Malignant carcinoid tumor metastatic to the dura mater simulating a meningioma

Abstract

A 50-year-old man, transferred from another hospital, was admitted because of adult onset seizures. Nine months earlier, he had undergone an esophagogastrectomy; the lesion was confirmed to be a carcinoid tumor. Laboratory tests, chest x-rays, and electrocardiogram were normal. A second liver and spleen scan was performed. A computed tomographic scan revealed a well-circumscribed homogeneous enhancement of a lesion in the left frontal superficial area. On the 10th day, the patient underwent a left frontal parietal craniotomy. Postoperatively, he manifested no residual neurological deficits and was discharged on the 6th postoperative day. A week later, he was readmitted for treatment of aphasia and right hemiparesis; he was treated and discharged. The patient survived 16 more months. The occurrence of central nervous system metastasis from carcinoid tumor is rare. This tumor resembled, in many respects, a parasagittal meningioma. Radiological findings on the computed tomographic scan were typical of these tumors. This patient was diagnosed as having metastatic disease just 9 months after the diagnosis of the primary tumor and 13 months from the onset of any symptoms. This is a short period of time compared with that reported in other cases.

Intracranial carcinoid without evidence of extracranial disease

“…Carcinoid tumours usually originate in the gastrointestinal tract but they can also arise in the bronchi, parotid gland, thymus, biliary tract, pancreas, testes and ovary [4,12]. Metastatic intracranial carcinoid has formed the basis of a number of short reports [1,5,9]. We report on a case of intracerebral carcinoid without evidence of extracranial disease; during a 5‐year follow‐up period, no disease has become manifest either clinically or radiologically.…”

“…Metastatic carcinoid in the central nervous system is a well‐documented but unusual finding [1,5,8,11]. In the series by Patchell and Posner, intracranial metastases were the second most common neurological complication arising from systemic disease [12].…”

Metastatic brain tumors with dural extension

“…At our institution, 425 craniotomies were performed for metastatic disease during a 3-year period, but only 22 were performed for a solitary MTDE. Reports of this type of metastatic tumor, in which single or very small numbers of cases are described, 5,9,10,14,16,19,22,23,26,28,30 also support the relative rarity of this type of lesion. Small, asymptomatic lesions may be more common, however.…”

“…18,29 Metastatic lesions that are based on or abutting the dura are much less common. Case reports and small series have contained descriptions of subdural hematomas, 14,22,28,30 neurological deficits, 10,17 and radiographic similarity to meningiomas 5,9,20,24,26,30 in these tumors. We have had concerns that patients with metastatic tumors with dural extension (MTDEs) would have a poorer outcome as a result of their higher incidences of recurrent disease and leptomeningeal disease relative to patients having subcortical lesions.…”

Metastatic Adenocarcinoma of the Dura Mimicking Petroclival Meningioma-Case Report-

“…9) Dural metastatic tumors may also present with radiographic similarities to meningiomas. 7,19) We treated a young female with a dural mass lesion that was initially considered to be a petroclival meningioma but was finally identified as a metastatic adenocarcinoma originating from the lung.…”