Multiple Pulmonary Metastases following Total Removal of a Bilateral Parasagittal Meningioma with Complete Occlusion of the Superior Sagittal Sinus: Report of a Case

Masataka Nakano,Aya Nakamura,Takao Arai,Naoki Kato,Yuzuru Hasegawa,Mitsuyoshi Watanabe,Toshiaki Abe,Toshihide Tanaka,Yukiko Kanetsuna,Tadashi Akiba,Hideki Marushima

doi:10.1155/2012/121470

Masataka Nakano, Aya Nakamura + Show 9 more

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https://doi.org/10.1155/2012/121470

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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.

Highlights

Meningioma is one of the most frequently encountered tumors of the central nervous system; it consists of meningoepithelial cells and generally originates from intracranial meninges
The tumor was immunoreactive for vimentin and epithelial membrane antigen (EMA), confirming the diagnosis of transitional meningioma (Figure 6(b))
These morphological and immunohistochemical findings were consistent with a WHO grade I meningioma

Summary

Introduction

Meningioma is one of the most frequently encountered tumors of the central nervous system; it consists of meningoepithelial cells and generally originates from intracranial meninges. Meningiomas have a potential to become more aggressive and invade the brain and/or calvaria or to metastasize outside the central nervous system. Most meningiomas with pulmonary metastases were histologically atypical (WHO grade II), anaplastic (WHO grade III) or initially benign meningiomas that changed to atypical or anaplastic tumors on recurrence [2, 3]. Case Reports in Neurological Medicine nervous system are known to occur rarely even from meningiomas that at first diagnosis are considered grade I tumors. The patient case was a recurrent parasagittal meningioma that invaded the superior sagittal sinus and eventually metastasized to the lung. In view of the slow-growing nature of these metastases and their good prognosis after resection, surgery is the treatment of choice [1]

Case Report

Histological Findings

Discussion