Seeding of malignant meningioma along a surgical trajectory on the scalp

Abstract

The authors report the case of an 11-year-old boy with a malignant meningioma of the right frontal meninges. The tumor was asymptomatic, despite visible exophytic extracranial growth. Neuroimaging demonstrated an en plaque meningioma bulging into the brain. Six months after the tumor had been totally removed by surgery, an isolated subcutaneous metastasis developed at the right preauricular area of the scalp, originating at the scar left by the first surgery. After removal of this metastasis, radiotherapy was conducted. To date the follow-up examinations have not revealed any additional metastases. To the best of the authors' knowledge, this is the first report of a seeding of a subcutaneous metastasis in a child with a malignant meningioma. The authors review the literature with reference to malignant meningiomas and their formation of metastasis. In cases of malignant meningiomas, piecemeal tumor removal carries the risk of iatrogenic cell dissemination even when precautions are taken.

Recurrent Meningioma With Metastasis to the Skin Incision-Case Report-

“…Three other cases of suspected iatrogenic metastasis of meningioma have been reported in three women and one man, aged 11 to 73 years. The metastases were located in the temporal muscle, 6) abdominal wall, 5) and scalp, 2) as in our case. The abdominal wall was the donor site for an autologous fat graft to pack the orbital defect after original tumor resection.…”

Survival in patients treated for anaplastic meningioma

“…5,7,11,20 The lungs are the most common site of metastasis, 5,7 but bone, liver, lymph node, and kidney sites have also been reported. 9,17,19,33 Our reported incidence of 18.9% likely reflects the fact that our institution is a cancer referral center and commonly encounters patients with more extensive disease burden. Interestingly, all of the patients with metastatic disease harbored de novo tumors, all of which were located along the convexity/parasagittal location.…”

Iatrogenic Drop Metastasis of Recurrent Meningioma in a Vascularized Free Omental Flap -Case Report-

“…1,7,12) The tumor in our patient was embedded in the omentum, and no other metastasis involving the lung, bones, liver, and lymph nodes was identified, so we suspected that the tumor was transferred during the previous surgical procedures. Iatrogenic seed- ing of neoplasms may occur during various types of surgical interventions.…”

“…2,3,9,14) However, only 4 cases of surgical seeding of meningiomas after single or multiple surgical procedures have been reported in 3 women and one man, aged 11 to 70 years (Table 1). 1,12,15,16) Two tumors were located in the scar of the previous skin incision, one in the scar of the temporal muscle, and one in the scar of the abdominal wall for harvesting abdominal fat. Three tumors were atypical or malignant meningioma.…”

“…1,5,7,16,17) Iatrogenic drop metastasis of meningioma is extremely rare, with only 4 reported cases. 1,12,15,16) We treated a patient with drop metastasis of WHO grade I meningioma in a vascularized free omental flap, which was used to reconstruct the surgical defect in the previous surgery.…”