnification ×10)

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A meningioma is typically a slow-growing tumor, constituting 15–20% of all intracranial neoplasms.[1] Widespread extracranial dissemination of benign meningiomas is particularly rare. In a patient with a history of meningioma, a comprehensive systemic examination should be performed for the detection of distant metastases as early as possible. The effective therapeutic strategy remains unclear due to the low incidence of its systemic dissemination.[2] Novel chemo- and radiotherapeutic regimen should be explored in order to treat the metastatic disease.[3] If the metastasis is solitary and the disease-free interval is prolonged, surgical resection of the lesion is recommended. The malignant lesions disseminate by a hematogenous route.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initial will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Demonte F, Al-Mefty O. Meningiomas. In: Kaye AH and Laws ER Jr, editors. Brain tumors. New York: Churchill Livingstone; 1995. pp 675-704.  Back to cited text no. 1
    
2.
Surov A, Gottschling S, Bolz J, Kornhuber M, Alfieri A, Holzhausen HJ, et al. Distant metastases in meningioma: An underestimated problem. J Neurooncol 2013;112:323-7.  Back to cited text no. 2
    
3.
Chua FH, Low SY, Tham CK, Ding C, Wong CF, Nolan CP. Disseminated extracranial metastatic meningioma. J Clin Neurosci 2016;33:214-6.  Back to cited text no. 3
    


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