Abstract Details

Title 59 Year old Gentleman with Multiple Extracranial Metastases from Anaplastic Meningioma

Topic Neuro-oncology

Presentation(s) P01 - (-)

Poster/Presentation
Number 108

Objective

Background Meningiomas are common, accounting for 20% of all intracranial tumors with the majority being WHO grade I tumors .Atypical meningiomas (WHO II) are more likely to recur but this is commonly adjacent to the site of the original disease. Multiple extracranial metastases are very rare.

Design/Methods The patient presented with a 6-month history of new-onset headaches with MRI brain revealing a right frontal extra-axial mass infiltrating the right frontal lobe.

Results Pathology showing a WHO grade II/III atypical meningioma with a Ki-67 index of 8.9%.CD44 immunohistochemical staining showed slight focal staining. A year later, the patient's surveillance MRI revealed a large tumor recurrence. Resected tumor showed a WHO grade III/III anaplastic meningioma with a Ki-67 index of 32%.Four months later, the patient suffered a pathological fracture of his left humerus. Imaging of the chest, abdomen and pelvis showed a large mass in the right gluteus maximus muscle and multiple lytic bone. Biopsy of the gluteal mass, showed a malignant tumor with spindle and epithelioid-appearing cells that were morphologically identical to the patient's anaplastic meningioma. CD44 staining of the recurrent tumor and gluteal metastasis also showed more diffuse and intense staining compared to the original tumor.

Conclusions The pattern of spread in our patient is rare since the lungs and pleura are quoted in the literature to be the most common site of metastases. To our knowledge this is the first biopsy-proven metastasis of a meningioma to muscle. Reliable indicators of tumor recurrence have not been identified but the Ki-67 and CD44 immunohistochemistry may be useful markers of more aggressive behavior. This case further underscores the importance of immunohistochemical markers of tumor proliferation in the histologic evaluation of meningioma.

Authors/Disclosures
David Cachia, MD PRESENTER	Dr. Cachia has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for RedHill Biopharma Ltd. Dr. Cachia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GuidePoint Global LLC. Dr. Cachia has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dedham Group. Dr. Cachia has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Massachusetts Neurological Society.
Lloyd M. Alderson, MD (Appledore Neurology Group)	No disclosure on file
	No disclosure on file
Thomas W. Smith, MD (Univ of Massachusetts Med Ctr)	No disclosure on file
	No disclosure on file
Xiaojun You, PhD (Biogen Idec Inc.)	No disclosure on file
Dean M. Wingerchuk, MD, FAAN (Mayo Clinic)	Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Meyer Squibb. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abcuro. Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters Kluwers.
Dean M. Wingerchuk, MD, FAAN (Mayo Clinic)	Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Meyer Squibb. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca. Dr. Wingerchuk has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Wingerchuk has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abcuro. Dr. Wingerchuk has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters Kluwers.

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