ALL Metrics
-
Views
-
Downloads
Get PDF
Get XML
Cite
Export
Track
Case Report
Revised

Case Report: Pulmonary metastases of malignant meningioma

[version 2; peer review: 2 approved, 2 approved with reservations]
PUBLISHED 29 Aug 2014
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

Abstract

Meningioma accounts for approximately one-third of primary central nervous system tumors. Most meningiomas are benign, although up to one third are classified as atypical or malignant. We describe a 63-year Caucasian male presenting with pleural metastases from an intracranial meningioma. Distant metastases from meningiomas are infrequently found in clinical practice and mostly are associated with atypical or malignant meningiomas. There is no standard treatment; however surgical resection of both the primary and metastatic lesions is the safest therapy. The overall prognosis of atypical meningiomas is poor. Our patient died one week after discharge from our hospital.

Revised Amendments from Version 1

We have revised the article text of the case report and discussion and taken the comments of the referees into account.

See the authors' detailed response to the review by Christine Marosi
See the authors' detailed response to the review by Daniel Vorobiof
See the authors' detailed response to the review by Matthias Simon

Case report

A 63-year-old Caucasian man was referred to our hospital for further analysis of slowly progressing pleural effusion with a history of cough and dyspnea. The patient had a long history of epilepsy and meningioma. He was working as head in a department of administration. He was married and had two healthy kids. As a medication he took Pantoprazol, Tegretol and Dorsolamide and had stopped smoking a long time ago.

Our patient was diagnosed with progression of a previous operated (Simpsom3 resection) and postoperatively irradiated (30 x 2 GY with a total doses of 60 Gy within the EORTC 22042 in a study context) atypical left parieto-occipital meningioma (WHO grade-II). Re-resection of the tumor (Simpsom4) was performed and histopathology showed a malignant meningioma (WHO grade-III). In the follow up after re-resection there was an obvious evidence of a residual tumour at the falx cerebri. One year later an asymptomatic re-recurrence was diagnosed (Figure 1A and B), for which conservative follow-up was performed without further surgical intervention. This was given in the form of re-irradiation with a total doses of 130 Gy (60 Gy given for the re-re-recurrent tumor at the resected area + additional 70 GY applied as an integrated boost with IMRT-technic for the residual tumor at the falx cerebri). This decision was taken due to the higher degree of aggressiveness of the malignant meningioma, as further surgical intervention would harm the patient rather than curing him.

49471c99-f5d4-4c14-a801-a6645f2cbda4_figure1.gif

Figure 1. MRI and CT scanning of the original meninigioma intra-cerebral and at distance metastasis intra-pleural.

A: T1 weighted image after administration of Gadolinium based contrast fluid shows a large extra-axial enhancing lesion in the left parieto-occipital region with local mass effect. Note that the sagittal sinus seems to be invaded. B: Contrast enhanced T1 weighted image after administration of Gadolinium based contrast fluid showing a large resection cavity after the second operation and recurrent disease at the most upper margin of the resection plane with enhancing areas surrounding the sagittal sinus. C: Midthoracal CT slice in the transverse plane. Scan performed after i.v. administration of iodine contrast. The lesion is easily distinguished at the left ventral thoracal intrapleural space, slightly enhanced suggesting solid tissue. Some pleural fluid is also present.

A few months later the patient was hospitalized with dyspnea, fatigue, productive cough and anorexia. Multiple pleural masses were detected at a chest computer-tomography (CT) scan. Histopathology was consistent with malignant meningioma (WHO grade-III, Figure 2A), there was a high expression in the EMA staining, also in the AE1/AE3 staining (Figure 2B). The CD 45 and CD 68 were positive and MIB-1 showed high proliferation. Palliative chemotherapy was offered but refused by the patient. The patient is died one week after discharge from the hospital as a result of voluntary euthanasia as was the will of the patient (valid written declaration).

49471c99-f5d4-4c14-a801-a6645f2cbda4_figure2.gif

Figure 2. Histology staining of a biopsy of the solid intrathoracal lesion showing the same morphology as the intracranial meningioma.

A: A specimen (HE-stained, 40x) showing histological resemblance between the intrathoracal lesion and the intracranial meningioma. B: Specimen (focal plus and focal weak) showed high expression in the EMA-staining and also in the AE1/AE3-staining.

