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Horikawa T, Nozawa S, Suzui N, Yamada K, Iwai C, Akiyama H. Lumbar clear cell meningioma mimicking schwannoma 7 years after resection of the same type of intracranial tumor: a case report. J Med Case Rep 2024; 18:82. [PMID: 38321548 PMCID: PMC10845630 DOI: 10.1186/s13256-024-04411-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Meningioma is the second most common intradural extramedullary tumor, following schwannoma. Meningioma is primarily categorized as benign World Health Organization grade 1, but clear cell meningioma is grade 2 of the intermediate malignant category. Clear cell meningiomas are rare, accounting for less than 1% of all meningioma tumors. There is no previous report of multiple intraspinal clear cell meningiomas without dural attachment. CASE PRESENTATION A 27-year-old Asian male patient presented with lower right extremity pain, and had undergone tumor resection for intracranial clear cell meningioma 7 years previously, with re-resection and radiotherapy for local tumor recurrence at our hospital's department of neurosurgery being carried out 4 years previously. No recurrence was observed since then. Preoperative lumbar magnetic resonance imaging showed two tumors at the L1 and L4 levels, both mimicking schwannoma with well-defined margins, no dural tail sign and homogeneous internal contrast. Intraoperative findings on tumor resection showed two tumors contiguous with the right L2 and L5 roots, which were not attached to the dura mater, similar to a schwannoma. After gross total resection, the postoperative pathology revealed no nuclear SMARCE1 antibody staining. The patient was diagnosed with clear cell meningioma. The patient's postoperative course went well, with no symptoms of nerve dropout and no recurrence 2 years after surgery. In this case, both lumbar lesions were well demarcated and spherical in shape, occurring with single roots. Tumor characteristics suggested a primary rather than a metastatic lesion. Clear cell meningioma is characterized by a SMARCE1 mutation and is different from other types of meningiomas. CONCLUSION To the best of our knowledge, this is the first report of multiple intraspinal clear cell meningiomas without dural attachment at the lumbar spine after resection of intracranial clear cell meningioma. We speculate that the two tumors were de novo lesions on the basis of the features of the tumors, although they were detected 7 years after the resection of intracranial clear cell meningioma.
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Affiliation(s)
- Tomoyuki Horikawa
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
- Department of Orthopaedic Surgery, Mino Municipal Hospital, Mino, Japan
| | - Satoshi Nozawa
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu, Japan
| | - Kazunari Yamada
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Chizuo Iwai
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
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Coca-Pelaz A, Bishop JA, Zidar N, Agaimy A, Gebrim EMMS, Mondin V, Cohen O, Strojan P, Rinaldo A, Shaha AR, de Bree R, Hamoir M, Mäkitie AA, Kowalski LP, Saba NF, Ferlito A. Cervical Lymph Node Metastases from Central Nervous System Tumors: A Systematic Review. Cancer Manag Res 2022; 14:1099-1111. [PMID: 35300060 PMCID: PMC8921675 DOI: 10.2147/cmar.s348102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Lymph node metastasis (LNM) from primary tumors of the central nervous system (CNS) is an infrequent condition, and classically it was thought that CNS tumors could not spread via the lymphatic route. Recent discoveries about this route of dissemination make its knowledge necessary for surgeons and pathologists to avoid delays in diagnosis and unnecessary treatments. The aim of this paper is to review the literature and to discuss the relevant pathogenetic mechanism and the cytologic features along with recommendations for surgical treatment of these cervical LNM. Materials and Methods Using PRISMA guidelines, we conducted a systematic review of the literature published from 1944 to 2021, updating the comprehensive review published in 2010 by our group. Results Our review includes data of 143 articles obtaining 174 patients with LNM from a primary CNS tumor. The mean age of the patients was 31.9 years (range, 0.1–87) and there were 61 females (35.1%) and 103 males (59.2%), and in 10 cases (5.7%) the gender was not specified. The more frequent sites of distant metastasis were bones (23%), lungs (11.5%) and non-cervical lymph nodes (11%). Conclusion Cervical LNM from CNS tumors is infrequent. Pathologic diagnosis can be obtained by fine-needle aspiration cytology in most cases, giving surgeons the option to plan the appropriate surgical treatment. Given the poor prognosis of these cases, the most conservative possible cervical dissection is usually the treatment of choice.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo (Asturias), Spain
- Correspondence: Andrés Coca-Pelaz, Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Avenida de Roma s/n, Oviedo (Asturias), 33011, Spain, Email
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Abbas Agaimy
- Institute of Pathology, Friedrich Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Eloisa Maria Mello Santiago Gebrim
- Otorhinolaryngology Department, National Institute of Rehabilitation, Mexico City, Mexico
- Radiology Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Vanni Mondin
- ENT Clinic, Policlinico Città di Udine, Udine, Italy
| | - Oded Cohen
- ARM - Center for Otolaryngology - Head and Neck Surgery and Oncology, Assuta Medical Center, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The NetherlAnds
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center and Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Solitary pulmonary metastasis after meningioma surgery of the head: a case report. Surg Case Rep 2022; 8:26. [PMID: 35122546 PMCID: PMC8818078 DOI: 10.1186/s40792-022-01379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Meningioma is the most common type of benign primary brain tumor that is rarely associated with distant metastasis. No established treatment strategy for metastatic meningiomas exists to date. Herein, we report a case of solitary pulmonary metastasis of meningioma detected 2 years after neurosurgical resection of the primary tumor. Case presentation A 75-year-old male patient underwent neurosurgical resection of a convexity meningioma (World Health Organization grade II atypical meningioma), followed by postoperative radiotherapy for the residual tumor. Two postoperative years later, a solitary 10-mm pulmonary nodule in the left lower lung lobe was detected on chest computed tomography. The patient underwent video-assisted thoracoscopic left lower lobectomy for suspected pulmonary metastasis of meningioma. The pathological diagnosis was solitary pulmonary metastasis of meningioma. No sign of further recurrence was noted at 8 months postoperatively. Conclusions We present a rare and unique surgical case of solitary pulmonary metastasis of meningioma. Further investigation is necessary to establish the standardized treatment strategy for metastatic meningiomas.
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Takai S, Wanibuchi M, Kawabata S, Takeuchi K, Sakurai Y, Suzuki M, Ono K, Miyatake SI. Reactor-based boron neutron capture therapy for 44 cases of recurrent and refractory high-grade meningiomas with long-term follow-up. Neuro Oncol 2021; 24:90-98. [PMID: 33984146 PMCID: PMC8730746 DOI: 10.1093/neuonc/noab108] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND High-grade meningioma (HGM) is difficult to treat, and recurrent HGM after radiotherapy has an especially poor prognosis. We retrospectively analyzed the cases of 44 consecutive patients with recurrent and refractory HGM who were treated by reactor-based boron neutron capture therapy (BNCT). METHODS In 2005-2019, we treated 44 recurrent and refractory HGMs by reactor-based BNCT. We analyzed the patients' tumor shrinkage, overall survival (OS) after initial diagnosis, OS after BNCT, progression-free survival (PFS) post-BNCT, and treatment failure patterns. RESULTS The median OS (mOS) after BNCT and mOS after initial diagnosis were 29.6 (95%CI: 16.1-40.4) and 98.4 (95%CI: 68.7-169.4) months, respectively. The median follow-up after BNCT was 26 (6.4-103) months. The grade 2 (20 cases) and 3 (24 cases) post-BNCT mOS values were 44.4 (95%CI: 27.4-not determined) and 21.55 (10.6-30.6) months, respectively (p=0.0009). Follow-up images were obtained from 36 cases at >3 months post-BNCT; 35 showed tumor shrinkage during the observation period. The post-BNCT median PFS (mPFS) of 36 cases was 13.7 (95%CI: 8.3-28.6) months. The post-BNCT mPFS values in patients with grade 2 and 3 disease were 24.3 (95%CI: 9.8-not determined) and 9.4 (6.3-14.4) months, respectively (p=0.0024). Local recurrence was observed in only 22.2% of cases. These results showed good local tumor control and prolonged survival for recurrent HGM cases. CONCLUSIONS Most of these cases had relatively large tumor volumes. The proportion of grade 3 patients was extremely high. Our patients thus seemed to have poor prognoses. Nevertheless, reactor-based BNCT exerted relatively good local control and favorable survival for recurrent and refractory HGMs.
