Meningioma 40 years after radiation therapy for retinoblastoma: genetic and phenotypic analysis, and minireview of literature

The authors present a case of 44-year-old Caucasian female diagnosed with meningothelial meningioma 40 years after radiotherapy for sporadic unilateral retinoblastoma. The genetic analysis of DNA from the meningioma revealed no oncogenic mutation in the RB1 gene. The analysis of meningioma cells by flow cytometry revealed the following immunophenotype: vimentin++ CD56+ GFAP- EGFR-. Intermediate intensities of Her-2/neu and Pgp expression were detected in a small percentage of tumour cells. Data suggest that the tumour was most likely induced by radiotherapy and did not arise as a second tumour as there was no hereditary predisposition to retinoblastoma.     

Meningiomas after radiation-therapy for benign astrocytomas

A 4.5 year-old-girl was submitted to subtotal removal of a benign astrocytoma of the left temporal lobe with basal ganglia extension and given radiotherapy. At age 27, she was found to harbor a right posterior frontal meningioma that was totally removed. A recurrence of the right convexity meningioma was again excised after a 4-year interval. The authors report this case to illustrate the possibility of the appearance of radiation-induced meningiomas after an interval of 22 years and briefly discuss 16 previous reports on this occurrence in benign astrocytomas.     

Invasive character of an intradural spinal meningioma in early childhood

The authors report the case of a 2-year-old baby girl with an intradural meningotheliomatous meningioma of the cauda equina which recurred three times. Despite four operative procedures and localized radiotherapy, the lesion kept on growing to reach the retroperitoneal space. Extensive laminectomy and associated radiotherapy were probably responsible for a spinal dislocation which had to be operated on. The child was left paraplegic with major bladder dysfunction after all procedures. This is the first reported case of well-documented malignant evolution of a spinal meningioma.     

High-dose radiation-induced meningiomas following acute lymphoblastic leukemia in children

The authors review three personal cases of patients who developed cerebral meningiomas following high-dose radiotherapy for acute lymphoblastic leukemia. Two patients were female and one male. Their ages when the leukemia appeared were between 11 and 15 years. All patients were treated with a course of prophylactic irradiation to the neuraxis for a total dose of 24 Gy. After an average interval of 10.4 years, all three patients presented a meningioma; histologically, one was meningothelial and two were fibrous. All three meningiomas presented atypical features. At follow-up 1, 4, and 4 years respectively after surgery, none of these patients presents neurological deficits or neuroradiological signs of recurrence. Forty-nine cases of high-dose radiation-induced meningioma are also reviewed.     

非典型性脑膜瘤及恶性脑膜瘤预后的相关因素分析

目的总结非典型性脑膜瘤(atypical meningioma,AM)及恶性脑膜瘤治疗中的经验,分析与其预后相关的主要临床因素。方法整理2004-10—2014-02就诊于我院的96例非典型性及恶性脑膜瘤患者的相关资料,包括性别、年龄等一般资料及远期生活质量评分(Karnofsky performance scale score,KPS评分)、生存期(overall survival,OS)、无进展生存期(progressionfree survival,PFS)、病理结果等。结果 96例患者中68例非典型性脑膜瘤和28例恶性脑膜瘤。80.9%非典型性脑膜瘤患者和67.9%恶性脑膜瘤患者手术达到SimpsonⅠ~Ⅲ级切除;31例(44.1%)非典型性脑膜瘤患者和19例(71.4%)恶性脑膜瘤患者术后进行放疗。中位随访时间25个月,恶性脑膜瘤患者总生存期较非典型性脑膜瘤更短,手术结合术后放疗的无进展生存期长于单纯手术治疗。结论对于非典型性脑膜瘤及恶性脑膜瘤,手术全切肿瘤非常重要,且术后放疗可延长患者生存期。     

Anaplastic meningioma in an adolescent: a report of a rare case and brief review of literature

Objective  Anaplastic meningioma is an uncommon neoplasm in childhood and adolescence. Due to the rarity, treatment options for anaplastic meningioma in this age group are not clearly outlined. Case  A 15-year-old boy presented with a left forehead swelling with a history of a left frontal tumor. Radiological investigations revealed a dura-based tumor with a large extracranial and a smaller intracranial component. Craniotomy with near-total excision of the tumor was performed. Histopathological examination of the tumor showed features of an anaplastic meningioma. The patient is currently receiving radiotherapy and chemotherapy. However, he has developed scalp swellings while on radiotherapy. Conclusion  Anaplastic meningioma is extremely rare in children. Extensive sampling is required to recognize the meningothelial nature of the tumor and immunohistochemistry helps in making an accurate diagnosis in such cases. Therapeutic interventions in such cases need to be closely monitored due to the aggressive behavior of this tumor.     

