Primary pulmonary meningioma with associated multiple micronodules: a case report and literature review

Abstract

Primary pulmonary meningioma (PPM) is a rare and benign slow growing tumor with good prognosis. It often presents as an asymptomatic, well-circumscribed, solitary pulmonary nodule. Wedge resection is the management of choice for both diagnosis and treatment. Here, we report one case of PPM with increased fluorodeoxyglucose (FDG) uptake and associated micronodules, which was clinically suspicious for malignancy. The patient was a 60-year-old female who presented with persistent shortness of breath for 1 year. Chest computed tomography showed a 1.5-cm well-circumscribed homogenous nodule in the left upper lobe with increased FDG uptake and multiple smaller well-circumscribed micronodules scattered in both lungs. Left upper lobe wedge resection confirmed the diagnosis of PPM. PPM can deceptively mimic malignancy, so recognizing this rare entity and including it in the differential diagnoses of pulmonary nodules, especially with avid uptake of FDG, is crucial to avoid misdiagnosis and overtreatment.

Primary pulmonary meningioma and minute pulmonary meningothelial-like nodules: Rare pulmonary nodular lesions requiring more awareness in clinical practice

“…Patients with PPMs and MPMNs usually present with no obvious symptoms, other than some atypical respiratory symptoms, although this can depend on tumor size, location, and accompanying diseases[ 5 - 7 ]. PPMs are usually found through imaging examinations[ 5 , 8 ]. Patients with PPMs are mainly middle-aged or older women[ 1 , 7 , 9 ].…”

“…The vast majority of PPMs are benign, well-circumscribed and solitary, with a favorable prognosis[ 5 , 10 - 12 ]. Therefore, the major therapeutic method for PPM is surgery, such as wedge resection or lobectomy[ 8 , 10 , 13 , 14 ]. It has also been suggested that a conservative approach, using close medical monitoring, is the best option for patients when the location, size, and number of smaller nodules challenge the accessibility for biopsy or resection[ 13 , 15 ].…”

“…Although accurate diagnoses based on imaging results is of great significance for developing appropriate treatment plans, it is currently impossible to differentiate PPM from other pulmonary nodule diseases or to differentiate between benign and malignant PPM through radiographic observation alone[ 6 , 10 ]. Thus, pathological examination is the most accurate method of diagnosis of PPM[ 7 , 8 , 10 ].…”

“…PPM, MPMN, and MPM have similar morphological and immunohistochemical features[ 1 ]. PPMs share the same histomorphology and WHO grading with that of central nerve system (CNS) meningiomas[ 8 , 19 ]. The premise underlying the diagnosis of PPM is that no CNS lesions are found in imaging modalities and that MPM can be ruled out[ 26 ].…”

Primary pulmonary meningioma

“…A total of 70 patients (including our case) have been diagnosed with PPM and reported in the English literature. 1,2 Most PPMs are benign (0.4-6.5 cm in diameter), but five malignant PPMs (1.5-15 cm) have been reported. Radiologically, a PPM typically presents as an isolated, well-defined solid nodule 1 ; however, some PPMs may present as ground-glass density nodules or multiple solid nodules.…”