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Affiliation(s)
- Satoshi Takai
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan.,Kansai BNCT Medical Center, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shinji Kawabata
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Koji Takeuchi
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshinori Sakurai
- Radiation Oncology Research Laboratory, Institute for Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Osaka, Japan
| | - Minoru Suzuki
- Radiation Oncology Research Laboratory, Institute for Integrated Radiation and Nuclear Science, Kyoto University, Kumatori, Osaka, Japan
| | - Koji Ono
- Kansai BNCT Medical Center, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shin-Ichi Miyatake
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan.,Kansai BNCT Medical Center, Osaka Medical College, Takatsuki, Osaka, Japan
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Hong CS, Erson-Omay EZ, Moliterno J. Multiple meningiomas arising within the same hemisphere associated with Li-Fraumeni syndrome. Surg Neurol Int 2021; 12:99. [PMID: 33880204 PMCID: PMC8053471 DOI: 10.25259/sni_125_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background: While meningiomas are some of the most common intracranial tumors, the presence of multiple ones at the time of presentation is rare and can most commonly be observed in patients with well-described syndromes (i.e., neurofibromatosis type 2) or those with prior cranial radiation history. In others, however, the pathophysiology remains unclear. Case Description: A 49-year-old female with no significant personal or familial oncologic medical history presented with a generalized seizure and was found to have ten meningiomas arising within the right hemisphere. She underwent a two-staged resection of all tumors, with pathology revealing the World Health Organization Grade I meningioma. Whole-exome sequencing revealed somatic NF2 mutations and heterozygous deletion of chromosome 22 overlapping with NF2, and analysis of the germline uncovered mutations of TP53, rendering a diagnosis of Li-Fraumeni Syndrome. Conclusions: This case represents a novel presentation of multiple meningiomas in a patient with newly diagnosed Li-Fraumeni syndrome, suggesting meningioma may be considered as part of this tumor-predisposed patient population.
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Affiliation(s)
- Christopher S Hong
- Department of Neurosurgery, Yale University School of Medicine, 20 York Street, LCI 8, New Haven, Connecticut, United States
| | - E Zeynep Erson-Omay
- Department of Neurosurgery, Yale University School of Medicine, 20 York Street, LCI 8, New Haven, Connecticut, United States
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale University School of Medicine, 20 York Street, LCI 8, New Haven, Connecticut, United States
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Gupta SK, Nayak N, Gandhoke CS, Gupta RK, Sharma AK, Singh P, Sharma R, Nehete LS. A Giant Nondural-Based Lumbosacral Clear Cell Meningioma Mimicking Schwannoma: A Case Report and Review of the Literature. Asian J Neurosurg 2021; 16:44-50. [PMID: 34211865 PMCID: PMC8202374 DOI: 10.4103/ajns.ajns_385_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/27/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022] Open
Abstract
Spinal clear cell meningiomas (CCMs) are rare and dural-based lesion usually affecting the younger population. We report the rare case of giant nondural-based spinal CCM mimicking schwannoma and review the literature. A literature search was performed at PubMed and Embase until January 1, 2020. A total of 19 cases of nondural-based spinal CCM was reported. The following relevant data were extracted: authors, publication year, patient and tumor characteristics, treatment, and outcome. The mean age of the presentation was 20.58 years. Twelve (63.16%) were female and seven patients (36.84%) were male. The most common location was lumbosacral region 15 (79%). Fifteen (79%) tumors had cranio-caudal dimension ≤2 vertebral level, and only four (21%) tumors had dimension ≥2 vertebral level. Gross total resection (GTR) was performed in 18 (95%) patients and subtotal resection (STR) in 1 patient. Recurrences were reported in five (26.14%) patients. Four of them showed recurrences within 6 months; earliest at 2.3 months in the patient had undergone STR. Our patient is 19-year-old male diagnosed with a lumbosacral intradural lesion. Craniocaudal dimension is ≥2 vertebral level shows the foraminal extension and vertebral scalloping. GTR is performed. Intraoperatively, the tumor has foraminal extension and shows attachment with right S1S2 nerve root. No dural attachment is found. Six-month follow-up magnetic resonance image shows no evidence of disease. Nondural-based spinal CCMs are extremely rare and should be kept as a differential diagnosis in young patients with giant intradural tumor, and whose radiological features suggesting of schwannoma. It affects young patients and usually involves more than one vertebral level. The chances of recurrences and metastasis are always high even after GTR; hence, close follow-up of the entire neuraxis is warranted.
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Affiliation(s)
| | - Nitish Nayak
- Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India
| | | | - Rakesh Kumar Gupta
- Department of Pathology and Laboratory Medicine, AIIMS, Raipur, Chhattisgarh, India
| | | | - Prashant Singh
- Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India
| | | | - Lokesh S Nehete
- Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India
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Chen HY, Zhao F, Qin JY, Lin HM, Su JP. Malignant meningioma with jugular vein invasion and carotid artery extension: A case report and review of the literature. World J Clin Cases 2020; 8:6110-6121. [PMID: 33344612 PMCID: PMC7723712 DOI: 10.12998/wjcc.v8.i23.6110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/22/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Grade II and III meningiomas [World Health Organization (WHO) classification] rarely have extracranial metastases via the blood circulation; however, we experienced a case with a metaplastic atypical meningioma and local de-differentiation that metastasized to the jugular vein, carotid artery and subclavian artery at the cervicothoracic junction. Such cases have seldom been reported before.
CASE SUMMARY The patient was a 30-year-old man who developed right neck masses with dysphagia, labored breathing, dizziness, and occasional earaches. Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness, and the post-operative pathology was a metaplastic atypical meningioma (WHO grade II) with local de-differentiation (WHO III). Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space. Head and neck angiography showed that the right common carotid artery was compressed and completely occluded, and the jugular vein was enveloped by the tumor and occluded. A balloon occlusion test showed no perfusion in the right common carotid artery. Tumor resection, carotid artery ligation, and subclavian artery reconstruction were performed. The tumor was a malignant meningioma. Post-operatively, the patient had Horner's syndrome and hoarseness.
CONCLUSION This case highlights the importance of the link between a large cervical mass and a primary intracranial tumor. Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid, it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.
