Multiple Intracranial Meningiomas Research Articles

Multiple Meningiomas with Different Histological Patterns in the Same Patient: Do They Exist? A Case Report and Literature Review

AbstractMeningiomas are the most common form of primary intracranial tumors, accounting for 13 to 26% of total neoplasms arising from arachnoid cap cells of the meningeal layer covering the central nervous system. Multiple intracranial meningiomas, which often have a syndromic association, account for less than 10% of total meningiomas. Multiple meningiomas with different histological patterns or grades in the same patient are very rare. Here we report such a rare case of meningioma with different histological patterns in the same patient. A 56-year-old lady presented to us with complaints of progressive right-sided weakness and speech disturbances, and her magnetic resonance imaging (MRI) showed two distinct extra-axial lesions over left frontal convexity and left fronto-temporo-parietal convexity. She underwent left fronto-temporo-parietal craniectomy and Simpson grade 1 excision of the lesions. Her histopathological examination revealed two different histological patterns: lesion 1 (left fronto-temporo-parietal convexity) was reported as a transitional World Health Organization (WHO) grade 1 meningioma and lesion 2 (left frontal convexity) was reported as angiomatous WHO grade 1 meningioma. She recovered well and was discharged in a stable condition after 3 weeks. Multiple meningiomas are defined as at least two spatially separated meningiomas occurring at the same time or more than two meningiomas arising sequentially from two clearly distinct regions. The exact mechanism of multicentricity is unknown. The treatment protocol for different histological types in the same patient is not clear. The extent of surgical resection remains the mainstay of the treatment and these patients should be followed up closely to watch for recurrence or malignant transformation. The role of radiotherapy in multiple meningiomas is yet to be established.

Regression of multiple intracranial meningiomas after cessation of long-term synthetic progesterone (megestrol) medication: case report and autopsy.

We report the history of a woman who developed four intracranial meningiomas during 11 years of therapy with the synthetic progesterone agonist megestrol. After discontinuation of the drug at age 75 years, she improved clinically and a CT scan showed near complete regression of the meningiomas by 78 years. Autopsy was performed at 83 years of age following an accidental death. At the tumor sites, we found both collagenous tissue with small islands of low grade meningioma having strong nuclear immunoreactivity for progesterone receptor and lipomatous tissue. A literature review showed similar cases of radiologic meningioma regression following discontinuance of progestins. Our case is the first one with histopathologic characterization of the end point.

Multiple intracranial meningioma: A case report

Multiple intracranial meningioma: A case report

MULTIPLE INTRACRANIAL MENINGIOMAS: A CASE REPORT AND A LITERATURE REVIEW

Multiple intracranial meningiomas refer to the presence of multiple meningiomas in multiple intracranial locations in the same patient without signs of neurofibromatosis. The incidence varies from 1% to 10%. Despite the diversity, the prognosis of multiple intracranial meningiomas has no difference from that of benign solitary meningioma. However, malignant tumors of different grades are observed to occur simultaneously in one-third of multiple meningiomas. Surgery is still the best choice for the treatment of symptomatic lesions. Our case review aims to introduce and discuss a 50-year-old female patient diagnosed with multiple intracranial meningiomas, and to describe its clinical, radiological, and histological characteristics. It also emphasizes that the patient had four tumors, underwent surgery, and had a good long-term overcome.

Sporadic multiple intracranial meningioma does not infer worse patient outcomes: results from a case control study.

Sporadic multiple meningioma are uncommon. Population-based data suggests that these patients have a reduced overall survival when compared to patients with solitary meningioma. The aim of this study was to investigate the clinical outcomes in multiple and solitary meningioma. A single-center matched cohort study (2008-2018) was performed. Patients with synchronous multiple meningioma at presentation, with no history of prior intracranial radiation, concurrent hormone replacement therapy or features of NF2-schwannomatosis were included. Eligible patients were matched 1:1 to patients with solitary meningioma. Outcomes of interest were occurrence of an intervention, recurrence, new meningioma development and mortality. Thirty-four patients harboring 76 meningioma at presentation were included. Mean age was 59.3years (SD = 13.5). Thirty-one (91.2%) were female. The median number of meningioma per patient was 2 (range 2-6). Eighteen patients (52.9%) were symptomatic at presentation. Median overall follow-up was 80.6months (IQR 44.1-99.6). Compared to patients with a sporadic meningioma, there was no difference in intervention rates (67.6% vs 70.6%, P = 0.792). Eight patients (34.8%) with a multiple meningioma had a WHO grade 2 meningioma compared to 7 (29.2%) with a solitary meningioma (P = 0.679). Median recurrence-free survival was 89months (95% CI 76-104) with no difference between the two groups (P = 0.209). Mean overall survival was 132months (95% CI 127-138) with no difference between the two groups (P = 0.860). One patient with multiple meningioma developed two further new meningioma 36months following diagnosis. Sporadic multiple meningioma may not have worse clinical outcomes. Management of patients with sporadic multiple meningioma should be tailored towards the symptomatic meningioma or high-risk asymptomatic meningioma.

