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Malignant intraventricular meningioma with craniospinal dissemination and concurrent pulmonary metastasis.

Tao CY, Wang JJ, Li H, You C - World J Surg Oncol (2014)

Bottom Line: The patient showed a local relapse and dissemination around the previous tumoral cavity and along the spinal canal during the last recurrence.Left pulmonary metastasis was also found.She died despite multiple lesion resections.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, 610041 Chengdu, Sichuan, China. tcy106@163.com.

ABSTRACT

Background: Malignant intraventricular meningiomas are quite rare and may spread along the craniospinal axis or extraneurally. However, simultaneous cerebrospinal dissemination and distal extraneural metastasis has seldom been reported.

Case presentation: A 51-year-old woman presented with recurrent anaplastic meningioma in the trigone of right lateral ventricle over a 1.5-year period. Suggested radiotherapy was refused after each operation. The patient showed a local relapse and dissemination around the previous tumoral cavity and along the spinal canal during the last recurrence. Left pulmonary metastasis was also found. She died despite multiple lesion resections.

Conclusions: Malignant intraventricular meningiomas are an uncommon subset of intracranial meningiomas, and have a great potential for intraneural and extraneural metastasis. Systemic investigation for metastasis is required after surgery, especially for those without adjuvant therapies.

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Radiological imaging of intracranial and extracranial metastasis. (A) MRI scan, disclosing local recurrence and diffuse enhancement around the cavity walls. (B) Tumor invasion of the tentorium and transverse sinus was seen (arrow). (C) MRI scan, revealing an enhanced nodule with dural tail in the right temporal lobe. (D, E) Spinal MRI scan with contrast, displaying a small extramedullary-intradural lesion at the C2 level and numerous punctate nodules along the spine surface. (F) Thoracic CT scan, showing a large mass in the left lung.
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Figure 2: Radiological imaging of intracranial and extracranial metastasis. (A) MRI scan, disclosing local recurrence and diffuse enhancement around the cavity walls. (B) Tumor invasion of the tentorium and transverse sinus was seen (arrow). (C) MRI scan, revealing an enhanced nodule with dural tail in the right temporal lobe. (D, E) Spinal MRI scan with contrast, displaying a small extramedullary-intradural lesion at the C2 level and numerous punctate nodules along the spine surface. (F) Thoracic CT scan, showing a large mass in the left lung.

Mentions: A 51-year-old woman presented with persistent headache in the right parietooccipital region and blurring of vision. Computed tomography (CT) of the head revealed a well-defined, irregular lobulated lesion in the trigone of the right ventricle. The lesion was hyperdense with intratumoral necrosis in its center and slight peritumoral edema (Figure 1A). Further magnetic resonance imaging (MRI) of the brain revealed that the tumor was 7 × 6 cm in size and heterogeneous when enhanced by contrast (Figure 1B). The patient underwent a total mass resection under microscopy. The postoperative course was uneventful. Anaplastic meningioma was confirmed by histopathological examination (Figure 1C). The patient refused radiation therapy. No residual tumor was detected three months after surgery (Figure 1D).One year later, the patient experience a recurrence of headaches and dizziness. Craniospinal MRI displayed a local recurrence (Figure 1E). A second craniotomy was performed to remove the recurrent mass totally, as well as the infiltrated meninges and bone flap. However, suggested radiotherapy was refused once again. She recovered well without any complication and follow-up MRI showed a huge residual cavity without obviously enhanced nodules in the surgical area (Figure 1F).Approximately 18 months after the first operation, regular MRI found a second tumor recurrence and diffuse enhancement around the cavity walls (Figure 2A). Infiltration of the tentorium and transverse sinus was also noted (Figure 2B). Moreover, an enhanced nodule measuring 0.5 cm in diameter with dural tail was detected in the right temporal region (Figure 2C). Following spinal MRI found a small extramedullary-intradural lesion at the C2 level and numerous punctate nodules along the spine surface (Figure 2D,E). A systemic search for extraneural metastasis including pulmonary and abdominal CT and bone scanning disclosed a huge mass in the left pulmonary lobe (Figure 2F).The patient underwent a third craniotomy. During the operation, tumors invading brain parenchyma, the tentorium, and transverse sinus were observed. Resection of the recurrent tumor with adhered brain tissue was carried out, but infiltrated tentorium and transverse sinus were cauterized only. After one week’s hospitalization, the patient underwent decompressive excision of cervical mass via C2 laminectomy because of radicular pain, and anaplastic meningioma was diagnosed. Two weeks later, the left pulmonary mass was resected by thoracotomy, which was consistent with metastatic anaplastic meningioma (Figure 3A-D). The patient died of pneumonia 1 month after the last surgical procedure.


