Metastatic Meningioma Research Articles

Metastatic meningioma WHO grade II of the cervical spine: case report and review of the literature

The authors report a rare case of metastatic atypical meningioma WHO grade II involving the dorso-lateral region of the cervical spine and causing spinal cord compression in a 76-year-old man. The patient was treated surgically in June 1998 for an atypical parasagittal meningioma in the right frontal lobe. Local recurrence with extension to the left hemisphere required surgical treatment in January 2000, and in December 2000 recurrence caused paraplegia of the lower extremities and paresis of the left arm. A 3rd operation was carried out in January 2001, followed by radiotherapy with a total dose of 45 Gy. The patient presented again in March 2003 because of pain in the neck and a progredient new paresis and paresthesia of the right arm. Computed tomogram of the cervical spine showed a large tumor with compression of the spinal cord. MRI was not possible due to a pacemaker which had been implanted in the meantime. Surgical subtotal removal of the tumor via hemilaminectomy of the 3rd and 4th cervical vertebrae was performed. After decompression of the cervical spine the paresis of the right arm improved, the paraplegia of the legs and the left arm, existing since December 2000, remained unchanged. Histological findings of the cranial lesions and the metastatic lesion had a similar appearance and were compatible with atypical meningioma (WHO grade II).

A Sequential Scanning of the Immune Efficiency in Astrocytoma (Grade I to Grade III), Meningioma and Secondary Glioma Patients with and without Therapeutic Scheduling

Purpose: Glioma induces immune suppression. However, data revealing the immune status in glioma patients with sequential therapeutic interventions is missing. Thus, the study aims at evaluating the sequential immune status of glioma bearing patients (Astrocytoma Grade I to Grade III) receiving conventional therapeutic measures. The results were compared with the immune status of metastatic secondary glioma and meningioma patients where there is minimal immune suppression and the effect of therapeutic intervention on the above score. Methods: Functional immune parameters of peripheral blood lymphocytes were assayed by CD2 receptors enumeration through E-rosetting and lymphocyte cytotoxicity assay and assessing the generation of reactive oxygen species by NBT assay of peripheral blood macrophages in patient groups bearing Astrocytoma (Grade I to Grade III), meningioma and secondary glioma. Results: Patients bearing Astrocytoma (all 3 grades) showed maximum immune suppression as compared to the normal subjects, diseased meningioma controls, and secondary glioma. Therapeutic interventions viz. radiotherapy, surgery and radiotherapy after surgery and chemotherapy could not recover the suppressed activity of the CD2 bearing lymphocytes and that of peripheral blood macrophages. However, therapeutic scheduling could recover the functional activity of the CD8 bearing lymphocytes and the CD56 NK cells from that of tumor bearing patients. Conclusion: Astrocytoma and not meningioma is capable of causing immunesuppression. As the tumor progresses from Grade I to Grade III, a linear reduction in the functional efficacy of immunocytes is seen to occur. Radiotherapy, surgery, and chemotherapy also induces an inhibitory effect towards the host immune system. The inhibitory effect of tumor as well as of therapy were mainly directed towards the CD2 bearing lymphocyte population and the peripheral blood macrophage population.

Metastatic meningioma to the eleventh dorsal vertebral body: total en bloc spondylectomy. Case report and review of the literature

