Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2020; 8(23): 6110-6121
Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.6110
Malignant meningioma with jugular vein invasion and carotid artery extension: A case report and review of the literature
Hui-Ying Chen, Feng Zhao, Jiang-Yuan Qin, Hai-Mei Lin, Ji-Ping Su
Hui-Ying Chen, Feng Zhao, Jiang-Yuan Qin, Hai-Mei Lin, 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
Author contributions: Su JP and Chen HY were the patient’s surgeons, reviewed the literature and contributed to manuscript drafting; Zhao F, Qin JY and Lin HM reviewed the literature; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient, patient’s mother, and patient’s brother for publication of this report and any accompanying images obtained at the time of the investigations, but not at the time of writing the patient case report.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Ping Su, PhD, Professor, Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. jipingsu@gxmu.edu.cn
Received: June 12, 2020
Peer-review started: June 12, 2020
First decision: September 13, 2020
Revised: September 22, 2020
Accepted: October 13, 2020
Article in press: October 13, 2020
Published online: December 6, 2020
Processing time: 175 Days and 0.1 Hours
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.

Keywords: Malignant meningioma, Metastasis, Carotid artery, Jugular vein, Resection and reconstruction, Case report

Core Tip: Malignant meningioma is considered to have a low incidence, and metastases to the cervical great vessels has been much less reported. We present herein, a rare case of primary intracranial malignant meningioma metastasizing to the parapharyngeal space, the common carotid artery and jugular vein in a young male patient. The pathology of the surgically resected tumor confirmed malignant meningioma. 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 intracranial metastasis spread through cerebrospinal fluid, it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.