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Affiliation(s)
- Hui-Ying Chen
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Feng Zhao
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jiang-Yuan Qin
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hai-Mei Lin
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ji-Ping Su
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Ronen N, Ronen S, Cochran E, Giorgadze T. Metastatic atypical meningioma to the parotid gland - A cytopathological correlation. Ann Diagn Pathol 2020; 46:151521. [PMID: 32305003 DOI: 10.1016/j.anndiagpath.2020.151521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 11/25/2022]
Abstract
The tumors involving the parotid gland are mainly primary, with metastatic lesions comprising only 5% of malignant salivary gland neoplasms. We are presenting a rare case of metastatic meningioma to the parotid in a 51-year-old male with a past medical history of recurrent atypical meningioma involving the frontal lobe. For the past 1.5 years, routine imaging showed parotid lesions with interval growth including a 2.0 cm dominant tender preauricular parotid mass. The chronicity and the number of lesions made malignancy unlikely. The differential diagnosis included non-specific lesions such as intraparotid lymph nodes and benign neoplasms. Fine needle aspiration of the parotid mass was performed to show loosely cohesive fragments and singly scattered neoplastic cells with mild nuclear pleomorphism and oncocytic cytoplasm. The main cytomorphologic differential diagnosis included oncocytic and myoepithelial-rich tumors. The neoplastic cells were immunoreactive to p63, calponin and SSTR2A and were negative for cytokeratins, progesterone receptor, S100, DOG-1, EMA, synaptophysin, and chromogranin. The cytology slides and the parotid gland mass resection were compared to the previous meningioma resection specimen which showed a similar morphology of the oncocytic tumor cells in some areas. The overall morphologic and immunohistochemical findings of the parotid tumor were consistent with metastatic meningioma. Extracranial metastases from intracranial tumors are extremely rare. Meningiomas arise from the dura matter, constitute 15% of primary brain tumors, and metastasize at an estimated rate of 0.1%. Despite how uncommon metastatic meningioma is, our case emphasizes the critical role of clinical history when evaluating parotid gland lesions.
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Affiliation(s)
- Natali Ronen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Shira Ronen
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Elizabeth Cochran
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America
| | - Tamara Giorgadze
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States of America.
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Li J, Deng X, Zhang S, Wang Q, Cheng J, Li X, Ke D, Hui X. Intracranial clear cell meningioma: Clinical study with long-term follow-up in 24 patients. Clin Neurol Neurosurg 2018; 175:74-83. [DOI: 10.1016/j.clineuro.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
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Li J, Zhang S, Wang Q, Cheng J, Deng X, Wang Y, Hui X. Spinal Clear Cell Meningioma: Clinical Study with Long-Term Follow-Up in 12 Patients. World Neurosurg 2018; 122:e415-e426. [PMID: 30342264 DOI: 10.1016/j.wneu.2018.10.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clear cell meningioma (CCM) is a rare histologic subtype of meningioma. The features of CCMs have commonly been based on intracranial cases. However, CCMs in the spinal cord are even rarer, and their natural history, management, and prognosis remain ill-defined. METHODS From January 2006 to January 2018, 12 patients with spinal CCM were treated in our hospital. The clinical features, radiologic findings, diagnosis, treatment, and outcome of these patients were analyzed retrospectively. Additionally, we performed a review of the reported data on spinal CCMs. RESULTS CCMs accounted for 2.8% of all the spinal meningiomas treated in our hospital. The most common localization of this disease was the lumbar region (7 of 12). The mean age at diagnosis was significantly younger than that of patients with spinal meningiomas (28.8 ± 13.4 years vs. 54.0 ± 14.4 years). During the follow-up period, 5 patients (41.7%) experienced tumor recurrence. Kaplan-Meier analysis showed that younger patients had a significantly shorter progression-free survival time than older patients. The review of the reported data showed that 55 cases of spinal CCMs had been reported. Nineteen patients (38.0%) had developed local recurrence, with a 5-year progression-free survival rate of 33.3%. CONCLUSIONS Spinal CCMs are extremely rare tumors with a predilection to affect younger patients and have a high recurrence rate. Although gross total resection is considered to be the optimal treatment, radiotherapy could be considered for patients who had undergone subtotal resection or for younger patients, regardless of the extent of removal. Close follow-up of the entire neuraxis for years is crucial.
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Affiliation(s)
- Jiuhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Qiguang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Jian Cheng
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Xueyun Deng
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Yanchao Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China.
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Mukherjee D, Hu JL, Chu RM. Isolated Extracranial Intraosseous Metastasis of an Intracranial Meningioma following Bevacizumab Therapy: Case Report and Review of the Literature. Asian J Neurosurg 2018; 13:98-101. [PMID: 29492134 PMCID: PMC5820909 DOI: 10.4103/1793-5482.185057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Meningiomas account for a significant proportion of all primary intracranial tumors; distant metastasis is quite rare. We report a patient with resected, atypical meningioma. The patient's clinical course over 5 years included two craniotomies, a course of radiation, and a shortened course of bevacizumab. Only 5 months after starting bevacizumab, the patient developed an isolated left clavicular pathological fracture attributable to metastatic anaplastic meningioma. This constitutes the first report of meningioma with isolated extracranial intraosseous metastasis in the modern English literature and highlights concerns associated with the use of anti-angiogenic agents in promoting more invasive tumor phenotypes upon disease recurrence.
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Affiliation(s)
- Debraj Mukherjee
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jethro L Hu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Ray M Chu
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
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Østergaard AA, Sydenham TV, Nybo M, Andersen ÅB. Cerebrospinal fluid pleocytosis level as a diagnostic predictor? A cross-sectional study. BMC Clin Pathol 2017; 17:15. [PMID: 28855847 PMCID: PMC5571639 DOI: 10.1186/s12907-017-0053-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/17/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Lumbar puncture with quantification of leukocytes and differential count of cellular subsets in the cerebrospinal fluid is a standard procedure in cases of suspected neuroinfectious conditions. However, a number of non-infectious causes may result in a low leukocyte number (0-1000 cells/ml). We wanted to assess the diagnostic diversity of unselected adult patients with pleocytosis in the cerebrospinal fluid. METHODS The study is based on data from cerebrospinal fluid (CSF) analyses of all adult patients (15 years or older) admitted to a large university hospital in Denmark during a two-year period (2008-2009). Data from the local patient administrative system supplied with data from patient charts were combined with laboratory data. RESULTS A total of 5390 cerebrospinal fluid samples from 3290 patients were included. Pleocytosis >5 leucocytes/μl was found in samples from 262 patients of which 106 (40.5%) were caused by infection of the central nervous system (CNS), 20 (7.6%) by infection outside CNS, 79 (30.2%) due to non-infectious neurological diseases, 23 (8.8%) by malignancy, and 34 (13.0%) caused by other conditions. Significantly higher mean CSF leukocytes was found in patients suffering from CNS infection (mean 1135 cells/μl, p-value <0.0001). CONCLUSIONS CNS infection, non-infectious neurological disease, malignancy, and infection outside CNS can cause pleocytosis of the cerebrospinal fluid. Leukocyte counts above 100/μl is mainly caused by CNS infection, whereas the number of differential diagnoses is higher if the CSF leukocyte counts is below 50/μl. These conditions are most commonly caused by non-infectious neurological diseases including seizures.
