778 - Pleural metastasis from anaplastic meningioma

Case Summary

This case report is a 64-year-old male presented with progressive right hemiparesis 2 months. CT brain shown left frontal mass with perilesional edema size 15*11 cm. He underwent to craniotomy and tumor removal. Histopathology of brain and dura tissues reported anaplastic meningioma (WHO grade III) with mitotic activity 20/10 HPF. In October 2016, he presented with masses at the scalp and 4 months later he had right hemiparesis and right facial palsy. MRI brain shown progressive left frontal lobe meningioma multiple scalp mass. In February 2017, the patient underwent for left frontal craniotomy with tumor removal. Pathological reported anaplastic (WHO grade III) with mitotic activity 20/10 HPF. CT chest shown multiple pulmonary nodules both lungs, enlarge hypodense node at a periaortic area and new develop right hypovascular nodule at the right kidney. Then he undergone the bronchoscopy but histopathologic had reported the presence of lung tissue with mild inflammation. That time he had received tamoxifen 20 mg once daily. Then he did Intensity-modulated radiotherapy (IMRT) at brain and scalp lesion. A tamoxifen was started in February 2017 until May 2017. Followed Magnetic resonance imaging (MRI) shown progressive of the residual at left frontotemporal regions with left frontal lobe invasion. CT chest was reported increased pleural effusion at right lung and increased both multiple solids nodules and mediastinal nodes. In June 2017, Pleural effusion had rapid increase in volume. After there he had been done pleuroscopy for pleural biopsy and talc pleurodesis. Histopathological of pleura shown metastatic meningioma. Immunohistochemistry shown positive EMA and D2-40 and negative for AE1/AE3, TTF-1, P40, calretinin, WT1, and CAM5.2. Then the patient had been palliative care until passed

Anaplastic meningioma is uncommon and poor prognosis tumor. It found about 2-3 % of all meningiomas. The tumor is aggressive and rapid growing and a higher rate of recurrence. The treatment of choice is complete surgery followed by radiotherapy. There is no standard effective of chemotherapy. Some evidence suggests hormonal therapy which use tamoxifen to treat inoperable meningioma. In this patient was received tamoxifen but poor response rate and finally tumor has a progression

Editorial acknowledgement

Clinical trial identification