NCMP-11. METASTATIC MENINGIOMA: AN UNUSUAL COURSE OF A COMMON DISEASE

Abstract

Abstract BACKGROUND The most common central nervous system (CNS) tumor in adult patients is meningioma, accounting for 30% of all intracranial tumors. Despite this, extracranial meningioma metastases are exceedingly rare, accounting for 0.1% of cases, with common locations for metastases localized to the lungs, liver, lymph nodes, and bone. RESULTS We present a 55-year-old female with a past medical history of tobacco use, hypertension and depression, who initially presented due to a generalized tonic-clonic seizure. MRI brain revealed an intracranial lesion in the left occipital lobe with mass effect, requiring craniotomy and resection. Pathology was consistent with WHO grade I meningioma and post-operatively a small area of residual tumor remained. PET/CT found a left lung nodule, which was thought to be due to her smoking history and was followed with annual scans. Four years later, she had an increase in the size of the meningioma on surveillance MRI scans. The patient then required repeat craniotomy which redemonstrated pathology of WHO grade I meningioma, then treated with stereotactic radiation 14 Gy. The subsequent annual surveillance pulmonary scan showed a growth of left pulmonary nodule. She underwent a left lingual wedge resection and was found to have low grade spindle cell tumor, consistent with metastatic meningioma. CONCLUSION Although rare, metastatic meningioma should be included in the differential diagnosis of patients with concomitant extracranial lesions. Our case highlights the importance of annual, surveillance scans of extracranial lesions in meningioma patients.