Abstract Details

Title WHO grade I meningioma with simultaneous pulmonary metastasis: a rare presentation

Topic Neuro-oncology

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-008

Objective NA

Background Meningiomas are the most common primary central nervous system tumor. They are classified according to World Health Organization (WHO) into three grades(I-III) that correlate with outcome. WHO grade I meningiomas are the most common (over 90%). Only 0.1% of meningiomas develop metastases; almost all are WHO grade II or III and/or develop metastasis at time of tumor recurrence. We describe a patient with WHO grade I meningioma with pulmonary metastases at presentation.

Design/Methods NA

Results A 68-year-old man presented with left-sided weakness and left-sided visual field deficit. MRI identified a right temporal-occipital infarct in the posterior cerebral artery region, and a homogenously enhancing skull base tumor, lytic erosion of the skull, and posterior occlusion of the sagittal sinus. CT angiogram did not reveal any intracranial or extracranial arterial disease. CT chest and abdomen showed multiple sub-centimeter pulmonary and spine lesions, leading to suspicion of metastatic cancer. Positron emission topography scan was unremarkable. Biopsy of a pulmonary nodule revealed meningeal cells positive for progesterone receptor. Surgical resection of the intracranial mass revealed meningeal cells with the same immunophenotype and morphology as the lung nodule. Secondary review of the brain and pulmonary tumors confirmed WHO grade I meningioma. There was no necrosis, mitoses, or brain invasion that would classify the tumor as a higher grade. Biopsies of the spine lesions revealed hemangiomas. Molecular sequencing of the intracranial tumor showed heterozygosity of neurofibromatosis 2 and overexpression of androgen receptor, epidermal growth factor receptor, and MET genes.

Conclusions We describe a rare case of metastatic WHO grade I meningioma who presented with acute stroke and venous sinus occlusion. Metastatic meningioma should be considered in a patient with intracranial imaging consistent with meningioma with simultaneous pulmonary nodules. Further molecular characterization of WHO grade I metastatic meningiomas could be utilized to better understand and perhaps predict disease behavior.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Kathryn S. Nevel, MD (Indiana University School of Medicine)	Dr. Nevel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Servier Pharmaceuticals. Dr. Nevel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Nevel has received publishing royalties from a publication relating to health care. Dr. Nevel has received personal compensation in the range of $500-$4,999 for serving as a Interviewer with Continuum Audio.

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