Abstract
Anaplastic meningioma is a World Health Organization (WHO) Class III lesion representing 2–3% of all meningiomas, with more aggressive spread, increased mortality and increased likelihood of recurrence. Metastases outside the blood–brain barrier are uncommon but can occur to the lungs, liver, bone and skin.Definitive diagnosis is obtained with pathological analysis. The World Health Organization classifies meningiomas into benign (Grade I), atypical (Grade II) and anaplastic/malignant (Grade III) based on histological findings including number of mitoses, cellularity, nucleus to cytoplasm etc. This case presents a 58-year-old female with history of treated anaplastic meningioma with new onset headache, nausea and vomiting. Workup demonstrated multiple new bilateral pulmonary nodules, which subsequent biopsy proved to be metastasis from recurrent anaplastic meningioma, with extensive intrathoracic involvement.
Highlights
Meningiomas arise from arachnoid cap cells of the meninges and represent approximately 13–26% of intracranial tumours.[1]
The majority of meningiomas occurs in middle aged or elderly patients but can be seen in younger populations with syndromes such as neurofibromatosis Type 2.2 Benign meningiomas are more prevalent in females, whereas atypical and Thomas and Dalal anaplastic meningiomas are more commonly seen in men.[2]
Criteria for anaplastic meningioma includes “>/=mitotic figures/10 HPF or focal or diffuse loss of meningothelial differentiation resulting in carcinoma, sarcoma, or melanoma –like appearance”
Summary
Meningiomas arise from arachnoid cap cells of the meninges and represent approximately 13–26% of intracranial tumours.[1]. Metastases outside the blood–brain barrier are uncommon but can occur to the lungs, liver, bone and skin.[1,2] Atypical and anaplastic meningiomas have been suggested in some studies to represent a malignant progression of benign meningiomas, with some series suggesting up to 28.5% of recurrent benign meningiomas demonstrating atypical or anaplastic pathology.[2,3]
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