Third ventricular atypical meningioma which recurred with further malignant progression

Abstract

Meningiomas in the third ventricle are rare, with only very few cases reported in the literature. We report a case of primary third ventricular anaplastic meningioma in a 49-year-old man who presented with progressive weakness of the left limbs and headache. Magnetic resonance imaging revealed a tumor which seemed to arise from the right thalamus and extending into third ventricle. The tumor was heterogeneously enhanced with gadolinium. It was totally removed by right transventricular-subchoroidal approach. The lesion was intraoperatively found to be whitish hard and embedded in right thalamus, but had attachment to choroid plexus near foramen Monroi with narrow interface. The histological diagnosis was atypical meningioma, WHO Grade II. Lesion recurred 20 months later and was resected via the same approach, which turned out to be papillary meningioma, WHO Grade III. The patient had second recurrence 23 months after second surgery which was operated and the final diagnosis was anaplastic meningioma (WHO Grade III). Literature review showed meningioma of the third ventricle is quite exceptional and more than half of the cases were aggressive subtypes (Grade II or III).

Third ventricle World Health Organization Grade II meningioma presenting with intraventricular hemorrhage and obstructive hydrocephalus: A case report and literature review

“…Most cases are reported in isolated case reports or case series describing all types of intraventricular meningiomas. [1,4,5,7,9,14,16-18,23] TVM most commonly not only presents with symptoms of HCP but can also present with ataxia, hemiparesis, and hypothalamic dysfunction. Our patient presented with acute IVH and obstructive HCP.…”

“…In one pathological series, only five total cases of Grade II TVMs were found on a literature review, none of which presented with IVH. [14]…”

“…Overall, studies have demonstrated that the WHO Grade I is the most common histopathological diagnosis of TVM with an incidence ranging from 50 to 84.6%. [14,16] The WHO Grades II and III are more uncommon, with incidences between 15.6–25% and 0–25%, respectively. [14,16] In these studies, the Grade II histopathological subtypes were either choroidal, fibrous, or atypical.…”

“…Clinically, TVM typically presents with obstructive hydrocephalus, ataxia, and hypothalamic dysfunction, along with other symptoms of elevated intracranial pressure. [14,16,18] It is exceptionally uncommon for TVMs to present with intraventricular hemorrhage (IVH), as only one case has been reported with this presentation. [15] We present a case of a 46-year-old male with WHO Grade II TVM who presented initially with acute obstructive hydrocephalus and later represented again with acute IVH with obstructive hydrocephalus.…”

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“…Clinically, TVM typically presents with obstructive hydrocephalus, ataxia, and hypothalamic dysfunction, along with other symptoms of elevated intracranial pressure. [14,16,18] It is exceptionally uncommon for TVMs to present with intraventricular hemorrhage (IVH), as only one case has been reported with this presentation. [15] We present a case of a 46-year-old male with WHO Grade II TVM who presented initially with acute obstructive hydrocephalus and later represented again with acute IVH with obstructive hydrocephalus.…”