Discussion

Pulmonary and pleural metastases from an intracranial meningioma are very rare. Distant metastases from meningiomas are infrequently found in clinical practice and mostly associated with atypical or malignant meningiomas. Meningiomas mainly recur loco-regional or adjacent to the radiation treatment fields1,2. There are only isolated case reports regarding pulmonary metastases from meningioma. Most lung metastases were incidentally detected by chest radiography or by CT-scans, because metastatic lesions are usually asymptomatic. The presence of pulmonary metastases appears to negatively affect survival in patients with recurrent meningioma3,4.

Regarding the relationship between the intracranial location and invasion of the sagittal sinus of the tumor and the pleural metastases the route of dissemination is most probably the central venous route to heart and lungs5. In previous case reports the lung was the most common extracranial metastatic site for intracranial meningioma6. Our case was unusual because of the highly rate of recurrences and later the distant metastases. There is no standard treatment in the case of distant metastases.

In this case, histopathologic findings of the primary tumor revealed hypercellularity, wide necrosis, and brain invasion into the normal brain parenchyma. Pathology of the lesion from the left thoracic wall was consistent with malignant meningioma.

Other case studies described that treatment of pulmonary metastasis of malignant meningioma consisted of surgical resection for both the primary or metastatic lesions1,5,7.

Postoperative conventional radiation therapy has been recommended for prevention of local recurrence, especially when resection is subtotal. There are insufficient data regarding radiation therapy by meningiomas with distant metastases, palliative chemotherapy is the only option in the case of distant metastases, however data regarding the efficacy of this systemic treatment are unknown.

Informed consent

Written informed consent for publication of clinical details and clinical images was obtained from the next of kin.

Comments on this article Comments (0)

Version 2
VERSION 2 PUBLISHED 21 Oct 2013
Comment
Author details Author details
Competing interests
Grant information
Copyright
Download
 
Export To
metrics
Views Downloads
F1000Research - -
PubMed Central
Data from PMC are received and updated monthly.
- -
Citations
CITE
how to cite this article
Basunaid S, Franssen FME, Accord R et al. Case Report: Pulmonary metastases of malignant meningioma [version 2; peer review: 2 approved, 2 approved with reservations]. F1000Research 2014, 2:222 (https://doi.org/10.12688/f1000research.2-222.v2)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
track
receive updates on this article
Track an article to receive email alerts on any updates to this article.

Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 2
VERSION 2
PUBLISHED 29 Aug 2014
Revised
Views
13
Cite
Reviewer Report 17 Sep 2014
Christine Marosi, Department of Oncology, Medical University of Vienna, Vienna, Austria 
Approved
VIEWS 13
The authors added valuable information on the radiotherapy in relapse as requested, so there is one question ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Marosi C. Reviewer Report For: Case Report: Pulmonary metastases of malignant meningioma [version 2; peer review: 2 approved, 2 approved with reservations]. F1000Research 2014, 2:222 (https://doi.org/10.5256/f1000research.5568.r6157)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 23 Sep 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    23 Sep 2014
    Author Response
    Dear Christine Marosi

    Thank you very much for your approval

    Suhail
    Competing Interests: no competing interests were disclosed.
COMMENTS ON THIS REPORT
  • Author Response 23 Sep 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    23 Sep 2014
    Author Response
    Dear Christine Marosi

    Thank you very much for your approval

    Suhail
    Competing Interests: no competing interests were disclosed.
Views
14
Cite
Reviewer Report 10 Sep 2014
Daniel Vorobiof, Department of Medical Oncology, Sandton Oncology Centre, Johannesburg, South Africa 
Approved
VIEWS 14
The authors have acted on the suggestions of the reviewers and improved the description of the ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Vorobiof D. Reviewer Report For: Case Report: Pulmonary metastases of malignant meningioma [version 2; peer review: 2 approved, 2 approved with reservations]. F1000Research 2014, 2:222 (https://doi.org/10.5256/f1000research.5568.r6093)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 23 Sep 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    23 Sep 2014
    Author Response
    Dear Daniel Vorobiof

    Many thanks for your approval.

    Suhail
    Competing Interests: no competing interests were disclosed.
COMMENTS ON THIS REPORT
  • Author Response 23 Sep 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    23 Sep 2014
    Author Response
    Dear Daniel Vorobiof

    Many thanks for your approval.

    Suhail
    Competing Interests: no competing interests were disclosed.
Version 1
VERSION 1
PUBLISHED 21 Oct 2013
Views
29
Cite
Reviewer Report 21 Aug 2014
Antonio Santacroce, Department of Neurosurgery, Heinrich Heine University, Dusseldorf, Germany 
Approved with Reservations
VIEWS 29
Basunaid et al. report on a patient harboring a recurrent meningioma who developed pleural metastases. The primary tumour is reported to be an atypical meningioma WHO Gr II, which upon recurrence shows a malignant histology WHO Gr. III.