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Affiliation(s)
| | | | - Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Åse Bengård Andersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark.,Department of Infectious Diseases 8632, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK 2100 Copenhagen OE, Denmark
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13
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Chowdhary S, Damlo S, Chamberlain MC. Cerebrospinal Fluid Dissemination and Neoplastic Meningitis in Primary Brain Tumors. Cancer Control 2017; 24:S1-S16. [PMID: 28557973 DOI: 10.1177/107327481702400118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Neoplastic meningitis, also known as leptomeningeal disease, affects the entire neuraxis. The clinical manifestations of the disease may affect the cranial nerves, cerebral hemispheres, or the spine. Because of the extent of disease involvement, treatment options and disease staging should involve all compartments of the cerebrospinal fluid (CSF) and subarachnoid space. Few studies of patients with primary brain tumors have specifically addressed treatment for the secondary complication of neoplastic meningitis. Therapy for neoplastic meningitis is palliative in nature and, rarely, may have a curative intent. METHODS A review of the medical literature pertinent to neoplastic meningitis in primary brain tumors was performed. The complication of neoplastic meningitis is described in detail for the various types of primary brain tumors. RESULTS Treatment of neoplastic meningitis is complicated because determining who should receive aggressive, central nervous system (CNS)-directed therapy is difficult. In general, the therapeutic response of neoplastic meningitis is a function of CSF cytology and, secondarily, of the clinical improvement in neurological manifestations related to the disease. CSF cytology may manifest a rostrocaudal disassociation; thus, consecutive, negative findings require that both lumbar and ventricular cytological testing are performed to confirm the complete response. Based on data from several prospective, randomized trials extrapolated to primary brain tumors, the median rate of survival for neoplastic meningitis is several months. Oftentimes, therapy directed at palliation may improve quality of life by protecting patients from experiencing continued neurological deterioration. CONCLUSIONS Neoplastic meningitis is a complicated disease in which response to therapy varies by histology. Thus, survival rates after CNS-directed therapy will differ by the underlying primary tumor. Optimal therapy of neoplastic meningitis is poorly defined, and few guidelines exist to guide clinicians on the most appropriate choice of therapy.
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Affiliation(s)
| | | | - Marc C Chamberlain
- Seattle Cancer Care Alliance, Cascadian Therapeutics, Seattle, Washington, USA.
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14
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Singh R, Ryan C, Chohan MO, Tisnado J, Hadjigeorgiou GF, Bilsky MH. Intracranial meningioma with vertebral or intraspinal metastasis: report of 2 cases and review of the literature. J Neurosurg Spine 2016; 25:775-781. [DOI: 10.3171/2016.5.spine151457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Extracranial meningioma metastases (EMM) occur in 0.1% of intracranial meningioma patients and are more commonly seen in those with atypical and anaplastic histologies. While the lungs and pleura are the most common site of EMM, intraspinal and vertebral EMM also occur and are not well described in the literature. Although the presence of EMM can worsen prognosis, no standard of care has been established for EMM management.
All patients treated for recurrent atypical/anaplastic meningiomas between January 1985 and July 2014 at Memorial Sloan Kettering Cancer Center were screened for intraspinal and vertebral EMM. Of these patients, 2 were identified as having recurrent meningioma complicated by vertebral or intraspinal EMM. A review of the literature was also conducted. The PubMed database was screened for intraspinal and vertebral EMM cases reported in the literature from 1985 to 2015. Nineteen articles were identified from the literature and included 24 individual cases with a total of 34 vertebral or intraspinal EMM. Forty-two percent (10/24) of patients with vertebral or intraspinal EMM had WHO Grade I tumors. Furthermore, 25% (6/24) of vertebral and intraspinal EMM occurred after the primary tumor but prior to any recurrence.
This paper highlights that vertebral and intraspinal EMM can occur in patients with WHO Grade I meningiomas and can occur before tumor recurrence. This challenges the notion that EMM are seen primarily in high-grade atypical and anaplastic meningiomas.
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Affiliation(s)
| | | | - Muhammad O. Chohan
- Departments of 1Neurosurgery and
- 2Department of Neurosurgery, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico; and
| | - Jamie Tisnado
- 3Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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15
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Fujimaki M, Takanashi M, Kobayashi M, Wada KI, Machida Y, Kondo A, Hattori N, Miwa H. Cerebrospinal fluid dissemination of anaplastic intraventricular meningioma: report of a case presenting with progressive brainstem dysfunction and multiple cranial nerve palsies. BMC Neurol 2016; 16:82. [PMID: 27245327 PMCID: PMC4886413 DOI: 10.1186/s12883-016-0611-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 05/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is extremely rare to see cerebrospinal fluid dissemination of intraventricular meningioma, particularly with the development of acute, progressive brainstem/cerebellar dysfunction with an absence of mass formation in the corresponding anatomical sites. CASE PRESENTATION An 81-year-old man was admitted because of double vision, right facial nerve palsy and truncal ataxia. Brain magnetic resonance imaging showed normal findings except for a tumor mass in the left lateral ventricle, which had been noted over 6 months previously. The patient developed hiccups, hyperventilation, and drowsiness, which worsened progressively, and did not respond to corticosteroid or intraventricular immunoglobulin therapy. Cerebrospinal fluid study revealed a mild elevation of protein, and cytology was negative. The patient died and an autopsy was performed. Postmortem investigation disclosed a malignant transformation of benign fibroid meningioma with cerebrospinal fluid dissemination of the malignant cells, diversely involving the surface of brainstem, cerebellum, and spinal cords, secondarily resulting in extensive ischemia in the brain parenchyma by vessel occlusion. CONCLUSION If a patient with an intraventricular tumor develops acute, progressive neurological symptoms, the possibility that it is be caused by cerebrospinal fluid dissemination of tumor cells, after malignant transformation, should be considered.
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Affiliation(s)
- Motoki Fujimaki
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan. .,Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan. .,, Postal Address: 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan.
| | - Masashi Takanashi
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan
| | - Manami Kobayashi
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan.,Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan
| | - Kei-ichiro Wada
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan
| | - Yutaka Machida
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyouku, Tokyo, 113-8431, Japan
| | - Hideto Miwa
- Department of Neurology, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerimaku, Tokyo, 177-8521, Japan
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Wang KDA, Su YB, Zhang Y. Recurrent intracranial meningioma with multiple pulmonary metastases: A case report. Oncol Lett 2015; 10:2765-2768. [PMID: 26722239 PMCID: PMC4665146 DOI: 10.3892/ol.2015.3670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 08/05/2015] [Indexed: 11/05/2022] Open
Abstract
Meningiomas are slow-growing tumors, which are generally considered to be benign and rarely metastasize. Although cases of extracranial metastatic meningioma have previously been reported, multiple pulmonary metastases from a benign intracranial meningioma is particularly rare. In the present report, a case of recurrent transitional meningioma with multiple lung nodules, which were demonstrated to be metastatic meningioma, is presented. A 54-year-old female patient received surgical resection of the tumor located in the left base of the middle cranial fossa in 2006. Post-surgery pathological examination indicated a transitional meningioma of World Health Organization grade I. The tumor recurred at the original site 1 year and 3 months later and was completely surgically removed once again. Radiotherapy was administered following the second surgery. Gamma Knife was used to remove the recurrent tumor 18 months following the second surgery. Simultaneously, a chest computed tomography scan revealed multiple pulmonary nodules, which were demonstrated to be metastatic meningioma following wedge resection of the superior lobe of the right lung. The clinical behavior of meningioma does not always correlate with the classification of meningioma. A higher rate of cellular proliferation is not essential for extracranial metastasis, and an individual meningioma of any type may metastasize. Comprehensive examinations should be performed for patients with a history of recurrent intracranial meningioma to detect any distant metastases as early as possible, even when the primary tumor is benign.