Ventriculoperitoneal shunt related meningioma following excision and radiotherapy for glioma

A 25-year-old man with a history of childhood cerebellar glioma treated by surgical removal, radiotherapy and a ventriculoperitoneal (VP) shunt presented with a 5 month history of frontal headaches. Imaging revealed a mass surrounding his shunt, which was surgically removed, with the shunt left in situ. Histopathological examination revealed an atypical and invasive meningioma. A similar case of a meningioma related to a shunt appears in the literature, again in the context of radiotherapy following removal of a previous neoplasm.     

2 cases of coexistence of meningioma and glioma]

The authors present two cases of a rare coexistence of cerebral meningioma and glioma. In one case meningioma was situated closely to malignant glioma. In the second case in a patient operated on for cerebral glioma a meningioma was removed 20 years later. The meningioma was situated far from the first tumour.     

横纹肌样脑膜瘤的临床诊疗特征(附二例报道)

目的 分析并探讨横纹肌样脑膜瘤的临床诊疗特点及预后. 方法 回顾性分析广州医学院第二附属医院神经外科收治的2例横纹肌样脑膜瘤患者的临床资料,并复习相关文献报道. 结果 2例患者均行肉眼全切除(Simpson Ⅰ级),术后未行放化疗,随访期限分别为2年和2个月.第1例于术后第2年复发,因未行再次手术而死亡.另1例术后2月因颅内感染死于全身并发症. 结论 横纹肌样脑膜瘤术前诊断困难,手术为治疗的首选,术后常于短期内复发,患者预后不佳.     

Tumor‐to‐tumor metastasis from pituitary carcinoma to radiation‐induced meningioma

Radiation‐induced meningioma and pituitary carcinoma are both uncommon. Tumor‐to‐tumor metastasis (TTM) from pituitary carcinoma to meningioma, to our knowledge, has not been previously reported. A 67‐year old man presented with a previous history of transcranial subtotal resection of pituitary adenoma, at the age of 36, followed by radiotherapy. The follow‐up was uneventful for the following 31 years. The patient presented with worsening sight and numbness of the right arm. Three separate lesions were found on MRI. Histological examinations revealed pituitary carcinomas and TTM from pituitary carcinoma to meningioma. A constant surveillance is necessary for patients with pituitary tumor, especially those followed by radiotherapy.     

Metastatic meningioma WHO grade II of the cervical spine: case report and review of the literature

The authors report a rare case of metastatic atypical meningioma WHO grade II involving the dorso-lateral region of the cervical spine and causing spinal cord compression in a 76-year-old man. The patient was treated surgically in June 1998 for an atypical parasagittal meningioma in the right frontal lobe. Local recurrence with extension to the left hemisphere required surgical treatment in January 2000, and in December 2000 recurrence caused paraplegia of the lower extremities and paresis of the left arm. A 3 (rd) operation was carried out in January 2001, followed by radiotherapy with a total dose of 45 Gy. The patient presented again in March 2003 because of pain in the neck and a progredient new paresis and paresthesia of the right arm. Computed tomogram of the cervical spine showed a large tumor with compression of the spinal cord. MRI was not possible due to a pacemaker which had been implanted in the meantime. Surgical subtotal removal of the tumor via hemilaminectomy of the 3 (rd) and 4 (th) cervical vertebrae was performed. After decompression of the cervical spine the paresis of the right arm improved, the paraplegia of the legs and the left arm, existing since December 2000, remained unchanged. Histological findings of the cranial lesions and the metastatic lesion had a similar appearance and were compatible with atypical meningioma (WHO grade II).     

Pituitary adenoma and parasagittal meningioma: an unusual association

Simultaneous detection of an intracranial meningioma with a pituitary tumour prior to radiotherapy is an extremely uncommon occurrence. Authors have managed an elderly acromegalic lady with an acidophilic pituitary adenoma, who also harboured an asymptomatic anterior third parasagittal meningioma. There were no features of neurofibromatosis. Both tumours were concurrently excised.     

Haemangiopericytic meningioma of the sacral canal: a case report.

