Primary pulmonary meningioma presenting as lung metastasis

A benign primary pulmonary meningioma, an extremely rare tumour, was incidentally detected in a 57-year-old woman in association with a contralateral pulmonary adenocarcinoma. The meningioma was initially suspected to be a metastasis. Both tumours were excised, with excellent outcome. Anatomic features of primary pulmonary meningioma and differential diagnosis are discussed.     

Primary pulmonary malignant meningioma

Primary pulmonary meningiomas are relatively rare and mostly benign. To exclude pulmonary metastasis of an intracranial meningioma, imaging studies of the brain should be performed. We believe that only one primary pulmonary malignant meningioma in which a metastasis from the brain was excluded has been reported. In this report we describe a second case with malignant features.     

Primary pulmonary meningioma first suspected of being a lung metastasis

Primary extracranial and extraspinal meningiomas are rare tumors. We describe a primary pulmonary meningioma first suspected of being a metastasis because it presented as a solitary subpleural pulmonary nodule in a patient with breast cancer. The absence of radiographic change after 6 months of chemotherapy led to resection of the breast and lung lesions. A complete central nervous system evaluation eliminated other locations of meningioma, allowing the diagnosis of primary pulmonary meningioma.     

Primary pulmonary malignant meningioma.

Fewer than 20 cases of primary pulmonary meningioma have been reported. Most of these cases have been histologically and clinically benign. We report an unusual case of primary pulmonary malignant meningioma with atypical histologic features and malignant behavior. A computed tomography scan of the head did not show evidence of tumor. The right upper lobe mass was resected and showed features of an atypical meningioma with loss of architectural pattern, mild nuclear pleomorphism, increased mitotic counts (up to 15 mitotic figures per 10 high power fields), and focally prominent nucleoli. Focally, cells with rhabdoid features were identified. The tumor's immunohistochemical and ultrastructural profiles were consistent with a meningioma. The tumor stained negative for estrogen and focally positive for progesterone receptors and had a MIB-1 labeling index (marker of cell proliferation) of 9.2%. Approximately 5 months after the initial resection, the patient experienced a tumor recurrence with multiple lymph node metastases, spread to the middle and lower lobes of the right lung, and metastasis to the diaphragm. Rarely, primary pulmonary meningiomas may present as high-grade malignant lesions.     

Metastasis of pulmonary adenocarcinoma in right sylvian secretory meningioma

We report a secretory meningioma with metastasis from a pulmonary adenocarcinoma in a 48-year-old woman. Secretory meningioma can simulate metastatic disease both clinically and pathologically. Secretory meningioma and tumour-to-tumour metastasis are each rare, and we believe this to be the first report of their coincidence.     

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.     

Pulmonary metastatic meningioma 26-years after craniotomy

A 68-year-old male, pointed out of bilateral lung tumors, was hospitalized for the evaluation of multiple lung tumors. Chest computed tomography demonstrated 10 x 10 mm and 30 x 60 mm tumors in left lower lung and a 16 x 16 mm tumor in right lower lung. He was operated under the diagnosis of intracranial meningioma 26-years ago. For purpose of diagnosis, partial resections of left lower lung were performed, and then these tumors were diagnosed as pulmonary metastasis of intracranial meningioma. This is a very rare case of pulmonary metastasis of meningioma 26-years after craniotomy.     

Coexistence of intracranial meningioma, pulmonary meningiomas, and lung cancer

Pulmonary metastases from a benign meningioma are rare occurrence, and the possible coexistence with other malignancies may be neglected in clinical practice. We report a patient with presumed stage IV lung cancer and a parietal meningioma. The patient underwent meningioma resection and a salvage operation for lung cancer. Palliative chemotherapy resulted in a partial response of the main tumor. Pathologic examination confirmed the rare coexistence of pulmonary squamous cell carcinoma and benign metastatic meningiomas. Although distant metastases from meningiomas are infrequent clinically, the possibility of pulmonary involvement should not be ignored in patients with aberrant responses of separate lesions after chemotherapy.     

Pulmonary meningioma. Immunohistochemical and ultrastructural features

Two cases of solitary primary pulmonary tumors showing the immunohistochemical and ultrastructural features of meningothelial meningiomas are presented. The benign clinical and radiologic course, the negative computed tomography scan of the brain (case 1), and negative neuropathologic investigation (case 2) support the diagnosis of a primary pulmonary meningioma rather than a metastazing malignant intracranial meningioma. Negative neuroendocrine markers (neuron-specific enolase, chromogranin, bombesin) and the lack of neurosecretory granules by electron microscopy confirm the diagnosis of this rare pulmonary tumor.     

Benign metastasizing meningioma. Case report

A patient with a histologically benign intracranial meningioma was found, at the time of initial presentation, also to have a pulmonary tumor. Fine-needle aspiration cytology of the lung mass was consistent with metastatic meningioma. When resected, the pulmonary tumor was found to be histologically benign. The patient has remained well and disease-free for 28 months. Only four other patients with apparently benign metastasizing meningiomas have been described previously.     

Tuberculoma mimicking falx meningioma--case report

A 25-year-old male presented with an intracranial tuberculoma mimicking falx meningioma manifesting as right lower monoparesis. The patient had a past history of pulmonary tuberculosis, cured by antituberculous therapy. Computed tomography and magnetic resonance (MR) imaging showed a lesion mimicking a falx meningioma. Surgery achieved subtotal resection. Histological and biochemical examinations revealed the surgical specimen was tuberculoma. He was treated with antituberculous therapy, and his gait disturbance disappeared. Follow-up MR imaging showed no regrowth.     

