Malignant transformation of recurrent meningioma with pulmonary metastases

A patient presented with a histologically benign intracranial meningioma which, after multiple recurrences, underwent malignant transformation. The patient survived 18 years following initial presentation. Pulmonary metastases were present over the final 8 years. Eleven subtotal resections of the meningioma were performed, including exenteration of the right eye and a thoracotomy. Radiation therapy and chemotherapy were relatively ineffective. The problem and treatment of recurrent meningiomas is briefly reviewed.     

Osteomatous meningioma report of two cases

Summary Two rare cases of osteomatous meningioma of the spinal cord are described. The capacity of these neoplasms to produce bone trabeculae represents one of the many potentialities of differentiation of meningioma cells, which may come from neural crest cells. This histogenetic derivation is sustained by the association of a meningioma with a schwannoma in the second case.From a histological diagnostic point of view, osteomatous meningioma must be distinguished carefully from a bone- infiltrating meningioma.     

Tentorial meningioma. Surgical experience with 20 cases]

We report our experience and long-term results of twenty patients with tentorial meningiomas who underwent surgical removal between 1987 and 1996. Computed tomography, angiography and magnetic resonance imaging were used as diagnostic tools for planning the surgical procedure. The tumor site was posterolateral in 6 cases (30%), posteromedial in 4 cases (20%), in the tentorium itself in 4 cases (20%), anterolateral in 3 cases (15%), at the apex of tentorial incisura in 2 cases (10%) and at the free border of the tentorial notch in 1 case (5%). Neuroradiologically, 70% of the meningiomas ranged from 1 to 3 cm. Lateral and medial tumors with solely or mainly supratentorial development were approached from above. The approach from below was selected for meningiomas with subtentorial involvement only. In meningiomas with both supra and subtentorial growth, a supratentorial bone flap was combined with a suboccipital craniectomy using a retromastoid incision. Radical surgical removal (Simpson's grade I and II) was achieved in 80% of the cases. There was no mortality. The follow-up averaged 4 years and revealed that 65% of patients were able to return to their premorbid activity. Complications were mainly postoperative brain oedema, functional deficits, seizures and psychological disorders. Recurrence rate amounted at 6.25% in the group where the tumors were totally removed (16 cases). From this retrospective study, the statistically significant prediction of a good outcome was: duration of symptoms from onset to the operation inferior or equal to 1 year (p < 0.01), good preoperative neurological conditions (Karnofsky scale from 80 to 100) (p < 0.05) and tumor size inferior or equal to 3 cm (p < 0.002).     

Surgical resection of pulmonary metastases from meningioma: Report of a case

Meningiomas rarely metastasize, and little information on pulmonary metastasectomy from meningioma has been documented. We herein report a case of a potentially curative resection for meningioma that metastasized to the lung. A 67-year-old woman was admitted to our hospital because of two masses in the right lung. In 1993, when the patient was 52 years old, she underwent a craniotomy for an atypical meningioma. The meningioma recurred once in the local site and was re-excised in 1997. In 2008, a screening chest X-ray detected two lung nodules in the right lung field. A computed tomographic scan demonstrated round masses with sharp borders, in the right S2 (2.2 cm in diameter) and S4 (1.1 cm in diameter) regions. A whole-body [¹⁸F]2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/CT examination revealed intense focal FDG uptake (maximum standard uptake value [SUV_max] = 6.9) in the larger mass, and weak FDG uptake (SUV_max = 2.3) in the smaller mass. A wedge resection of S2 and a middle lobectomy of the right lung were performed, and the final diagnosis was pulmonary metastases from an intracranial meningioma. The patient is presently doing well 20 months after the surgery without any signs of recurrence. Our case demonstrates that surgery should be considered when pulmonary metastases are deemed completely resectable by a preoperative radiological examination, and that a good clinical outcome can be achieved.     

