Metastatic meningioma: a rare cause of mediastinal lymphadenopathy.

Abstract

DescriptionA 69-year-old man with known, stable atypical meningioma of the brain diagnosed 5 years previously presented with severe shortness of breath. The patient had previously been treated with surgery and radiotherapy to the brain. Chest X-ray revealed bulky mediastinal lymphadenopathy (figure 1). CT (figure 2) confirmed mediastinal and upper abdominal lymphadenopathy in addition to multiple pulmonary emboli. The patient underwent an endoscopic ultrasound and fine-needle aspiration (EUS-FNA), an established technique that enables prompt cytological sampling and assessment. 1The EUS-FNA preparations showed sheets and clusters of bland, polygonal epithelioid cells ( figure 3). These demonstrated strong immunohistochemical positivity (figure 4) for epithelial membrane antigen. The final immunopanel was strongly supportive of metastatic meningioma.Meningiomas are common intracranial tumours, classified by WHO into three grades based on mitotic activity and tumour differentiation.2 Atypical (grade 2) and anaplastic (grade 3) meningiomas account for less than 5% of all meningiomas, and metastases from these lesions are rare (0.1%). 3Due to the small number of patients with a diagnosis of metastastic meningioma, there are no established treatment pathways and the prognosis is unknown. 3 The patient in our case report completed radiotherapy to the mediastinum at a dose of 30 Gy in 10 fractions over 10 days, which improved his respiratory symptoms alongside a reducing dose of steroids. Following clinic discussion, he declined systemic treatment options and opted for palliative care.Metastatic meningioma: a rare cause of mediastinal lymphadenopathy. Figure 1 Chest X-ray.

Delayed solitary mediastinal lymph node metastasis from a benign meningothelial meningioma six years after surgical resection of an intracranial tumor

“…Metastasis to the mediastinal lymph nodes is usually found concurrently with pulmonary metastasis. Mediastinal lymph node metastasis from a meningioma without pulmonary metastasis is very rare; we found only two cases while searching Medline 4,5 . One case involved a mediastinal metastasis from an intracranial meningioma, similar to the case presented here, while the second case involved metastasis from an intramedullary spinal meningioma of the thoracic vertebra.…”

Metastatic Cavernous Sinus Meningioma: A Theory of Probable Predisposing Factor for Metastasis of Meningioma

“…Nevertheless, they were rarely reported with aggressive behavior and metastasis to regional or distant organs in various case reports. [4][5][6][7][8][9][10] Meningiomas with aggressive behavior would either directly invade the surrounding tissue, or disseminate mostly via hematogenous route, and less frequently via lymphatic and cerebrospinal fluid (CSF) pathways. [10][11][12][13] Intracranial meningiomas are expected for local invasion involving intracranial venous channels, bones, soft tissue and paranasal sinuses, in contrast to distant metastasis.…”

“…10 Moreover, liver, lymph nodes, bones, peritoneum, scalp and orbita were reported for being metastasized by meningiomas. [4][5][6][7][8][9] Despite of case reports, the risk factors and metastasis pattern are quite unknown for intracranial meningiomas. Surov et al reviewed the reports of 115 cases with metastatic meningiomas and found that the most frequent metastasized meningiomas were WHO grade III (40%), followed by grade I (33.9%), and grade II (20.9%) meningiomas.…”