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Affiliation(s)
- Ke-DA Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Yi-Bing Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Balik V, Sulla I, Park HH, Sarissky M. In vitro testing to a panel of potential chemotherapeutics and current concepts of chemotherapy in benign meningiomas. Surg Oncol 2015; 24:292-9. [DOI: 10.1016/j.suronc.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/05/2015] [Accepted: 06/07/2015] [Indexed: 01/02/2023]
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Li B, Tao B, Bai H, Zhong J, Wu X, Shi J, Sun H, Li S. Papillary meningioma: an aggressive variant meningioma with clinical features and treatment: a retrospective study of 10 cases. Int J Neurosci 2015; 126:878-87. [PMID: 26299848 DOI: 10.3109/00207454.2015.1077833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bin Li
- 1Department of Neurosurgery Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bangbao Tao
- 1Department of Neurosurgery Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hongmin Bai
- 2Department of Neurosurgery, Liuhua Bridge Hospital, Guangzhou, China
| | - Jun Zhong
- 1Department of Neurosurgery Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiangru Wu
- 3Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juanhong Shi
- 3Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Sun
- 3Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shiting Li
- 1Department of Neurosurgery Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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19
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Avecillas-Chasin JM, Saceda-Gutierrez J, Alonso-Lera P, Garcia-Pumarino R, Issa S, López E, Barcia JA. Scalp Metastases of Recurrent Meningiomas: Aggressive Behavior or Surgical Seeding? World Neurosurg 2015; 84:121-31. [PMID: 25765926 DOI: 10.1016/j.wneu.2015.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 01/16/2023]
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20
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Torres-Martín M, Kusak ME, Isla A, Burbano RR, Pinto GR, Melendez B, Castresana JS, Rey JA. Whole exome sequencing in a case of sporadic multiple meningioma reveals shared NF2, FAM109B, and TPRXL mutations, together with unique SMARCB1 alterations in a subset of tumor nodules. Cancer Genet 2015; 208:327-32. [DOI: 10.1016/j.cancergen.2015.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 12/19/2022]
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21
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Park KS, Kim KH, Park SH, Hwang JH, Lee DH. Intracranial meningioma with leptomeningeal dissemination : retrospective study with review of the literature. J Korean Neurosurg Soc 2015; 57:258-65. [PMID: 25932292 PMCID: PMC4414769 DOI: 10.3340/jkns.2015.57.4.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/01/2015] [Accepted: 02/09/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The purposes of this article are to present 5 cases of intracranial meningioma with leptomeningeal dissemination (LD) and investigate the characteristics of this disease. METHODS We present a retrospective case series of 5 females at our institutions (age ranged 21-72 years, mean 54.6 years) diagnosed with LD of an intracranial meningioma after surgery between 1998 and 2013. A database search revealed 45 cases with LD of meningioma in the English literature. Characteristic features were analyzed and compared. RESULTS The incidence rate at our institutions of LD of meningioma was 0.9% (5/534). World Health Organization (WHO) grade was distributed as follows: I : 2, II : 2, and III : 1. Time to LD ranged from 2.5 months to 6.9 years; the patient with WHO grade III had the shortest interval to LD. The patient with an intraventricular meningioma (WHO grade II) had the second shortest interval to LD (1.7 years), and simultaneously revealed both LD and extraneuronal metastases. Four of 5 patients showed a disease progression, with the survival ranging from 1 month to 3.8 years after LD. Based on the literature, the initial tumor was an intraventricular meningioma in 9 patients, and their time to LD was shorter on average (mean 1.9 years). Histologically, 26 of 45 (58%) were initially diagnosed with a WHO grade II or III meningioma, and 6 of 19 patients (32%) with WHO grade I revealed malignant transformation. CONCLUSION This study shows that intraventricular location and histologically aggressive features seem to increase the chance of LD of meningioma.
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Affiliation(s)
- Ki-Su Park
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ki-Hong Kim
- Department of Neurosurgery, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong-Hyun Lee
- Department of Neurosurgery, Kyungpook National University School of Medicine, Daegu, Korea
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22
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Patterns of relapse and growth kinetics of surgery- and radiation-refractory meningiomas. J Neurooncol 2015; 123:151-60. [DOI: 10.1007/s11060-015-1778-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
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23
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Rossetto M, Persano L, Scienza R, Della Puppa A. Hydrocephalus after meningioma surgery. Neurosurg Focus 2013; 35:E8. [PMID: 24175868 DOI: 10.3171/2012.12.focus12214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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24
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Kawabata S, Hiramatsu R, Kuroiwa T, Ono K, Miyatake SI. Boron neutron capture therapy for recurrent high-grade meningiomas. J Neurosurg 2013; 119:837-44. [PMID: 23808536 DOI: 10.3171/2013.5.jns122204] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Similar to glioblastomas, high-grade meningiomas are difficult pathologies to control. In this study, the authors used boron neutron capture therapy (BNCT), a tumor-selective intensive particle radiation modality, to treat high-grade meningioma. METHODS From June 2005 to September 2011, BNCT was applied 28 times in 20 cases of recurrent high-grade meningioma. All patients had previously undergone intensive treatments such as repetitive surgeries and multiple sessions of radiation therapy. Fluorine-18-labeled boronophenylalanine ((18)F-BPA) PET was performed before BNCT in 19 of the 20 cases; BPA is itself a therapeutic compound. Compound uptake, tumor shrinkage, long-term control rate including survival time, and failure pattern of the treated patients were all evaluated. RESULTS Eighteen of 19 cases studied using (18)F-BPA PET showed good BPA uptake, with ratios of tumor to normal brain greater than 2.7. These ratios indicated the likely effects of BNCT prior to neutron irradiation. The original tumor sizes were between 4.3 cm(3) and 109 cm(3). A mean tumor volume reduction of 64.5% was obtained after BNCT within just 2 months. The median follow-up duration was 13 months. Six patients are still alive; at present, the median survival times after BNCT and diagnosis are 14.1 months (95% CI 8.6-40.4 months) and 45.7 months (95% CI 32.4-70.7 months), respectively. Clinical symptoms before BNCT, such as hemiparesis and facial pain, were improved after BNCT in symptomatic cases. Systemic metastasis, intracranial distant recurrence outside the radiation field, CSF dissemination, and local tumor progression were observed in 6, 7, 3, and 3 cases, respectively, during the clinical course. Apparent pseudoprogression was observed in at least 3 cases. Symptomatic radiation injuries occurred in 6 cases, and were controllable in all but 1 case. CONCLUSIONS Boron neutron capture therapy may be especially effective in cases of high-grade meningioma.
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Affiliation(s)
- Shinji Kawabata
- Department of Neurosurgery, Osaka Medical College, Takatsuki
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26
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Tsuda K, Akutsu H, Yamamoto T, Ishikawa E, Saito A, Nakai K, Takano S, Matsumura A. Benign spinal meningioma without dural attachment presenting delayed CSF dissemination and malignant transformation. Brain Tumor Pathol 2012; 30:185-91. [PMID: 22915133 DOI: 10.1007/s10014-012-0116-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 08/06/2012] [Indexed: 11/30/2022]
Abstract
Benign spinal meningiomas have good prognoses, with low rates of recurrence and no cerebrospinal fluid (CSF) dissemination. However, we experienced an extremely rare case of initially benign non-dura-based spinal meningioma that showed multiple CSF disseminated lesions, which progressed for 14 years. A 29-year-old woman without neurofibromatosis presented with progressing dysesthesia in her lower limbs, low back pain, and intermittent claudication. Magnetic resonance imaging (MRI) showed an intradural extramedullary mass lesion at the Th10/11 level. The patient underwent a tumor resection. Intraoperative findings indicated that the tumor had no dural attachment. Histopathological diagnosis after gross total removal was microcystic meningioma (grade I, WHO 2007). Seven years after the first operation, other lesions appeared at the levels of Th11/12, L1, and L2/3 in MRI. These tumors were slow growing and became symptomatic; thus, a second surgery was performed 14 years after the first operation. The histopathological diagnosis was atypical meningioma (grade II, WHO 2007). Benign spinal meningiomas show CSF dissemination extremely rarely, although some authors have reported non-dura-based intraspinal clear-cell meningiomas showing CSF dissemination. However, even in cases of WHO grade I, neurosurgeons should pay attention to late CSF dissemination and malignant transformation after surgical removal of non-dura-based intraspinal meningiomas.