New developments in surgery of pulmonary metastases]

Two groups of patients, 107 between 1977-1986 and 122 between 1987-1991, who underwent surgery for pulmonary metastases, were compared with each other. The most frequent primary sites were the kidney and the testes in the first and the kidney and the colon-rectum in the second group. We recorded a 1-year survival rate of 79% and a 5-year survival rate of 37% in the first group. In the second group there was a 3-year survival rate of 53%. Our analyses are showing that more metastatic lesions are usually found at operation than indicated by CT scan preoperatively. The discrepancy amounts to 19% in presumably solitary metastases and increases to 50% and more if two or more lesions were identified preoperatively. Therefore, bilateral exploration is advocated as a standard procedure in pulmonary metastatic surgery.     

Surgical treatment of pulmonary metastases of osteosarcoma. Apropos of 206 operated cases]

Two hundred and six patients were operated for lung metastases from osteosarcoma over a period of 7 years. The operative mortality was 0.3%. The actuarial survival for the overall population was 78% at one year. 50% at two years, 40% at three years and 34% at five years. The most significant prognostic factors (p < 0.01) were the number of metastases, the duration of the free interval and the degree of differentiation. Sex, age, site and type of resection of osteosarcoma or the metastases did not have any influence on prognosis. Surgical resection of lung metastases currently constitutes an essential part of the multidisciplinary management of osteosarcoma.     

Spinal meningioma en plaque. Report of two cases

Two cases of spinal meningiomas exhibiting en plaque patterns of growth are presented, one of which is reviewed more fully with emphasis on the radiographic and histological characteristics. The difficulties in diagnosis of this unusual tumor, its surgical management, and its postoperative course are discussed.     

Prostatic carcinoma presenting as neck lymph node metastases: report of two cases]

We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1,700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.     

Cell kinetics of hepatic metastases as a prognostic marker in patients with advanced colorectal carcinoma

Cell kinetics was determined, as 3H-thymidine labeling index (LI), in hepatic lesions from 36 patients with primary colorectal carcinoma: LI values ranged from 0.9% to 23.5% and were normally distributed. Cell kinetics was not related to sex or age of the patient, or to liver function. For clinical studies the median LI value of 10% was used to separate slowly and rapidly proliferating lesions. Univariate analysis showed that patients radically resected and with a low LI tumor have a longer disease-free interval and a better probability of 12-month survival than those non-radically resected and with a high LI tumor. When treatment and cell kinetics were taken into consideration, the probability of 12-month survival was 100% for patients with slowly proliferating and radically resected hepatic metastases. Patients with rapidly proliferating tumors, regardless of type of treatment, had the worst prognosis.     

Recurrent meningioma with malignant changes and extracranial multiple metastases

A case of recurrent meningioma with malignant change and extracranial multiple metastases is reported. A 51-year-old female was operated on and left parasagittal meningioma was extirpated by Simpson grade II. Histological diagnosis was fibroblastic and transitional meningioma with slight atypism. Six years later, however, the tumor (transitional meningioma with slight mitosis) recurred in the same portion and was removed again by Simpson grade II. Further more, four years after the second operation, bilateral parasagittal meningioma (atypical meningioma; transitional type) was extirpated by Simpson grade I including superior sagittal sinus and falx. Only eight months after the last operation, a few tumors with central necrosis were demonstrated in the bilateral parasagittal area on a computerized tomography scan and she received radiation therapy. But the tumor had metastasized to the extracranial multiple organs including lungs, liver, pancreas, adrenal gland, muscles, multiple bones and lymph nodes. Post mortem diagnosis was malignant meningioma. We reviewed and discussed the characteristics of metastasizing meningioma, the effectiveness of radiation therapy on the prevention of recurrence of meningioma and the curative effect of radiation therapy for recurrent or metastasized meningioma.     

Gastric metastases. Apropos of 17 cases]

Seventeen cases of gastric metastases are reported; some of them appeared after a long latency period. Two cancers prevail from an aetiological standpoint: melanoma (7 cases) and breast cancer (4 cases). Endoscopic appearance is often typical in melanoma, but suggests a primary carcinoma or radiation-induced lesions in breast cancer. Surgery is reserved to located lesions, but seems to have no incidence on prognosis. Overall mean survival is 11 months with a range of 3 months to 5 years.