Primary Pulmonary Meningioma in an Elderly Patient: Case Report

Abstract

INTRODUCTION: Pulmonary nodules are common findings on imaging studies, such as pre-operative exams for elective surgeries. Part of these nodules show up as early-stage lung cancer or even metastatic pulmonary disease. We report a case of a 79 year old patient who was thought to have metastatic pulmonary disease of unknown primary site. After surgical lung biopsy, she had the diagnosis of a rare condition: pulmonary meningioma. CASE PRESENTATION:A healthy 79 year old female patient without pulmonary symptoms was up to perform colecystectomy due to gallstone, found in a routine ultrasound, in Sancta Maggiore Hospital, a specialized center for elderly patients in Sao Paulo, Brazil. She had hypertension, hyperlipidemia, hypothyroidism and a myocardial infarction 7 years ago, treated with angioplasty and coronary stent, with no background of cancer, smoking, alcoholism, allergies or previous surgeries. During a preoperative examination, chest X-ray and CT scan revealed several pulmonary nodules, suggesting pulmonary carcinomatosis. She had a normal neurological investigation. The patient underwent lung biopsy by non-anatomical segmentectomy (wedge res section) of the posterior basal segment of the right lower lobe. The macroscopic appearance was carcinomatosis, because of the several solid micronodules spread throughout the lung. Freezing biopsy was positive for cancer, but without lung cancer pattern.The final pathological pattern showed proliferation of spindle cell with clear limits, but with perivascular infiltration. Absence of necrosis and mitosis. Immunohistochemical analysis has shown diffuse expression of EMA (epithelial membrane antigen) and progesterone receptor, and pulmonary meningioma was the definitive diagnosis. In subsequent imaging exams, there was no evidence of metastatic disease, except for the lungs. DISCUSSION:The pulmonary metastatic form of meningioma is a rare condition. It is considered benign, but malignant behavior has been reported sometimes. Primary lung meningioma are even rarer and described only in about 40 cases, first in 1981. Most of these cases were asymptomatic, without any neurological signs. We also noted that the pulmonary meningioma is rare in the elderly. The most affected group is aged around 60 years old. There are few reports of this condition in patients older than 75 years. The oncology group decided not to prescribe chemotherapy because of the low rating of cell replication. The patient is being followed up by the multidisciplinary group.CONCLUSIONS: Pulmonary meningioma is a rare disease, especiallywhen it is primary. The appearance of this condition in elderly people has very few reports, which makes this case unique. Reference #1: Wang M, Zhan R, Zhang C, Zhou Y. Multiple pulmonary metastases in recurrent intracranial meningioma: Case report and literature review. J Int Med Res. 2016 Mar 4. pii: 0300060515618053.Reference #2: Kim YY, Hong YK, Kie JH, Ryu SJ.Primary pulmonary meningioma: an unusual cause of a nodule with strong and homogeneous enhancement.