Metastatic Meningioma to the Lung With Multiple Pleural Metastases

Kaminski, Joseph; Movsas, Benjamin; King, Elizabeth G.; Yang, Chichuan; Kronz, Joseph D.; Alli, Patricia M.; Williams, Julia; Brem, Henry

doi:10.1097/00000421-200112000-00010

Cited by 56 publications

(43 citation statements)

References 11 publications

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“…Firstly, there were only two nodules detectable on imaging. This is consistent with previous reports, which indicated that pulmonary metastases number more than three in only 13% of cases [15]. Rapid enhancement of pulmonary lesions post iv contrast, as seen in the present case, is similar to that of intracranial meningiomas.…”

Section: Discussionsupporting

confidence: 94%

Metastatic meningioma: positron emission tomography CT imaging findings

Brennan¹,

O’Connor²,

O’Regan³

et al. 2010

BJR

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ABSTRACT. The imaging findings of a case of metastasing meningioma are described. The case illustrates a number of rare and interesting features. The patient presented with haemoptysis 22 years after the initial resection of an intracranial meningioma. CT demonstrated heterogeneous masses with avid peripheral enhancement without central enhancement. Blood supply to the larger lesion was partially from small feeding vessels from the inferior pulmonary vein. These findings correlate with a previously published case in which there was avid uptake of fluoro-18-deoxyglucose peripherally with lesser uptake centrally. The diagnosis of metastasing meningioma was confirmed on percutaneous lung tissue biopsy. . Meningiomas are usually indolent, slow-growing tumours and surgery is curative in the majority of cases [2,3]. We present a rare case of a woman who had resection of an intracranial meningioma performed 22 years previously. The patient presented with haemoptysis and on imaging was found to have bilateral pulmonary lesions; these were confirmed as metastatic meningioma following CT-guided percutaneous biopsy. This report focuses primarily on the imaging features of a meningioma that metastasised to lung. Particular reference is given to CT and combined positron emission tomography and CT (PET/CT) appearances. The role of percutaneous lung biopsy in histological confirmation of the diagnosis is also briefly discussed. Case reportA 74-year-old woman presented with haemoptysis. She had a history of intracranial meningioma, resected 22 years previously in 1985. The patient had undergone two further resections for intracranial local recurrence in 1988 and 1992 (3 years and 7 years following initial resection, respectively). A chest radiograph revealed two well-circumscribed masses, one at each lung base without a pleural abnormality. CT scan of the thorax was performed and included unenhanced, arterial phase (25 s post-iv contrast administration) and portal venousphase (75 s post-iv contrast administration) imaging (Figure 1). CT demonstrated two well-circumscribed rounded lesions, which were peripherally located in the lungs: a 3.8 cm mass in the right lower lobe and a second 2.7 cm mass in the left lower lobe. The lesions had low-density centres (21 HU) that did not significantly enhance post-iv contrast administration (29 HU in arterial and portal venous phase images). The periphery of the lesions enhanced from 50 HU on the unenhanced images to 111 HU on the arterial phase images and de-enhanced to 83 HU on portal venous-phase images. The periphery of these lesions, therefore, enhanced avidly post-iv contrast administration; the lesions were noted to have prominent feeding vessels in their walls, which were fed by branches of the inferior pulmonary veins. CT scan of the brain (pre and post iv contrast administration) showed no evidence of recurrent or metastatic disease.Full-body combined fluoro-18-deoxyglucose (FDG) PET/CT imaging demonstrated avid FDG uptake within both lung lesions with standard uptake values (SUV)...

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Section: Discussionsupporting

confidence: 94%

Metastatic meningioma: positron emission tomography CT imaging findings

Brennan¹,

O’Connor²,

O’Regan³

et al. 2010

BJR

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“…To our knowledge, this is the second case of metastasis to the pleura from benign (WHO grade I) meningioma reported in literature. 2) The route of the first metastasis in our case is unclear, but may have been through the superior sagittal sinus and caval system given the parafalcine location of the primary tumors and history of prior intracranial surgery. Around the second metastasis and since then, there is a possibility that the operative procedure results in dissemination.…”

Section: Discussionmentioning

confidence: 90%

“…4) Kaminski, et al reported thattumors with clearly malignant features have a higher metastatic rate. 2) Certain histological subtypes are inherently prone to recur or spread, including the WHO grade II clear cell and chordoid variants and the WHO grade III rhabdoid and papillary variants. Of these, the papillary variant carries the highest risk of late distant metastases.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary and Pleural Metastases from Benign Meningeal Meningioma: A Case Report

Nakayama

Horio

Horiguchi

et al. 2014

ATCS

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“…7 The most common site of metastasis is the lung, comprising 61% of all meningioma metastases. 2 Despite this, a systemic workup for distant metastases is not usually included in the evaluation paradigm for patients with high-risk recurrent meningioma.…”

Section: Discussionmentioning

confidence: 99%

“…2,14,22 However, in patients with histologically atypical (WHO grade II) or anaplastic (WHO grade III) tumors, these treatment approaches are almost never curative, with 10-year disease-free survival rates of 13% and 0%, respectively. 14,22 In these patients, treatment with doxorubicin, hydroxyurea, temozolomide, irinotecan, interferon-a, tamoxifen, imatinib, mifepristone, or octreotide acetate have been attempted.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary metastases in patients with recurrent, treatment‐resistant meningioma

Alexandru

Glantz

Kim

et al. 2011

Cancer

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BACKGROUND:Meningioma is the most common extra-axial primary intracranial tumor in adults that rarely metastasizes outside of the central nervous system (CNS). Among recognized sites of metastases, the lung is the most common, but the importance of lung metastases relative to prognosis is unknown. 111 Indium ( 111 In)-octreotide scintigraphy (octreotide scanning) is a valuable imaging modality with which to evaluate intracranial meningiomas and their response to treatment with somatostatin analogues and has the potential to identify extracranial metastatic disease. METHODS: In this retrospective multicenter study, adult patients treated for recurrent meningioma were identified. These patients underwent 111 In-octreotide positron emission tomography/computed tomography imaging (octreotide scintigraphy) and were found to have positive octreotide uptake in their lungs. RESULTS: Six cases were identified with recurrent meningioma (after surgery, radiotherapy, and at least 1 chemotherapy agent) and pulmonary lesions by octreotide scintigraphy. Biopsy of a pulmonary lesion in 1 patient confirmed the diagnosis of metastatic meningioma. Patients with metastatic pulmonary involvement identified by 111 In-octreotide scintigraphy in this case series had an overall survival of 6 months, which is less than that reported from previously published series of patients with unknown systemic disease status. CONCLUSIONS: 111 In-octreotide scintigraphy is useful for assessing both CNS disease and extracranial metastases. The presence of pulmonary metastases appears to negatively affect survival in patients with recurrent meningioma. The usefulness of 111 In-octreotide scintigraphy should be considered in staging patients with recurrent meningioma who are considered for further treatment. A prospective study to confirm this finding is warranted.

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Metastatic Meningioma to the Lung With Multiple Pleural Metastases

Cited by 56 publications

References 11 publications

Metastatic meningioma: positron emission tomography CT imaging findings

Metastatic meningioma: positron emission tomography CT imaging findings

Pulmonary and Pleural Metastases from Benign Meningeal Meningioma: A Case Report

Pulmonary metastases in patients with recurrent, treatment‐resistant meningioma

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