Unique presentation of giant multiple meningiomas during immediate postpartum, case report and review of literature

We report a case with presentation and diagnosis of multiple intracranial giant meningiomas after epidural anesthesia on vaginal delivery It rsquo s a years old woman multiparous of that after placing the epidural catheter during vaginal delivery began with severe and persistent headache confusion drowsiness and right hemiparesis After vaginal delivery studies showed a giant right olfactory groove meningioma and giant left lesser sphenoid wing meningioma A two stage surgery was performed A gross total resection of both tumors and complete recovery of her symptoms was achieved after surgery

Gamma Knife Radiosurgery for Patients with Multiple Intracranial Meningiomas

The aim of this study was to evaluate the safety and efficacy of Gamma Knife radiosurgery (GKRS) in patients with multiple intracranial meningiomas (MIMs). The authors performed a retrospective analysis of 42 consecutive patients (7 men and 35 women) with MIMs who underwent GKRS. The median age of the patients at the time of GKRS was 57.5 years (range, 27-77 years). A total of 115 tumors among 42 patients were identified through imaging or postoperative histopathologic examination, of which 90 were treated with GKRS. Follow-up imaging studies were available for 75 tumors in 36 patients (83.3%), with a mean follow-up period of 45.0 months (range, 6.6-90.4 months); 41 patients (97.6%) received clinical follow-up for 16.7 to 106.7 months (average, 57.1 months). Local tumor control was achieved in 68 tumors (90.7%) at the last follow-up. On univariate analysis, surgical resection before GKRS more than once (P= 0.048) and high World Health Organization (WHO) classification (grades II and III) (P= 0.001) were associated with tumor progression. Patients with worsening clinical manifestation showed correlation with peritumor edema (P< 0.001) and had >2 lesions treated by GKRS (P<0.001) on univariate analysis. GKRS is a safe and effective treatment for MIMs. Variables including surgical resection before GKRS more than once, high grade WHO classification, peritumor edema, and >2 tumors treated by GKRS are predictors of unfavorable outcome after GKRS.

Multiple Intracranial Meningiomas: A Case Series and Review of the Literature

To review the published data to create a more comprehensive natural history of multiple meningiomas (MM). A review of MM published until now was carried out through a Medline search up to August 2018. The use of the "multiple meningiomas" keyword returned 278 articles, and the characteristics analyzed in our present cohort were searched on those publications. Articles without detailed description of clinical findings, neuroimaging confirmation of tumor multiplicity, follow-up at least of 5 years, and clear description of clinical findings were excluded. We added series to this review. 293 patients with MM were analyzed: 220 women and 73 men, with a total of 932 tumors (3.1 tumors per patient). The majority of tumors were located in the convexity (653% to 74.5%). The total number of tumors treated was 429 (43.9%): 338 (78.8%) by surgical resection and 91 (21.2%) by radiotherapy. Histopathologic description was available in 303 of 429 cases, being grade I in 272 (90.3%) cases, with a predominance of the meningothelial subtype (30.7%). Tumor recurrence was described in 32 (8.07%) among 397 and only 10 deaths (3.4%) of 281 reported cases, where this characteristic was evaluated. World Health Organization grade I predominance was observed among multiple meningiomas in similarity to single meningiomas. Only a fraction of MM patients (43.89%) needed treatment. A benign tumor behavior was corroborated by the observed low frequency of recurrence and mortality.