One in every thousand intracranial meningiomas metastatize extracranially. Lung and intraabdominal organs are most frequently affected. Only 7% involve vertebrae and just a dozen cases have been reported in the literature. To our knowledge, this is the first description of a total en bloc spondylectomy through a posterior approach for the treatment of an intraosseous metastatic meningioma to the eleventh dorsal vertebra. In March 1996, a 37 year-old male underwent surgical resection for a left occipital intraventricular benign meningioma (WHO I). He was reoperated in February 2002 due to local recurrence. By the end on 2003 he developed progressively invalidating dorsolumbar pain. MRI studies revealed a T11 intraosseous mass. In March 2004, a percutaneous biopsy and vertebroplasty were performed. The pathological specimen was identified as adenocarcinoma and he initiated chemotherapy. Advice from a second pathologist was seeked, who suggested the diagnosis of intraosseous meningioma. Workup studies failed to reveal any primary tumor. In May 2004 the patient was admitted to our department and a new transpedicular biopsy confirmed the diagnosis. In June 2004 he underwent T11 total en bloc spondylectomy (Tomita's procedure), fusion with bone and calcium substitute-filled stackable carbon-fiber cages, and T9 to L1 transpedicular screw fixation. No postoperative complications ocurred and he is, so far, free from primary and secondary disease. Definite pathology: benign meningioma (WHO I). Distant metastases from intracranial meningiomas are rare entities, arising from benign lesions in, at least, 60% of cases. Enam et al proposed a specific pathological score to differentiate benign, atypic and malignant meningiomas. Such score correlates with the chance of metastatizing: more than 40% in malignant meningiomas compared to 3.8% of brain tumors overall. The ability to metastatize seems to be linked to vascular or lifatic invasiveness. Metastases ocurr more frequently in angioblastic, papillary and meningothelial variants. Hematogenous (especially venous; Batson's perivertebral plexus), linfatic and cerebrospinal fluid are the main routes involved in the spreading of the tumor. Craniotomy itself may also play a role, for the majority of patients have been previously operated on repeatedly. The interval between the onset of the intracranial disease and the appearance of the metastasis varies from months to many years. The value of transpedicular biopsy is widely recognized (efficacy over 80%) and the suitability of the specimen for pathological examination improves when wide inner caliber trephines are used. In the case presented we applied the oncologic concept of vertebral en bloc resection. We believe this case represents a paradigmatic indication of this technique because it respects the concepts of radical resection and spinal stability, and offers an opportunity for the curation of the disease.

Evaluation of Metastatic Meningioma With 2-Deoxy-2-[18F]Fluoro-D-Glucose PET/CT

The purpose of this study was to characterize the 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT imaging findings of sacral metastatic meningioma. An 18-year-old woman with a history of metastatic meningioma, who presented with intractable pain and spasm of the right lower extremity, underwent FDG PET/CT imaging. FDG PET/CT scan demonstrated a moderately hypermetabolic sacral mass. The biopsy of the lesion was consistent with a high-grade malignant meningioma. Although meningioma is typically a benign tumor, in rare instances, it metastasizes. The current case example exhibits moderately increased metabolism despite findings of high-grade malignancy on biopsy.

An atypical spinal meningioma with CSF metastasis: fatal progression despite aggressive treatment

The authors report the case of a 23-year-old man who presented with a C1-3 spinal mass. Following intraspinal decompression the tumor was histologically classified as an atypical meningioma (World Health Organization grade II). Two further surgical interventions resulted in almost total removal of the meningioma. In addition, radiotherapy was performed. During the 1.5-year follow-up period the diagnostic examinations identified a local tumor recurrence, an intraspinal C-6 metastasis, and a segmental instability with anterior C2-3 slippage and C3-4 kyphosis. The tumor was resected and occipitocervical stabilization was performed. Histological examination showed no change in malignancy. Despite additional hydroxyurea-based chemotherapy, the patient presented 4 months later with a hemiparesis and a massive recurrence of the tumor mass involving the posterior fossa and the upper thoracic spine. Because there were no further therapeutical options, the patient died. The authors discuss more aggressive therapeutic options in addition to surgery in patients with metastatic atypical meningiomas. The results in the reported case indicate that meningiomas associated with cerebrospinal fluid metastasis may represent a higher grade of malignancy.

Metastatic Meningioma WHO Grade II of the Cervical Spine: Case Report and Review of the Literature

The authors report a rare case of metastatic atypical meningioma WHO grade II involving the dorso-lateral region of the cervical spine and causing spinal cord compression in a 76-year-old man. The patient was treated surgically in June 1998 for an atypical parasagittal meningioma in the right frontal lobe. Local recurrence with extension to the left hemisphere required surgical treatment in January 2000, and in December 2000 recurrence caused paraplegia of the lower extremities and paresis of the left arm. A 3 (rd) operation was carried out in January 2001, followed by radiotherapy with a total dose of 45 Gy. The patient presented again in March 2003 because of pain in the neck and a progredient new paresis and paresthesia of the right arm. Computed tomogram of the cervical spine showed a large tumor with compression of the spinal cord. MRI was not possible due to a pacemaker which had been implanted in the meantime. Surgical subtotal removal of the tumor via hemilaminectomy of the 3 (rd) and 4 (th) cervical vertebrae was performed. After decompression of the cervical spine the paresis of the right arm improved, the paraplegia of the legs and the left arm, existing since December 2000, remained unchanged. Histological findings of the cranial lesions and the metastatic lesion had a similar appearance and were compatible with atypical meningioma (WHO grade II).