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Affiliation(s)
- Kyoji Tsuda
- Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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27
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Multiple Pulmonary Metastases following Total Removal of a Bilateral Parasagittal Meningioma with Complete Occlusion of the Superior Sagittal Sinus: Report of a Case. Case Rep Neurol Med 2012; 2012:121470. [PMID: 22934204 PMCID: PMC3420403 DOI: 10.1155/2012/121470] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 05/30/2012] [Indexed: 12/21/2022] Open
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.
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28
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Wauters CAP, Poelen J, Mulder I, Venderink D, Strobbe LJA, Wesseling P. Contribution of CSF cytology in the diagnostic work-up of breast cancer patients with neurological symptoms: a retrospective analysis over two decades. J Neurooncol 2012; 107:581-9. [PMID: 22215233 DOI: 10.1007/s11060-011-0782-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 12/19/2011] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the contribution of cytological analysis of cerebrospinal fluid (CSF) in the diagnostic work-up of breast cancer patients who present with neurological symptoms suspected for central nervous system (CNS) metastases. In the period 1989-2009, a total of 81 patients with breast cancer underwent CSF cytological examination. Relevant tumour characteristics, clinical presentation and radiological findings were scored. The CSF cytological diagnosis was classified according to the 1996 NCI-sponsored conference approach as malignant, suspicious for malignancy, atypical, benign or inadequate. During the course of 20 years, 145 CSF cytological examinations were performed. Relatively common neurological symptoms resulting in cytological CSF examination were headache (n = 25), nausea and vomiting (n = 19), sensory disturbances (n = 16), and cranial nerve dysfunction (n = 16). Of these, headache and nausea/vomiting were most often associated with malignant cells in the CSF (CSF(+)) (in 48 and 53% of the cases, respectively). The 4 patients with both headache and confusion/altered mental status all had CSF(+). In 10 patients, CSF(+) was found despite the absence of radiological evidence for metastasis in/around the CNS. In our series, repeated CSF analysis appeared to have limited additional value, and CSF(+) was strongly correlated with shorter survival. A substantial number of patients with neurological symptoms but without radiological abnormalities can have CSF(+). In our series, the additional value of repeated cytological examination of CSF was limited. Our study underscores the value of CSF cytology as a tool for the unequivocal diagnosis of metastatic spread of breast cancer to the CNS, and confirms that CSF(+) is a strong predictor of poor survival.
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Affiliation(s)
- C A P Wauters
- Department of Pathology, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.
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Abe H, Kawahara A, Sugita Y, Yamaguchi T, Terasaki M, Kage M. Follow-up evaluation of radiation-induced DNA damage in CSF disseminated high-grade glioma using phospho-histone H2AX antibody. Diagn Cytopathol 2011; 40:435-9. [PMID: 21538957 DOI: 10.1002/dc.21696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 02/16/2011] [Indexed: 11/08/2022]
Abstract
Cytological examination of cerebrospinal fluid (CSF) is used not only for the diagnosis of spinal disease, but also to assess the postoperative effect of treatment. We experienced a case of high-grade glioma in disseminated CSF, and retrospectively examined the clinical, pathological and cytological features. We further investigated radiation-induced DNA damage in glioma cells using phospho-Histone H2AX antibody. A five-year-old boy received a clinical diagnosis of optic nerve glioma, and was followed-up for three months after chemotherapy. Magnetic resonance imaging was repeated, revealing abnormalities in other brain areas. The pathological diagnosis was anaplastic astrocytoma. CSF dissemination was detected, and increases in the number and mitosis of tumor cells were observed in CSF cytology. After radiotherapy the tumor cells in CSF decreased markedly. On cytomorphologic and immunocytochemical evaluation post-irradiation, tumor cells showed vacuolation of both the nucleus and cytoplasm, degeneration of nuclear chromatin, and alteration of the phospho-Histone H2AX expression, compared with tumor cells before the irradiation. CSF cytology is an effective means of evaluating DNA damage in tumor cells after irradiation, and may be useful in assessing the therapeutic response.
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Affiliation(s)
- Hideyuki Abe
- Department of Diagnostic Pathology, Kurume University Hospital, Japan.
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Kim JP, Park BJ, Lim YJ. Papillary meningioma with leptomeningeal seeding. J Korean Neurosurg Soc 2011; 49:124-7. [PMID: 21519503 PMCID: PMC3079099 DOI: 10.3340/jkns.2011.49.2.124] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 06/24/2010] [Accepted: 01/13/2011] [Indexed: 11/27/2022] Open
Abstract
A 43-year-old male presenting with headache and dizziness underwent craniotomy and gross total resection of an extraaxial tumor was achieved via left occipital interhemispheric approach. The tumor was diagnosed as papillary meningioma arising from the left falcotentorium with such pathologic characteristics of bronchoalveolar adenocarcinoma. At postoperative day 40, he developed generalized tonic clonic seizure and then progressed to a status epilepticus pattern. Brain magnetic resonance imaging showed irregular leptomeningeal enhancement with a significant peritumoral area. Through a cerebrospinal fluid (CSF) study, we identified the meningioma cells of the papillary type from the CSF. At the postoperative day 60, he fell into semicomatose state, and the computed tomography imaging showed low density on both cerebral hemispheres, except the basal ganglia and cerebellum, with overall brain swelling and an increased intracranial pressure. He died on the following day. We experienced a rare case of a papillary meningioma with leptomeningeal seeding.
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Affiliation(s)
- Joo Pyung Kim
- Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Bong Jin Park
- Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Jin Lim
- Department of Neurosurgery, Kyung Hee University College of Medicine, Seoul, Korea
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KAWAHARA Y, NAKADA M, HAYASHI Y, WATANABE T, TAMASE A, HAYASHI Y, UCHIYAMA N, NITTA H, HAMADA JI. Anaplastic Meningioma With Extremely Rapid Recurrence -Case Report-. Neurol Med Chir (Tokyo) 2011; 51:386-8. [DOI: 10.2176/nmc.51.386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yosuke KAWAHARA
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Mitsutoshi NAKADA
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Yutaka HAYASHI
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Takuya WATANABE
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Akira TAMASE
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Yasuhiko HAYASHI
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Naoyuki UCHIYAMA
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Hisashi NITTA
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Jun-ichiro HAMADA
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
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[Morphological characteristics of meningiomas]. ACTA ACUST UNITED AC 2010; 63:237-40. [PMID: 21053467 DOI: 10.2298/mpns1004237g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Meningiomas are common intracranial neoplasms which originate from the soft meninges, precisely from meningeal arachnoidal cells. The aim of this investigation was to establish the age and sex distribution of the examinees, localization, frequency and histological types of meningiomas. MATERIAL AND METHODS The investigation was carried out in the period from January 2001 to June 2006. It included 490 consecutive patients of both sexes with diagnosed intracranial tumors and undergoing surgical treatment at the Neurosurgery Clinic of the Clinical Center of Vojvodina. The surgery samples were analyzed in the Laboratory of the Institute of Pathology and Histology of the Clinical Center of Vojvodina. Out of 490 patients with diagnosed intracranial tumors, 137 (27.96%) were diagnosed to have meningiomas. RESULTS Meningiomas were more frequent in females (63%) than in males (37%) and they were most common in the 50-59 year age group (37.2%). The most common localization of meningiomas was the frontal region (36.5%). Meningiomas were more common on the left side (44.5%). In regard to other histological types of intracranial tumors, meningiomas were more frequent in females (36.3%). The most common histological type of meningiomas was transitional meningiomas (59.1%). The commonest histological types of meningiomas were benign meningiomas (93.4%). Malignant histological types of meningiomas were more common in males (83.3%), whereas benign histological types were more common in females (64.1%). CONCLUSION A typical patient with meningiomas is a woman 50-59 years old. The tumor is located in the left frontal region. On histology it is benign, transitional type of meningiomas.