Multiple Intracranial Meningioma in a Woman with Headache

Meningioma is one of the most common primary brain tumors in adults. The literature indicates a higher prevalence of multiple meningiomas in women, which might be attributed to the hormonal factors, such as expression of progesterone receptor.Here we report a 58-year-old woman with a 4-year history of headache, which was aggravated during the few months before her admission. The patient was diagnosed with multiple meningiomas based on her brain magnetic resonance imaging. Therefore, she underwent surgical excision of the tumor and had no complications or signs of recurrence in the site of surgery, after a 3-year follow-up.Although multiple meningioma is not frequent, it does not differ from solitary tumors in terms of prognosis and management. Our experience shows that complete removal of the tumors is not possible in all cases of multiple meningioma and resection of the largest tumors results in favorable outcomes.

Multiple meningiomas in a woman irradiated in utero

Meningiomas are a common central nervous system tumour and radiation is a known risk factor for their development. In utero radiation exposure correlates to developmental abnormalities and carcinogenesis in a dose- and gestational age-related manner. Radiation induced meningioma has been reported in detail in the literature in patients who had been irradiated earlier in life. At the time of publication, there was no data on radiation exposure whilst in utero and meningioma. We report on a 42-year-old woman with multiple intracranial meningiomas and no other risk factors except a history of in utero exposure to low dose X-ray radiation at 12weeks gestational age.

Multiple intracranial meningiomas with severe bone destruction and extensive calcification: one case report

Multiple intracranial meningiomas with severe bone destruction and extensive calcification: one case report

A rare intracranial tumor consisting of malignant anaplastic and papillary meningioma subtypes.

Sir, I read with great interest the paper by Kochanski et al.[2] describing a case of a rare intracranial tumor consisting of malignant anaplastic and papillary meningioma subtypes. As mentioned, multiple intracranial meningiomas and meningiomas showing collision with other intracranial tumors such as astrocytoma and metastatic tumors are well known pathologies. Indeed, coincidence of meningiomas with different radiological findings and histological types are very rare entities. We have previously reported a coincidence of two intracranial meningiomas—a myxomatous metaplastic meningioma (myxoid meningioma) grade 1 (WHO-93) and a psammamotous meningioma grade 1 (WHO-93)—in a 65-year-old man.[1] The tumors were located on the greater wing sphenoid bone and at the level of the precentral gyrus in the left temporoparietal region, respectively. The tumor that was diagnosed as myxoid meningioma was showing hyperintensity in T2-weighted magnetic resonance imaging sequences; and the other tumor was showing hypointensity in all pulse sequences. Multiple meningiomas with the same histopathological diagnoses with multicentric localizations may be due to spreading via cerebrospinal fluid or venous structures; however, the origin of the multiple tumors of different histological type should have independent pathogenesis. In the presence of lesions with different imaging features and/or different operative findings suggestive of separate histological diagnosis, the removal of all components and examination of the whole surgical specimens have more importance. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Successful treatment of multiple intracranial meningiomas with mifepristone (RU486).

TPS2108 Background: Meningiomas, the most frequent primary brain tumors in adults, are twice more frequent in females compared to males. Several evidence suggest a role for female sex hormones, and...

Stereotactic radiosurgery in patients with multiple intracranial meningiomas

Stereotactic radiosurgery in patients with multiple intracranial meningiomas

Multiple Intracranial Meningiomas: A Review of the Literature and a Case Report

Multiple intracranial meningiomas are a condition where there is more than one meningioma in several intracranial locations in the same patient without signs of neurofibromatosis. Incidence varies from 1 to 10%. The prognosis of multiple intracranial meningioma does not differ from benign solitary meningiomas despite the multiplicity. However, the simultaneous occurrence of different grades of malignancy is observed in one-third of multiple meningiomas. Surgery remains the best option for treatment of symptomatic lesions. Our case review aims to present and discuss a 75-year-old female patient diagnosed with multiple intracranial meningiomas, describing their clinical, radiological, histological characteristics. It also highlights the fact that the patient had two tumours, underwent surgery, and so far has a good quality of life.

Multiple Intracranial Meningiomas and Cavernous Hemangiomas

Intracerebral meningiomas and cavernous hemangiomas (hemangiomas, cavernomas) are entities frequently encountered by neuroradiologists and neurosurgeons. Even multiple tumors can often be observed in patients with certain congenital conditions, eg. multiple meningiomas in neurofibromatosis type 2 or multiple cavernous hemangiomas in familial cavernous malformations. However, there are only very few reported cases of concurrent meningiomas and cavernous hemangiomas, all but one related to prior radiotherapy. We describe the second case of concurrent multiple meningiomas and cavernous hemangiomas occurring de novo without a history of radiation.