Malignant intraventricular meningioma with craniospinal dissemination and concurrent pulmonary metastasis.

Tao CY, Wang JJ, Li H, You C - World J Surg Oncol (2014)

Radiological imaging of intracranial and extracranial metastasis. (A) MRI scan, disclosing local recurrence and diffuse enhancement around the cavity walls. (B) Tumor invasion of the tentorium and transverse sinus was seen (arrow). (C) MRI scan, revealing an enhanced nodule with dural tail in the right temporal lobe. (D, E) Spinal MRI scan with contrast, displaying a small extramedullary-intradural lesion at the C2 level and numerous punctate nodules along the spine surface. (F) Thoracic CT scan, showing a large mass in the left lung.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126346&req=5

Figure 2: Radiological imaging of intracranial and extracranial metastasis. (A) MRI scan, disclosing local recurrence and diffuse enhancement around the cavity walls. (B) Tumor invasion of the tentorium and transverse sinus was seen (arrow). (C) MRI scan, revealing an enhanced nodule with dural tail in the right temporal lobe. (D, E) Spinal MRI scan with contrast, displaying a small extramedullary-intradural lesion at the C2 level and numerous punctate nodules along the spine surface. (F) Thoracic CT scan, showing a large mass in the left lung.
Mentions: A 51-year-old woman presented with persistent headache in the right parietooccipital region and blurring of vision. Computed tomography (CT) of the head revealed a well-defined, irregular lobulated lesion in the trigone of the right ventricle. The lesion was hyperdense with intratumoral necrosis in its center and slight peritumoral edema (Figure 1A). Further magnetic resonance imaging (MRI) of the brain revealed that the tumor was 7 × 6 cm in size and heterogeneous when enhanced by contrast (Figure 1B). The patient underwent a total mass resection under microscopy. The postoperative course was uneventful. Anaplastic meningioma was confirmed by histopathological examination (Figure 1C). The patient refused radiation therapy. No residual tumor was detected three months after surgery (Figure 1D).One year later, the patient experience a recurrence of headaches and dizziness. Craniospinal MRI displayed a local recurrence (Figure 1E). A second craniotomy was performed to remove the recurrent mass totally, as well as the infiltrated meninges and bone flap. However, suggested radiotherapy was refused once again. She recovered well without any complication and follow-up MRI showed a huge residual cavity without obviously enhanced nodules in the surgical area (Figure 1F).Approximately 18 months after the first operation, regular MRI found a second tumor recurrence and diffuse enhancement around the cavity walls (Figure 2A). Infiltration of the tentorium and transverse sinus was also noted (Figure 2B). Moreover, an enhanced nodule measuring 0.5 cm in diameter with dural tail was detected in the right temporal region (Figure 2C). Following spinal MRI found a small extramedullary-intradural lesion at the C2 level and numerous punctate nodules along the spine surface (Figure 2D,E). A systemic search for extraneural metastasis including pulmonary and abdominal CT and bone scanning disclosed a huge mass in the left pulmonary lobe (Figure 2F).The patient underwent a third craniotomy. During the operation, tumors invading brain parenchyma, the tentorium, and transverse sinus were observed. Resection of the recurrent tumor with adhered brain tissue was carried out, but infiltrated tentorium and transverse sinus were cauterized only. After one week’s hospitalization, the patient underwent decompressive excision of cervical mass via C2 laminectomy because of radicular pain, and anaplastic meningioma was diagnosed. Two weeks later, the left pulmonary mass was resected by thoracotomy, which was consistent with metastatic anaplastic meningioma (Figure 3A-D). The patient died of pneumonia 1 month after the last surgical procedure.

Bottom Line: The patient showed a local relapse and dissemination around the previous tumoral cavity and along the spinal canal during the last recurrence.Left pulmonary metastasis was also found.She died despite multiple lesion resections.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guoxue Alley, 610041 Chengdu, Sichuan, China. tcy106@163.com.

ABSTRACT

Background: Malignant intraventricular meningiomas are quite rare and may spread along the craniospinal axis or extraneurally. However, simultaneous cerebrospinal dissemination and distal extraneural metastasis has seldom been reported.

Case presentation: A 51-year-old woman presented with recurrent anaplastic meningioma in the trigone of right lateral ventricle over a 1.5-year period. Suggested radiotherapy was refused after each operation. The patient showed a local relapse and dissemination around the previous tumoral cavity and along the spinal canal during the last recurrence. Left pulmonary metastasis was also found. She died despite multiple lesion resections.

Conclusions: Malignant intraventricular meningiomas are an uncommon subset of intracranial meningiomas, and have a great potential for intraneural and extraneural metastasis. Systemic investigation for metastasis is required after surgery, especially for those without adjuvant therapies.

Show MeSH
Related in: MedlinePlus