Metastatic Meningioma to the Liver Successfully Treated with a Wedge Resection and Radiation Therapy: Report of a Case

Meningiomas account for approximately 15%-20% of all primary brain tumors. Metastatic meningiomas are rare. Less than 100 cases of extracranial metastatic meningiomas have been reported in the literature. An unusual case of metastatic meningioma to the liver successfully treated by a surgical resection and radiation therapy is presented.

Small-cell tumors of the liver: A cytological study of 91 cases and a review of the literature

This study was designed to consider the cytomorphological spectrum, differential diagnosis, and the role of ancillary studies in small-cell tumors of the liver. Three independent pathologists reviewed cytological slides from 91 cases of small-cell tumors of the liver. The results were compared with the findings of three recently published studies (Cytopathology 11 (2000) 262-267; Diagn Cytopathol 19 (1998) 29-32; and Acta Cytol 40 (1996) 937-947). The role of immunohistochemistry in reaching timely and specific diagnoses was also examined. The diagnostic categories included 44 cases of metastatic small-cell undifferentiated carcinoma, 15 cases of metastatic neuroendocrine carcinoma, 10 cases of metastatic adenocarcinoma, 7 cases of malignant lymphoma, 4 cases of hepatocellular carcinoma with small-cell features, 2 cases of cholangiocarcinoma, 1 case of poorly differentiated carcinoma, and 8 cases of rare tumors including granulosa cell tumor (2 cases), sarcoma (4 cases), malignant melanoma with small-cell features (1 case), and meningioma with small-cell features (1 case). Metastatic granulosa cell-tumor, metastatic melanoma, and metastatic meningioma should be included in the differential diagnoses of small-cell malignancies found in the liver.

Metastatic meningioma to the thoracic and lumbar vertebral bodies : A case report

Metastatic meningioma to the thoracic and lumbar vertebral bodies : A case report

Chest Wall Metastasis from Recurrent Meningioma

Meningiomas are generally considered benign lesions. A minority, however, are capable of metastasis. The ones most likely to do so are commonly recurrent or frankly malignant in nature. The optimal management of such metastases is unclear. This is the first reported case of meningioma presenting as an isolated metastasis to the chest wall. This case involves a 64-year-old woman without significant medical or family history who underwent resection of a meningioma of the right cerebral hemisphere. She was treated 10 years later for recurrence by stereotactic radiosurgery. Three years after that, the patient's family noticed a mass on the left chest wall. A CT scan revealed destruction of the ninth rib laterally and subpleural extension. The patient subsequently underwent resection of full-thickness chest wall for a presumed soft-tissue sarcoma. Further pathologic evaluation including electron microscopy and immunohistochemistry revealed metastatic meningioma. The patient received adjuvant radiation to the chest wall and is currently free of disease at the chest wall one year after surgery. This case illustrates the difficulty in establishing an accurate diagnosis of metastatic meningioma. Consequently in selected patients with a history of the disease the diagnosis of metastatic meningioma must at least be considered. Resection of an isolated metastasis in this setting appears warranted.

Metastatic atypical meningioma: case report and review of the literature

Extracranial metastasis of an intracranial meningioma is rare. We discuss the clinical, radiological and histopathological presentation of an elderly man with pulmonary metastases from a recurrent meningioma of atypical histology, and review the literature pertaining to this phenomenon.

Meningioma Metastatic to the Lung

Meningiomas constitute 15% to 18% of all primary intracranial and intraspinal tumors. Distant extracranial metastases are reported to occur in fewer than 1 in 1000 cases. Of 1992 primary intracranial meningiomas seen at Mayo Clinic Rochester from 1972 through 1994, we identified 3 (0.15%) with documented extracranial metastasis. A review of the literature suggests that previous craniotomy, venous sinus invasion, local recurrences, histological malignancy, and papillary morphology may be risk factors for systemic spread, as demonstrated in our cases. Although rare, metastatic meningioma should be considered in the differential diagnosis of abnormal findings on chest radiography in patients with known or suspected intracranial meningioma.