Tuberculum Sellae Meningioma Growing during Pregnancy: A Difficult Decision-Making Process

A 43-yr-old woman presented to us 32 wk into her second pregnancy with a 2-wk history of progressive visual impairment (consisting of bitemporal emianopia and visual acuity decrease to 1/10 in the left eye and 4/10 in the right eye) due to a tuberculum sellae meningioma (TBM) (Fig. 1A). The diagnosis was based on the presence of typical radiological features of a meningioma overlying a normal-sized sella with a preserved pituitary gland. She was given oral dexamethasone to accelerate the fetal lung maturation. A healthy boy was born at 34 wk gestation by cesarean section. After delivery, visual disturbances did not improve, and the patient underwent an endoscopic transsphenoidal transplanum/transtuberculum approach (ETTA), obtaining radical removal of the meningioma. Histological examination showed a meningotheliomatous meningioma with marked expression of progesterone receptors (Fig. 2). The postoperative course was uneventful, and she was discharged home on d 5 with complete recovery of her visual function. The patient did not show hypothalamic/pituitary dysfunction during or after pregnancy. Three months later, magnetic resonance imaging confirmed the radical removal of the tumor (Fig. 1B). When last seen 5 months after surgery, she was in good clinical condition. To our knowledge, 13 other cases of TBM growing during pregnancy have been reported (1–4), but our patient was the first to be treated by ETTA, a minimally invasive approach that favored a prompt return home of the mother to her child. The high expression of progesterone receptor in the specimen (Fig. 2) confirms the physiopathological mechanism suggested by other authors to explain the rapid growth of the tumor during pregnancy (1–4). Interestingly, supporting this hypothesis, regression of multiple intracranial meningiomas after discontinuation of long-standing use of megestrol acetate has been recently reported (5).

Regression of multiple intracranial meningiomas after cessation of long-term progesterone agonist therapy

The authors present the case of a patient that demonstrates the long-standing use of megestrol acetate, a progesterone agonist, and its association with multiple intracranial meningioma presentation. Discontinuation of megestrol acetate led to shrinkage of multiple tumors and to the complete resolution of one tumor. Histological examination demonstrated that the largest tumor had high (by > 25% of tumor cell nuclei) progesterone-positive expression, including progesterone receptor (PR) isoform B, compared with low expression of PR isoform A; there was no evidence of estrogen receptor expression and only unaccentuated collagen expression. This is the first clinical report illustrating a causal relationship between exogenous hormones and modulation of meningioma biology in situ.

Regression of intracranial meningioma following intratumoral hemorrhage

An intratumoral hemorrhage within a meningioma occurs infrequently; in less than 3% of all lesions. When hemorrhage does occur, however, it is associated with a poor prognosis and significant mortality rates. We report a 66-year-old woman with a 10-year history of multiple intracranial meningiomas managed conservatively who underwent surgical resection of a spheno-orbital lesion for decompression of the right optic nerve. Postoperatively, an intratumoral hemorrhage developed in a contralateral lesion, which was managed conservatively. During follow up, the hemorrhaged lesion became significantly smaller. To our knowledge there are no published reports of spontaneous resolution of a meningioma after intratumoral hemorrhage without surgical management. We review the literature on hemorrhage in meningiomas and postulate some pathophysiologic mechanisms for the bleeding and subsequent tumor resolution seen in this patient.

Multiple Intracranial Meningiomas Causing Papilledema and Visual Loss in a Patient With Nevoid Basal Cell Carcinoma Syndrome

A 27-year-old man with nevoid basal cell carcinoma syndrome (NBCCS, Gorlin syndrome) who had undergone craniospinal irradiation for a childhood brain stem medulloblastoma complained of progressive binocular visual loss. Ophthalmologic examination disclosed subnormal visual acuity and visual fields in both eyes attributed to chronic papilledema. Brain MRI demonstrated mass effect from multiple large meningiomas. After embolization and surgical resection of the largest meningioma, papilledema disappeared and visual dysfunction resolved partially. This is the sixth reported patient with NBCCS, medulloblastoma, and craniospinal radiation who has developed intracranial meningioma, further documenting the fact that such patients have a relatively high likelihood of developing meningiomas, especially multiple meningiomas. Because patients with NBCCS are often mentally impaired and because papilledema can progress silently before causing irreversible visual loss, periodic ophthalmologic examination is advisable after craniospinal radiation.