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Mondin V, Ferlito A, Devaney KO, Woolgar JA, Rinaldo A. A survey of metastatic central nervous system tumors to cervical lymph nodes. Eur Arch Otorhinolaryngol 2010; 267:1657-66. [PMID: 20694730 DOI: 10.1007/s00405-010-1357-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 07/26/2010] [Indexed: 10/19/2022]
Abstract
In the realm of head and neck diseases, one particularly common clinical presentation is that of the patient with a cervical mass. In children, neck masses often prove to be developmental cysts; in adults, the recent onset of a neck mass can signal a metastasis from a head and neck squamous carcinoma. Less often, both adults and children may present with cervical masses caused by either non-Hodgkin's lymphoma or Hodgkin's disease. There are, of course, less frequently encountered differential diagnostic possibilities; one of the most uncommon of all is the possibility of metastasis from an intracranial tumor. Intracranial tumors rarely give rise to cervical node metastases. The present review examines the published experience with 128 tumors that gave rise to cervical node metastases in both adult and in pediatric patients. While it is presumed that the blood-brain barrier blocks the spread of most tumors beyond the intracranial locale, this is speculative. Although many of the cervical node metastases reported here arose after craniotomy (and, presumably, after breaching of the blood-brain barrier), some arose in the absence of any preceding surgical procedure. Cervical node metastases may arise from glial tumors (including glioblastoma multiforme, in both adult and pediatric patients) and non-glial tumors (such as medulloblastoma in pediatric patients). The history of a previous intracranial lesion is often the key to correct diagnosis, since, without prompting, neither the pathologist nor the radiologist is likely to think of a cervical node metastasis from a brain tumor when assessing a cervical mass of unknown etiology.
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Affiliation(s)
- Vanni Mondin
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
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Kuroda H, Kashimura H, Ogasawara K, Sugawara A, Sasoh M, Arai H, Ogawa A. Malignant intracranial meningioma with spinal metastasis--case report. Neurol Med Chir (Tokyo) 2009; 49:258-61. [PMID: 19556736 DOI: 10.2176/nmc.49.258] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 48-year-old woman presented with a left cerebellopontine angle mass. Over a 93-month period, the patient underwent seven surgeries, two radiosurgeries, and one external beam radiotherapy. The tumor was histologically benign at the first operation, but exhibited unusually aggressive behavior after failed radiosurgery and demonstrated clinical characteristics of malignancy such as spinal metastasis. The patient underwent gamma knife radiosurgery (GKR) for recurrence after the first operation, despite the tumor being located in a resectable region. The tumor did not respond. Six months after the sixth surgery, the patient presented with progressive lower extremity paraparesis and sensory disturbance below the T11 dermatome. Magnetic resonance imaging revealed multiple intradural mass lesions located at the T2, T11-T12, and L2 levels. She died 4 months after the diagnosis of spinal metastases. Retrospectively, we speculate that if a tumor is located in a resectable region and Simpson grade I or II tumor resection is possible, direct surgery may be a safer option than GKR.
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Affiliation(s)
- Hiroki Kuroda
- Department of Neurosurgery, Iwate Medical University School of Medicine, Morioka, Iwate, Japan
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Eom KS, Kim DW, Kim TY. Diffuse craniospinal metastases of intraventricular rhabdoid papillary meningioma with glial fibrillary acidic protein expression: a case report. Clin Neurol Neurosurg 2009; 111:619-23. [PMID: 19482417 DOI: 10.1016/j.clineuro.2009.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 03/08/2009] [Accepted: 05/02/2009] [Indexed: 11/29/2022]
Abstract
Rhabdoid papillary meningioma is a recently described clinically aggressive variant of meningiomas with a high recurrence rate. Additionally, only one case of intraventricular rhabdoid meningioma has been reported so far. We present a case of a 50-year-old man who developed an intracranial tumor of the left lateral ventricle at the trigone, for which he underwent total tumor resection followed by gamma knife radiosurgery for recurrence of the tumor. The histological diagnosis was rhabdoid papillary meningioma. Five years after surgery, diffuse craniospinal leptomeningeal metastases developed and subtotal removal of the spinal tumor was performed. The spinal tumor was considered to have metastasized via cerebrospinal fluid (CSF) in view of its histological features that were identical to those of the primary tumor. Immunohistochemistry revealed the unusual cytoplasmic expression of glial fibrillary acidic protein (GFAP) of tumor cells. To our knowledge, this is the first reported case of diffuse craniospinal metastases of intraventricular rhabdoid papillary meningioma with GFAP expression and the second reported case of the rhabdoid subtype amongst intraventricular meningiomas.
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Affiliation(s)
- Ki Seong Eom
- Department of Neurosurgery, Wonkwang University School of Medicine, Iksan 570-749, Republic of Korea
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Doxtader EE, Butts SC, Holsapple JW, Fuller CE. Aggressive pediatric meningioma with soft tissue and lymph node metastases: a case report. Pediatr Dev Pathol 2009; 12:244-8. [PMID: 19086745 DOI: 10.2350/08-07-0501.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 11/26/2008] [Indexed: 11/20/2022]
Abstract
Metastatic meningioma is extremely rare, occurring in an estimated 0.1% of cases. We report a case of pediatric meningioma metastatic to cervical soft tissue and lymph nodes. An 8-year-old boy presented with headaches, dizziness, and involuntary eye flickering. Magnetic resonance imaging (MRI) revealed a 7.5-cm parasagittal, dural-based mass with venous sinus encasement. Therapeutic embolization was followed by bilateral craniotomy, achieving subtotal resection. Histopathologic examination revealed an atypical meningioma with regions of hypercellularity, small cell morphology, sheeting architecture, increased mitoses, and brain invasion. Surveillance MRI studies showed growth of residual tumor and enlarging cervical soft tissue masses with posterior triangle lymphadenopathy. Radiation and surgical resection were employed for the intracranial tumor burden; resection of the soft tissue masses revealed metastatic meningioma, with soft tissue infiltration and metastasis to 8 lymph nodes. This case demonstrates the aggressive biologic potential of pediatric meningiomas, with potential for distant spread via cerebrospinal fluid leakage and lymphatic invasion.
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Affiliation(s)
- Erika E Doxtader
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA.
