A Case of Extra-axial Anaplastic Meningioma with Direct Orbital Extension

PURPOSE: We report the first case of extra-axial anaplastic meningioma with direct orbital extension for differential diagnosis of orbital tumors. CASE SUMMARY: An 83-year-old woman presented with a protruding left eye and a palpable mass on the forehead. A brain computed tomography scan revealed a huge sarcomatous mass that had directly invaded the surrounding tissues. We removed the tumor by craniotomy and found that it involved the extradural and intradural spaces, brain parenchyma, subcutaneous tissue, left temporalis, orbital roof, and the other frontal lobe across the midline. A cranioplasty was performed, and the orbital roof was reconstructed with artificial bone and bone cement. The final histological diagnosis was anaplastic meningioma. The left eyeball was restored to its normal position 1 month after the surgery. Also, visual acuity and eye movement of the left eye were preserved. CONCLUSIONS: Direct orbital extension of originated extra-axial cerebral convexity anaplastic meningioma is rare but should be considered in the differential diagnosis of a rapidly growing orbital mass.

Meningioma anaplásico / Anaplastic meningioma

Se presenta el caso clínico de un paciente que comenzó a presentar cefalea, vértigos, trastornos visuales y pérdida del equilibrio. Mediante la resonancia magnética se visualizó una imagen tumoral parietal izquierda de 3 cm diámetro, de localización extraaxial y contornos lobulados bien definidos, con gran captación no homogénea de contraste, rodeada de extenso edema perilesional. Se realizó angiotomografía, previa a la cirugía, en busca de irrigación y daño vascular. Se logró la resección de 95% de la lesión (grado II de Simpson), que incluyó duramadre adyacente infiltrada y respetó el seno longitudinal superior. Los resultados anatomopatológicos confirmaron que se trataba de un meningioma anaplásico de grado III, con criterio de tratamiento coadyuvante.

The case report of a patient who began presenting headache, vertigos, visual disorders and loss of balance is presented. By means of the magnetic resonance a left tumoral parietal image of 3 cm diameter was visualized, of extra-axial localization and well defined lobulated contours, with great non-homogeneous zones of contrast, surrounded by extensive perilesional edema. An angiotomography was carried out, previous to the surgery, looking for irrigation and vascular compromise. The resection of 95% of the lesion was achieved (grade II of Simpson) which included adjacent infiltrated dura madre and preserving the superior longitudinal sinus. Pathological results confirmed that it was an anaplastic meningioma grade III, with criterium for adyuvant treatment.

Multiple Extracranial Metastases of Atypical Meningiomas

Meningiomas are usually benign neoplasms in which extracranial metastases occur very rarely. We report a case of multiple extracranial metastases of an atypical meningioma following a local recurrence. A 68-year-old man presented with left-side motor weakness and dysarthria for two weeks. A computed tomography (CT) scan and magnetic resonance imaging (MRI) showed an intraventricular tumor. We performed a total mass removal, and the histopathologic findings were consistent with benign meningioma. Eight months later, the meningioma recurred. We performed a reoperation and whole brain radiation therapy postoperatively. The histopathologic findings showed atypical meningioma. Six months later, CT and MRI revealed metastases to multiple vertebrae, lung, ribs and perirenal soft tissue so a decompressive laminectomy with mass removal was performed. The histopathologic findings of the spinal tumors showed atypical meningioma. The results from perirenal biopsies were consistent with metastatic meningioma. In conclusion, extracranial metastasis as well as local recurrence must be considered in atypical or anaplastic meningioma. There must be regular follow-ups. Finally, an evaluation of the chest, abdomen and bone is necessary, especially when related symptoms or signs develop.

A Subcortical Anaplastic Meningioma

Meningioma without dural attachment usually occurs in the intraventricular region, the pineal region, and the sylvian fissure. However, subcortical meningioma located far from such locations is extremely rare. The authors report a case of subcortical anaplastic meningioma without any dural attachment in a 41-year-old woman.

Anaplastic Cystic Meningioma

The authors present a case of malignant cystic meningioma in the left frontal convexity. The patient was 80-year-old male and presented with personality change and walking difficulty. Computerized tomography and magnetic resonance image demonstrated a round mass attached to the left frontal convexity dura. Intratumoral and peritumoral cystic lesions were also seen. Total removal of tumor was performed and the histological dia-gnosis was anaplastic meningioma.

Malignant Meningioma: Clinical, Radiologic and Pathologic Characteristics

This is a report of the clinico-pathologic findings in six cases of histologically verified malignant meningiomas-three hemangiopericytic and three anaplastic types. They were three males and three females and two of them were reoperated for recurrence. The hemangiopericytic types had similar angiographic and macroscopic features and malignant characteristics such as increased mitoses. The anaplastic types lacked typical arrangement, but had a large number of mitoses, increased cellularity, focal necrosis, pleomorphism, anaplasia, and the adjacent normal parenchymal infiltration. However the metastasis was not yet proven in these cases.

Malignant Meningioma: Clinical, Radiologic and Pathologic Characteristics

This is a report of the clinico-pathologic findings in six cases of histologically verified malignant meningiomas-three hemangiopericytic and three anaplastic types. They were three males and three females and two of them were reoperated for recurrence. The hemangiopericytic types had similar angiographic and macroscopic features and malignant characteristics such as increased mitoses. The anaplastic types lacked typical arrangement, but had a large number of mitoses, increased cellularity, focal necrosis, pleomorphism, anaplasia, and the adjacent normal parenchymal infiltration. However the metastasis was not yet proven in these cases.