Meningioma metastases: incidence and proposed screening paradigm

Abstract

OBJECTIVEExtracranial meningioma metastases are uncommon, occurring in less than 1% of patients diagnosed with meningioma. Due to the rarity of meningioma metastases, patients are not routinely screened for distant disease. In this series, we report their experience with meningioma metastases and results of screening for metastases in select patients with recurrent meningiomas.METHODSAll patients undergoing resection or stereotactic radiosurgery for primary or recurrent meningioma from 2009 to 2017 at a single center were retrospectively reviewed to identify patients who were diagnosed with or underwent imaging to evaluate for systemic metastases. Imaging to evaluate for metastases was performed with CT scanning of the chest, abdomen, and pelvis or whole-body PET/CT using either FDG or 68Ga-DOTA-octreotate (DOTATATE) tracers in 28 patients. Indications for imaging were symptomatic lesions concerning for metastasis or asymptomatic screening in patients with greater than 2 recurrences being evaluated for additional treatment.RESULTSOf 1193 patients treated for meningioma, 922 (77.3%) patients had confirmed or presumed WHO grade I tumors, 236 (19.8%) had grade II tumors, and 35 (2.9%) had grade III tumors. Mean follow-up was 4.3 years. A total of 207 patients experienced recurrences (17.4%), with a mean of 1.8 recurrences. Imaging for metastases was performed in 28 patients; 1 metastasis was grade I (3.6%), 16 were grade II (57.1%), and 11 were grade III (39.3%). Five patients (17.9%) underwent imaging because of symptomatic lesions. Of the 28 patients screened, 27 patients had prior recurrent meningioma (96.4%), with a median of 3 recurrences. On imaging, 10 patients had extracranial lesions suspicious for metastasis (35.7%). At biopsy, 8 were meningioma metastases, 1 was a nonmeningioma malignancy, and 1 patient was lost to follow-up prior to biopsy. Biopsy-confirmed metastases occurred in the liver (5), lung (3), mediastinum (1), and bone (1). The observed incidence of metastases was 0.67% (n = 8). Incidence increased to 2% of WHO grade II and 8.6% of grade III meningiomas. Using the proposed indications for screening, the number needed to screen to identify one patient with biopsy-confirmed malignancy was 3.83.CONCLUSIONSSystemic imaging of patients with multiply recurrent meningioma or symptoms concerning for metastasis may identify extracranial metastases in a significant proportion of patients and can inform decision making for additional treatments.

Distinct genomic subclasses of high-grade/progressive meningiomas: NF2-associated, NF2-exclusive, and NF2-agnostic

“…Finally, we identified and genotyped 35 disseminated meningiomas, with half of the cases with metastases outside of the CNS. Our study adds to the existing literature by providing genomic data on metastatic meningiomas which are quite rare (2%) [9]. We show that metastatic meningiomas are derived from all three subclasses in our study, with half of cases harboring NF2-mutations.…”

Low-grade intracranial meningioma with bilateral pulmonary metastases incidentally detected postpartum: a case report and review of the literature

“…[ 25 ] 45 5 Left frontal II Surgery and radiotherapy NA Dalle Ore et al . [ 26 ] 69 5.4 Cerebellum III No intervention Alive after 5 months F/U 75 9.2 Falx, parasagittal II No intervention Alive after 1.5 months F/U 64 10.8 Parasagittal III Hydroxyurea, EBRT Alive after 13 months F/U Vakil et al . [ 1 ] 91 1 Left frontoparietal III Radiotherapy with sunitinib Alive after 13 months F/U Sathirareuangchai et al .…”

Grade III Solitary Fibrous Tumor/Hemangiopericytoma: A Rare Case of a World Health Organization Grade III Anaplastic Hemangiopericytoma

“…SFT/HPC tumors can often share imaging characteristics with meningiomas, though meningiomas are much more common and less likely to recur or metastasize extracranially [10]. HPCs (grade II and III SFT/HPC) are usually solitary, attached to the dura, are hypervascular with avid enhancement, and can cause adjacent edema, all of which are similar imaging characteristics to that of meningiomas.…”