1443 - Pulmonary metastases in recurrent intracranial meningioma: A case report

Case Summary

Metastases in meningiomas are rare. Here is a case of a 60-year-old gentleman with 1-year history of right parietal swelling, treated as right parietal osteoma. However, symptoms worsen with increasing scalp swelling with headache and vomiting. MRI showed right parietal enplaque meningioma with calvarial involvement. 1^st craniotomy, excision of tumor and titanium cranioplasty on January 2014. HPE reported as meningioma, WHO Grade 1. Surveillance MRI done showed stable lesion unlikely residual. Early 2017 he had the same symptom associated with right hemiparesis. MRI suggestive of tumour recurrence at surgical bed extending to left parasagittal parietal with involvement of adjacent left parietal bone, scalp, and superior sagittal sinus. 2^nd craniotomy with tumor excision done on March 2017 with HPE reported as grade 1 meningioma. Subsequent MRI showed recurrence at right posterior parietal extra-axial bulk of tumor with mass effect. Proceed with 3^rd operation, HPE reported as atypical meningioma, WHO grade II with bone invasion. Another MRI done showed new adjacent left high parietal meningioma. He was monitored and repeated MRI April 2018 tumor become larger. Clinically there are 2 lumps at previous surgical site associated with right upper limb focal seizure. During pre-operative investigation baseline chest x-ray showed large left lower lobe mass. CT Thorax in May 2018 reported confirm large lower lobe mass with another smaller lesion at left upper lobe. Lung biopsy done and consistent with metastatic meningioma. Planned for lobectomy and metastetectomy. However, upon reviewing him chest X-ray showed rapid progression of lung mass with poor performance status. Thus, he was offered best supportive care.

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