I share the ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Santacroce A. Reviewer Report For: Case Report: Pulmonary metastases of malignant meningioma [version 2; peer review: 2 approved, 2 approved with reservations]. F1000Research 2014, 2:222 (https://doi.org/10.5256/f1000research.2443.r5747)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
Views
26
Cite
Reviewer Report 27 Jun 2014
Christine Marosi, Department of Oncology, Medical University of Vienna, Vienna, Austria 
Approved with Reservations
VIEWS 26
I fully agree with the reviewer from Bonn, Matthias Simon. Meningiomas grade III are fortunately rare and they do metastasize through vascular pathways. Of course a register of such cases would be a valuable tool to get an idea of ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Marosi C. Reviewer Report For: Case Report: Pulmonary metastases of malignant meningioma [version 2; peer review: 2 approved, 2 approved with reservations]. F1000Research 2014, 2:222 (https://doi.org/10.5256/f1000research.2443.r5253)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 27 Jun 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    27 Jun 2014
    Author Response
    I would like to thank Dr. Marosi for her time spent on reviewing this case report, and the valuable comments given. I would like to leave my current version as ... Continue reading
COMMENTS ON THIS REPORT
  • Author Response 27 Jun 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    27 Jun 2014
    Author Response
    I would like to thank Dr. Marosi for her time spent on reviewing this case report, and the valuable comments given. I would like to leave my current version as ... Continue reading
Views
30
Cite
Reviewer Report 16 Jan 2014
Matthias Simon, Department of Neurology, University of Bonn, Bonn, Germany 
Approved with Reservations
VIEWS 30
Basunaid et al. describe a patient with a recurrent meningioma who ultimately developed pleural metastases. The primary tumor was assigned to WHO grade II, and the recurrent tumor to grade III. While this paper by itself does not provide truly novel information, ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Simon M. Reviewer Report For: Case Report: Pulmonary metastases of malignant meningioma [version 2; peer review: 2 approved, 2 approved with reservations]. F1000Research 2014, 2:222 (https://doi.org/10.5256/f1000research.2443.r2861)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Author Response 27 Jun 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    27 Jun 2014
    Author Response
    I would like to thank Dr. Simon for his time and valuable comment. I wish to leave my current version as it is.
    Competing Interests: No competing interests were disclosed.
COMMENTS ON THIS REPORT
  • Author Response 27 Jun 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    27 Jun 2014
    Author Response
    I would like to thank Dr. Simon for his time and valuable comment. I wish to leave my current version as it is.
    Competing Interests: No competing interests were disclosed.
Views
41
Cite
Reviewer Report 29 Oct 2013
Daniel Vorobiof, Department of Medical Oncology, Sandton Oncology Centre, Johannesburg, South Africa 
Not Approved
VIEWS 41
This case report documents an unusual spread of a malignant meningioma. It doesn't add any further ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Vorobiof D. Reviewer Report For: Case Report: Pulmonary metastases of malignant meningioma [version 2; peer review: 2 approved, 2 approved with reservations]. F1000Research 2014, 2:222 (https://doi.org/10.5256/f1000research.2443.r2143)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
  • Reader Comment 06 Jun 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    06 Jun 2014
    Reader Comment
    Dear Sir,

    I am not sure if you consider this an unusual spread of malignant meningioma. There were at least 3 years between the time of discovering it (by accident after a ... Continue reading
COMMENTS ON THIS REPORT
  • Reader Comment 06 Jun 2014
    Suhail Basunaid, Mayo University Hospital,, Ireland
    06 Jun 2014
    Reader Comment
    Dear Sir,

    I am not sure if you consider this an unusual spread of malignant meningioma. There were at least 3 years between the time of discovering it (by accident after a ... Continue reading

Comments on this article Comments (0)

Version 2
VERSION 2 PUBLISHED 21 Oct 2013
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
Sign In
If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password.

The email address should be the one you originally registered with F1000.

Email address not valid, please try again

You registered with F1000 via Google, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Google account password, please click here.

You registered with F1000 via Facebook, so we cannot reset your password.

To sign in, please click here.

If you still need help with your Facebook account password, please click here.

Code not correct, please try again
Email us for further assistance.
Server error, please try again.