Venous thromboembolism after brain tumor surgery: a retrospective review

We retrospectively reviewed the incidence rate of clinical postoperative deep vein thrombosis and/or pulmonary embolism in 1703 patients undergoing initial craniotomy for meningioma, glioma, or cerebral metastasis. The incidence rate of clinical thromboembolic complications was 1.59% for all tumor groups within the first 4 weeks of surgery. Patients undergoing surgery for meningiomas had a statistically significant increased risk of thromboembolism despite fewer overall perioperative risk factors, when compared with the other tumor groups. The tumor-specific incidence rates of deep vein thrombosis and/or pulmonary embolism for meningioma, glioma, and metastasis were 3.09%, 0.97%, and 1.03%, respectively. Whether this difference was a result of increased surgical time or an inherent property of meningiomas could not be ascertained.     

Solitary lung meningioma with synchronous brain nodules: clinical and pathological features

Meningiomas are tumours arising from the meninges that ensheath the central nervous system. They are benign tumours, but can very rarely metastasize. We report a case of pulmonary meningioma diagnosed incidentally with concurrent brain masses in an ex-smoker and discuss the difficulties in surgical decision making in a mass that may have represented lung cancer with brain metastases. We also review the literature reporting pulmonary meningiomas.     

Primary pulmonary meningioma

Primary pulmonary meningiomas are extremely rare. In this article we report one case with benign primary pulmonary meningioma. The literature is reviewed and the clinical manifestations, radiographic findings, and pathologic features are presented.     

Papillary meningioma with pulmonary metastasis. Case report

Successful surgical treatment by extirpation of remote metastases is extremely rare. A patient was admitted in whom multiple metastases to the lung occurred 8 years after extirpation of a papillary meningioma of the posterior fossa. The meningioma did not recur at the original site. The pulmonary metastases were surgically removed. The histological and electron microscopic findings of this case are presented.     

Cell kinetics in two cases of meningioma with ultra-late pulmonary metastases]

In order to elucidate the influence of surgical intervention on cell kinetics, we investigated the DNA ploidy pattern and mitotic index in two patients with metastatic pulmonary meningioma more than 10 years after the first operation for primary brain lesions. The first patient, with hemangiopericytomatous meningioma, showed a diploid pattern in all resected specimens and intrathoracic metastases obtained at autopsy, and also showed a constant mitotic indices throughout the clinical course. The second patient, with meningothelial meningioma, also showed a diploid pattern and constant mitotic indices throughout the clinical course. There was no difference in the two parameters between this second patient and 5 non-metastatic control cases. In conclusion, there was no positive correlation between these two parameters and the acceleration of tumor growth detected at every surgical intervention.     

Complications of treatment: pulmonary embolism following craniotomy for meningioma

We present two case reports of patients who suffered a pulmonary embolism (PE) in the week following surgery for removal of a meningioma. Both patients were anticoagulated in the first week following surgery, and as a result, both suffered intracerebral bleeds requiring further surgery. An inferior vena caval (IVC) filter was then used in both patients to prevent further embolic events. Following our experience, we believe that it is dangerous to use intravenous anticoagulation within 6 days of cranial surgery for removal of a meningioma. We have reviewed the literature concerning the present guidelines for thromboembolic prophylaxis in patients requiring neurosurgery and believe that consideration of subcutaneous low-molecular-weight heparin should now be given to all patients requiring craniotomy for removal of a meningioma.     

Primary pulmonary meningioma; report of a case

Primary pulmonary meningiomas are quite rare, and their occurrence has been reported only sporadically. A 49-year-old, asymptomatic female was hospitalized for the evaluation of a coin lesion in the left lung radiography. She has no history of previous neoplasm or symptom referable to the central nervous system. Chest computed tomography (CT) demonstrated a 9 x 14 mm, round, noncalcified, well-demarcated lesion in the left upper lobe of the lung (S(1+2)). For diagnostic purposes, enucleation of the tumor was performed. The resected specimen revealed histologically classical typical meningioma. Because postoperative magnetic resonance imaging (MRI) of the brain did not show any intracranial mass, this case was and diagnosed as a primary pulmonary meningioma. The patient was discharged with no complication, and alive without recurrence of disease 14 months after surgery.     

Marked decrease in arterial oxygen tension associated with continuous intravenous nifedipine administration

Intravenous nifedipine was administered to treat arterial hypertension in a 54-year-old woman presenting for removal of a meningioma. A marked decrease in arterial oxygen tension occurred during the nifedipine infusion. Inhibition of hypoxic pulmonary vasoconstriction by nifedipine is discussed.     

Resected atypical meningioma relapsed to anaplastic meningioma during luteinizing hormone-releasing hormone agonist therapy

A 55-year old man with a history of meningioma treated with LHRH-agonist plus radiotherapy for prostate cancer (PCa) experienced a meningioma growth during hormone therapy (HT). Meningioma was radically resected revealing an atypical meningioma and HT was continued due to the high risk of PCa relapse until symptomatic meningioma relapse occurred after further 10 months. Gross lesions were radically removed and histology revealed anaplastic meningioma. This is the first case of rapid meningioma evolution to an anaplastic histology during LHRH-agonist.