Aspiration biopsy cytology of pleuro-pulmonary metastasis from a recurrent meningioma

A transthoracic fine-needle aspiration biopsy, sampled under echographic guidance from a pleuro-pulmonary mass, proved to be a metastatic meningioma. The meningioma had been operated on from the left parietal lobe, twelve years previously. Cytologic specimens showed nests of round-to-spindle-shaped tumor cells with whorl formation; the cells were immunoreactive for vimentin and epithelial-membrane antigen. The cytological appearance of the tumor cells was diagnostic of meningioma. In the course of the clinical staging, a recurrent cerebral meningioma was found and was judged to be inoperable, because of extensive growth and brain infiltration.

Metastatic Meningioma to the Second Cervical Vertebral Body

A rare case of C2 vertebral body metastasis from a parasagittal meningioma is reported. The metastatic lesion was found 13 years after resection of the primary lesion. The primary and the metastatic lesions had a similar and benign histological appearance. Remote metastasis of a meningioma can occur even with a benign histological finding after a variable disease-free period.

Metastatic Meningioma to the Second Cervical Vertebral Body

Metastatic Meningioma to the Second Cervical Vertebral Body

Expression of CD15 in tumours of the nervous system.

The expression of the CD15 epitope was investigated by immunohistochemistry, western blotting and immuno-thin-layer chromatography on a large series of human nervous system tumours and ethylnitrosourea-induced rat gliomas. Our results show that CD15 is expressed as a glycoprotein- or glycolipid-associated epitope in normal human and rat brain. In contrast, immunoreactivity for CD15 was absent in tumour cells of experimental rat gliomas. In human tumours we found a more complex expression pattern. While intra- and perivascular granulocytes as well as macrophages in necrotic areas of anaplastic tumours were always strongly CD15-positive, immunoreactive tumour cells were detectable only in a fraction of low-grade gliomas. Anaplastic gliomas and glioblastomas consistently did not express the epitope on their tumour cells. In addition to individual low-grade gliomas, we found CD15-positive cases among metastatic carcinomas, craniopharyngeomas, meningiomas, germinomas and malignant melanomas. Our results suggest that immunohistochemistry for CD15 is potentially useful in diagnostic neuropathology as a marker for granulocytes in paraffin sections, as a supplementary tool for the histopathological grading of gliomas, and as an aid for differentiation between anaplastic glioma cells and non-neoplastic glia. Furthermore, it can be speculated that the lack of CD15 expression on anaplastic glioma cells may potentially be responsible for some of their characteristics--such as altered cellular interaction and loss of contact inhibition.

Primary and metastatic pulmonary meningioma

Patient 1 was a 53-year-old man who had a very rare primary pulmonary meningioma that developed in the left lingular segment. When this report was written, 7 years had passed since he underwent operation, and no recurrence of the meningioma had been detected. In Patient 2, a 61-year-old woman, multiple pulmonary metastases were confirmed 19 years after she had undergone operation for multiple cerebellar meningiomas, and the metastases were resected. After 2 years, multiple intraperitoneal metastases were found, and thus aggressive surgery was performed. Currently, 22 years after the operation for the primary cerebellar meningioma, the patient is alive without any subjective symptoms, although intraperitoneal metastases have recurred. To date, only four cases (all in women) of primary pulmonary meningioma have been reported. Case 1 reported in this article is thus the first case in a male patient to be reported, and, in addition, this patient also has the first reported case to have been evaluated for more than 5 years. In Case 2, however, each of the excised extracranial tumor lesions was histologically homogeneous and showed a hemangiopericytomatous pattern. The histologic picture of those tumor lesions was exactly the same as the picture of a small portion of the cerebellar meningiomas excised 19 years earlier. Thus, all those extracranial tumor lesions were diagnosed to be metastatic meningiomas. However, it is difficult to explain why there had been no symptoms for as long as 19 years until the pulmonary metastases were discovered.

Gadolinium-DOTA enhanced MR imaging of intracranial lesions.

Gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N",N"'-tetraacetic acid (Gd-DOTA) is the first of a new class of macrocyclic paramagnetic magnetic resonance (MR) contrast agents (gadolinium cryptelates) to be used in clinical practice. Gadolinium-DOTA possesses relaxation properties similar to those of gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). We report our initial clinical experience in 38 patients with intracranial lesions studied with MR before and after injection of Gd-DOTA. Diseases included primary and metastatic brain tumor, cerebral infarct, vascular malformation, meningioma, hemangiopericytoma, schwannoma, and pituitary macroadenoma. Gadolinium-DOTA was administered intravenously in a dosage of 0.1 mmol/kg body weight. All studies were performed on a superconductive 0.5 T system. As compared to noncontrast T1- and T2-weighted images (WI), Gd-DOTA enhanced T1 WI were useful in defining the anatomy of malignant intraaxial tumors (high-grade glioma, metastasis) and in tumor versus edema differentiation. Low-grade gliomas did not enhance; in these cases the precontrast T2-weighted sequence was found to be more informative. In post-operative patients, Gd-DOTA allowed us to demonstrate residual tumor or tumor recurrence. Extraaxial tumors (meningioma, hemangiopericytoma, neuroma) enhanced markedly, presumably reflecting tumor vascularity. In our experience, the use of Gd-DOTA improves the anatomic definition of cerebral lesions and in some cases increases both MR sensitivity and specificity. We found Gd-DOTA to be a well tolerated and effective paramagnetic contrast agent. Gadolinium-DOTA can be considered as an alternative water-soluble MR contrast agent to Gd-DTPA.

Primary Intracranial Malignant Lymphoma

Nine cases of primary intracranial malignant lymphoma, which accounts for 3.3% of all intracranial tumors seen in the authors' institution, were studied in terms of diagnostic computed tomographic (CT) features, the tumors' histologic appearance, treatment, post-treatment blood immunologic and cerebrospinal fluid (CSF) characteristics, and outcome. The patients were seven males and two females aged 42 to 67 years. Their chief signs and symptoms on admission were intracranial hypertension, focal signs, and disturbance of consciousness. CT, which proved the most useful preoperative diagnostic technique, demonstrated multiple lesions in seven cases and, in all cases, regions of isodensity or slight high density that were enhanced by contrast medium. According to the patterns of enhancement, the tumors were classed as diffuse (three cases) or nodular (six cases). The former is considered typical of malignant lymphoma, whereas the latter type was sometimes indistinguishable from metastatic tumor and meningioma. At surgery, one patient underwent radical tumor excision, two partial removal, and six biopsy only. Histologic examination revealed one tumor to be of the diffuse small cell type, three of the medium cell type, and five of the large cell type (Lymphoma Study Group classification). Of seven tumors in which lymphocytes were examined by peroxidase-antiperoxidase staining, four were of the B cell type. Postoperatively, whole brain irradiation with 29 to 46 Gy was followed by local irradiation with 15 to 50 Gy. If the tumor persisted, one of three chemotherapies was administered. In one case, methotrexate was given intrathecally. Seven patients were divided into two groups: long remission (three) and recurrence (four). These two groups were compared in terms of serum immunoglobulin levels, T and B cell ratios, CSF characteristics, CT features, tumor cell type, and treatment. No clear differences were found.

Androgen receptor binding activity in meningiomas

Analyses of androgen receptor binding activity in 54 intracranial, intraspinal, and metastatic meningiomas were performed with a specific radioligand binding technique using [ 3H]R 1881 as radioligand. [ 3H]R 5020 was used for the concurrent determination of progesterone receptor binding activity. Moderate concentrations of androgen receptors (33.4 ± 5.4 fmol/mg protein) were detected in 35 (65%), whereas high levels of progesterone binding components (236 ± 35 fmol/mg protein) were demonstrated in 48 (89%) tumors. The androgen receptor binding activity was positively correlated with the progesterone receptor binding activity ( r, = 0.38, p < 0.05). This relationship is suggestive of an androgen regulation of the progesterone receptor via the androgen receptor system. The presence of androgen and progesterone receptors in a large proportion of meningiomas, and the tendency for a dependence of androgen receptor and progesterone receptor binding activity on the histological subtype could have implications for tumor therapy.