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Sioka C, Kyritsis AP. Chemotherapy, hormonal therapy, and immunotherapy for recurrent meningiomas. J Neurooncol 2009; 92:1-6. [DOI: 10.1007/s11060-008-9734-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Accepted: 11/03/2008] [Indexed: 11/26/2022]
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Manzano-Sanz C, Garcia-Conde M, Roldan-Delgado H, Martel-Barth-Hansen D. Anaplastic transformation of an atypical intraventricular meningioma with metastases to the liver: case report. Neurocirugia (Astur) 2009. [DOI: 10.1016/s1130-1473(09)70132-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Erkutlu I, Buyukhatipoglu H, Alptekin M, Berkyurek E, Tutar E, Gok A. Spinal drop metastases from a papillary meningioma: a case report and review of the literature: utility of CSF sampling. Med Oncol 2008; 26:242-6. [PMID: 18937081 DOI: 10.1007/s12032-008-9101-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Accepted: 09/29/2008] [Indexed: 11/28/2022]
Abstract
In this paper, we report a rare case of a 29-year-old boy who presented with papillary meningioma originating from the posterior fossa meninges. After a long, disease-free period, however, spinal drop metastases occurred 32 months after resection of the primary tumor. The primary and metastatic lesions had a similar histological appearance, meaning that multiple spinal metastatic lesions occurred through CSF route even after a gross total resection of the tumor. Tumor seeding during surgery is the evident reason for spinal metastasis, although we strictly adhered to the standard precautions for operations for malignant tumors such as obstruction of the cisterna magna with cotton paddies, and changing surgical gloves and instruments during the operation. In this report, we briefly discuss an exceedingly rare variant of meningioma, the papillary variant, and suggest a new approach, a CSF sampling, in the management of both malignant and benign meningiomas. CSF sampling allows for the early detection of metastasis and of tumor cells before metastasis has occurred, thus allowing treatment to begin as soon as possible. This early detection and management is possibly associated with longer survival. Furthermore, we discussed that meningiomas are tumors that are not as benign as initially thought.
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Chamberlain MC, Glantz MJ. Interferon-α for recurrent World Health Organization grade 1 intracranial meningiomas. Cancer 2008; 113:2146-51. [DOI: 10.1002/cncr.23803] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Métastase sous-cutanée au niveau de la voie d’abord d’un méningiome atypique de la tente du cervelet. Neurochirurgie 2008; 54:556-60. [PMID: 18572203 DOI: 10.1016/j.neuchi.2008.02.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 02/21/2008] [Indexed: 11/22/2022]
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Fulkerson DH, Horner TG, Hattab EM. Histologically benign intraventricular meningioma with concurrent pulmonary metastasis: Case report and review of the literature. Clin Neurol Neurosurg 2008; 110:416-9. [DOI: 10.1016/j.clineuro.2007.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 12/19/2007] [Accepted: 12/25/2007] [Indexed: 10/22/2022]
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Gladin CR, Salsano E, Menghi F, Grisoli M, Ghielmetti F, Milanesi I, Pollo B, Brock S, Cusin A, Minati L, Finocchiaro G, Bruzzone MG. Loss of heterozygosity studies in extracranial metastatic meningiomas. J Neurooncol 2007; 85:81-5. [PMID: 17453146 DOI: 10.1007/s11060-007-9386-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 03/30/2007] [Indexed: 11/28/2022]
Abstract
Although most meningiomas are slow-growing tumours associated with favourable prognosis, they often present local recurrence after surgical treatment; by contrast, extracranial metastatic meningiomas are rare, occurring in less than 1% of the cases. Risk factors for distal spread remain largely unknown. We report three cases with lung or bone metastases from intracranial recurrent meningiomas. Loss of heterozygosity (LOH) analysis on 1p, 9p, 10q, 14q, and 22q was conducted in available primary, recurrent and metastatic lesions, showing the same LOH pattern in the distal metastases and in the intracranial meningioma. LOH at 1p, 14q and 9p, known to be associated with increased aggressiveness, were found. The results highlight the potential clinical relevance of integrating histopathological studies with molecular genetic analysis in the follow-up of patients with different types of meningiomas.
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Affiliation(s)
- Caroline Regna Gladin
- Department of Experimental Neurology and Diagnostics, Fondazione IRCCS Istituto Neurologico Besta, Milano, Italy
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Lightfoot NJ, Lucas PG, Finnis NDM. Disseminated haemangioblastoma without evidence of the von Hippel-Lindau syndrome or haemangioblastomatosis--A case report and clinico-pathological correlation. Clin Neurol Neurosurg 2007; 109:305-10. [PMID: 17250956 DOI: 10.1016/j.clineuro.2006.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 12/16/2006] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
A 71-year-old Caucasian female presented to our service with disseminated cranial and spinal haemangioblastomata but no other features to suggest the von Hippel-Lindau syndrome. We feel that this represents cellular dissemination through the cerebro-spinal fluid and may be an intermediate step to the development of frank haemangioblastomatosis. By comparing this presentation to that of other tumours we have suggested a potential pathological mechanism and have discussed its management.
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Affiliation(s)
- Nicholas J Lightfoot
- Department of Neurosurgery, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
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Tournat H, Huchet A, Ouhabrache N, Thomas IC, Roubaud G, Maire JP. Évolution métastatique osseuse d'un méningiome récidivant : à propos d'un cas. Cancer Radiother 2006; 10:590-4. [PMID: 16876455 DOI: 10.1016/j.canrad.2006.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 06/19/2006] [Accepted: 06/20/2006] [Indexed: 10/24/2022]
Abstract
We report the case of a 57-year-old man who presented with two local recurrences and metastatic dissemination of a papillary meningioma of the sphenoid 3 years after surgery. Treatment consisted in a combination of surgery for the local recurrence in the initial site, radiotherapy and chemotherapy for bone metastases. Evolution of the disease spread over 7.5 years. The literature relating metastatic meningiomas is reviewed; prognostic factors and main therapeutic protocols are discussed.
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Affiliation(s)
- Helène Tournat
- Service d'Oncologie Médicale et de Radiothérapie, Hôpital Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux cedex, France
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Abstract
Neoplastic meningitis is a complication of the CNS that occurs in 3-5% of patients with cancer and is characterised by multifocal neurological signs and symptoms. Diagnosis is problematic because the disease is commonly the result of pleomorphic manifestations of neoplastic meningitis and co-occurrence of disease at other sites. Useful tests to establish diagnosis and guide treatment include MRI of the brain and spine, cerebrospinal fluid (CSF) cytology, and radioisotope CSF flow studies. Assessment of the extent of disease of the CNS is of value because large-volume subarachnoid disease or CSF flow obstruction is prognostically significant. Radiotherapy is an established and beneficial treatment for patients with neoplastic meningitis with large tumour volume including parenchymal brain metastasis, sites of symptomatic disease, or CSF flow block. Because neoplastic meningitis affects the entire neuraxis, chemotherapy treatment can include intra-CSF fluid (either intraventricular or intralumbar) or systemic therapy. Most patients (>70%) with neoplastic meningitis have progressive systemic disease and consequently treatment is palliative and tumour response is of restricted durability. Furthermore, as there is no compelling evidence of a survival advantage with aggressive multimodal treatment, future trials need be done to determine the effect of treatment on quality of life and control of neurological symptoms.
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Affiliation(s)
- Beate Gleissner
- Medical Clinic I, University Hospital of Saarland Medical School, Homburg, Saar, Germany
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