Extracranial metastasis of malignant meningioma: A case report and review of literature
Wang Y, Stone C, and Mukherjee A. Extracranial metastasis of malignant meningioma: A case report and review of literature. Journal of Neuropathology and Experimental Neurology 2020; 79(6):706.
Journal of Neuropathology and Experimental Neurology
Introduction: Extracranial metastasis of meningioma are extremely rare, occurring in about 1 in 1000 meningiomas and most often in association with grade III meningiomas. Rare metastasis from histologically benign meningiomas has also been reported, typically after surgery. Most reported cases of metastatic meningiomas do not have molecular genetic analysis of the tumor. Here we present a case of metastatic meningioma with histopathologic and molecular genetic findings.
Case Report: An 82 years old female presented with a recurrent right convexity meningioma. She had a grade I meningioma resected in 2016. The tumor recurred at the same side in 2018 for which she underwent repeat resection followed by radiotherapy. The histopathology showed atypical (WHO grade II) meningioma. Patient underwent an embolization followed by a third resection in 2019 with pathology indicating anaplastic (malignant) meningioma (WHO grade III). Within a few months, there were pulmonary nodules, pancreatic lesions, gastric antrum thickening, right breast nodule, T1 body and pedicle lesions and a thyroid nodule. Lung mass biopsy pathology showed metastatic anaplastic (malignant) meningioma. A comprehensive NGS panel done on the primary brain tumor from third recurrence showed frameshift mutations of NF2, ARID1A and SEDT2 along with copy number loss of CDKN2A and CDKN2B. No further treatment was offered and the family opted for supportive care.
Discussion: We present histopathologic and molecular genetic findings of a rare case of metastatic meningioma with literature review. Extracranial metastasis of meningiomas is very rare with no effective systemic therapy. Molecular genetic characterization of this rare subset of tumors will add to our understanding of these tumors and their potential treatment.