A case of haemangiopericytic meningioma of the sacral canal in a 25 year old man, an uncommon tumour at a rare site, is described. The tumour was malignant and largely undifferentiated although there was light and electron microscopic evidence of dual differentiation in areas towards haemangiopericytoma and meningioma. The patient, with cauda equina syndrome, was treated by partial resection and post-operative radiotherapy and remains well 12 months after treatment.     

Extracranial Extension of Intracranial Atypical Meningioma En Plaque with Osteoblastic Change of the Skull

Meningioma is a common primary tumor of central nervous system. However, extracranial extension of the intracranial meningioma is unusual, and mostly accompanied the osteolytic change of the skull. We herein describe an atypical meningioma having extracranial extension with hyperostotic change of the skull. The patient was a 72-year-old woman who presented a large mass in the right frontal scalp and left hemiparesis. Brain magnetic resonance imaging and computed tomography scans revealed an intracranial mass, diffuse meningeal thickening, hyperostotic change of the skull with focal extension into the right frontal scalp. She underwent total removal of extracranial tumor, bifrontal craniectomy, and partial removal of intracranial tumor followed by cranioplasty. Tumor pathology was confirmed as atypical meningioma, and she received adjuvant radiotherapy. In this report, we present and discuss a meningioma en plaque of atypical histopathology having an extracranial extension with diffuse intracranial growth and hyperostotic change of the skull.     

Meningioma–primary brain lymphoma association

The authors report a rare meningioma–primary cerebral B cell lymphoma association that occurred in an insulin‐dependent type‐I diabetic woman. The woman was initially operated on because of meningothelial meningioma of the fronto‐basal region, and 2 months later showed a primitive‐non‐Hodgkin B cell lymphoma, localized in the same area as the meningioma. The published literature on the meningioma–primary cerebral lymphoma association is revised.     

Intracranial meningiomas: diagnosis and treatment

Meningiomas are extra-axial CNS tumors which have a female predominance and occur in middle-to-late adult life. Most meningiomas (90%) are benign, 6% are atypical and a small proportion (2%) are malignant. Most patients diagnosed with a meningioma undergo surgical resection to relieve neurological symptoms. Complete surgical resection is often curative. For most incompletely resected or recurrent tumors not previously irradiated, radiotherapy is administered. Radiotherapy may be administered as either conventional external beam irradiation or stereotactically by linear accelerator, gamma knife or cyberknife radiosurgery. Advocates of stereotactic radiotherapy have suggested this therapy in lieu of surgery particularly in poor surgical risk patients, patients with meningiomas in eloquent or surgically inaccessible locations and in patients of advanced age. When the meningioma is unresectable or all other treatments (e.g., surgery and radiotherapy) have failed, hormonal chemotherapy may be considered. Notwithstanding limited data, hydroxyurea has been modestly successful in patients with recurrent meningiomas.     

Meningioma showing VHL gene inactivation in a patient with von Hippel-Lindau disease

The genetic mechanism of the tumorigenesis of meningioma in conjunction with von Hippel-Lindau (VHL) disease is unclear. The authors present a case of VHL disease associated with a posterior fossa meningioma and with multiple cerebellar hemangioblastomas. A germline mutation of the VHL gene and loss of heterozygosity on the VHL gene locus in 3p were detected in the meningioma. Tumorigenesis of a meningioma associated with VHL disease could be caused by inactivation of both alleles of the VHL gene.     

Pediatric cystic meningioma: report of three cases

Three cases of pediatric cystic meningioma are reported. In a review of the literature the authors stress the importance and difficulty of accurate preoperative diagnosis. Cystic meningioma in pediatric patients differs from that in adults in the following respects: higher incidence, predilection for males, shorter clinical history, less specific neuroradiological diagnosis, frequent absence of a dural attachment, prevalence of Nauta type II cystic meningioma, and high incidence of the fibroblastic histotype.     

Histologically benign intraventricular meningioma with concurrent pulmonary metastasis: case report and review of the literature

Only 1-2% of all meningiomas are intraventricular in location. Metastasis from a histologically "benign" meningioma is a rare, but well-documented event. However, there are only four reported cases in the literature of metastatic spread from a purely intraventricular meningioma. The tumors in these reports had a frankly malignant histology or were associated with surgical manipulation and recurrence of the primary lesion. In this report, the authors present a rare case of the concurrent presentation of a histologically benign intraventricular meningioma and a solitary lung lesion which proved to be metastatic meningioma.