Extracerebral Pterional Metastasis from Malignant Meningioma: A Case Report

Anaplastic or malignant meningiomas that are classified as World Health Organization (WHO) grade III account for less than 1% of all meningiomas diagnosed. Despite the aggressive course, distant metastases are a rarity, occurring in only 0.1% to 0.2% of cases. We report the case of a 56-year-old woman who presented with parasagittal benign meningioma that underwent malignant transformation along with metastasis into the right orbitosphenoid region. The clinical, radiological, and histopathological aspects are highlighted, with an emphasis on the natural history of meningiomas.

Effect of miR-191 on the proliferation of malignant meningioma cell through EGR1/TP53 signaling pathway / 中华内分泌外科杂志

Objective To study the influence of miR-191 expression on the proliferation of human malignant meningioma cell line IOMM-Lee in vitro and to explore its mechanism.Methods The expression of miR-191 in malignant meningioma tissue,the adjacent normal tissues and human Malignant meningioma cell lines IOMM-Lee and CH157-MN was tested by Realtime PCR.miR-191 inhibitor was transfected in IOMM-Lee cells and MTT assay was employed to detect the cell viability.Bioinformatics prediction software was used in miR-191 target gene predictive analysis and verified by luciferase reporter system.The effect of EGR1 siRNA on the proliferation of IOMM-Lee cells was observed.Prorein interaction database was used to analyze which proteins could interact with EGR1.The effect of inhibition of EGR1 expression on TP53 protein expression was detected.The influence of inhibition of miR-191 expression on EGR1and TP53 expression was observed.Result The expression of miR-191 in malignant meningioma tissue (0.933±0.144) was higher than that in the adjacent normal tissue (0.459±0.104,P＜0.05).The expressiong of miR-191 in humam malignant meningioma cell line IOMM-Lee (1.25±0.07) was higher than that in CH157-MN cell line (0.50±0.14,P＜0.05).The cell proliferation capability was significantly decreased in miR-191 inhibitor group [(0.53±0.02) vs (0.74±0.01),P＜0.05].EGR1 was identified and validated to be a target gene of miR-191.Inhibition of EGR1 gene can promote OMM-Lee cell proliferation (0.83±0.02,0.71 ±0.01,P＜0.05).EGR 1 could positively regulate TP53 protein expression [(13 758.17±57.22) vs (10 239.00±71.30),P＜0.001.miR-191 Inhibition could increase EGR1 [(14 663.00±80.08) vs (11 184.33±153.90),P＜0.001] and TP53 expression [(15 206.17±102.08) vs(11 400.17±97.00),P＜0.001].Conclusion Downregulation of miR-191 can inhibit the proliferation of IOMM-Lee cell,which may be related to the upregulation of EGR1/TP53 signaling pathway.

Prognostic Factors of Atypical Meningioma: Overall Survival Rate and Progression Free Survival Rate

OBJECTIVE: Atypical meningioma is rare tumor and there is no accurate guide line for optimal treatment. This retrospective study analyzed the prognostic factors, the effect of different methods of treatments and the behavior of atypical meningioma. METHODS: Thirty six patients were diagnosed as atypical meningioma, among 273 patients who were given a diagnosis of meningioma in the period of 2002 to 2015. Age, gender, tumor location, Ki 67, Simpson grade and treatment received were analyzed. We studied the correlation between these factors with recurrence, overall survival rate and progression free survival. RESULTS: Median overall survival time and progression free survival time are 60 and 53 (months). Better survival rate was observed for patients less than 50 years old but with no statistical significance (p=0.322). And patients with total resection compared with subtotal resection also showed better survival rate but no statistical significance (p=0.744). Patients with a tumor located in skull base compared with patients with a tumor located in brain convexity and parasagittal showed better progression free survival (p=0.048). Total resection is associated with longer progression-free survival than incomplete resection (p=0.018). CONCLUSION: We confirmed that Simpson grade was significant factor for statistically affect to progression free survival in univariate analysis. In case of skull base atypical tumor, it is analyzed that it has more recurrence than tumor located elsewhere. Overall survival was not affected statistically by patient age, gender, tumor location, Ki 67, Simpson grade and treatment received in this study.

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.

Long Term Clinical Outcomes of Malignant Meningiomas

OBJECTIVE: Malignant meningiomas are rare and have worse prognosis than benign meningiomas. We report our experience of a malignant meningioma and review relevant literature in an attempt to investigate the clinical features, treatment, and prognosis of these tumors. METHODS: Fifteen patients underwent surgical treatment for intracranial malignant meningiomas between year 1990 and 2012 in our institution. Anaplastic meningiomas were diagnosed in thirteen cases and papillary meningiomas in two. Fourteen patients (93.3%) received radiotherapy after surgical resection. All patients were followed regularly including clinical-neurological follow-up as well as magnetic resonance imaging. Progression was determined radiographically when there was more than 10% of mass volume increase or when there were onset or worsening of neurological symptoms not attributable to other causes. RESULTS: Six patients were male and nine were women, and their mean age was 56.9 years (range 36-78). The median follow-up was 54 months (range 3-246). According to our study result, the 5-year progression free survival rate of malignant meningiomas was 53.6%. There were 2 cases (13.3%) of postoperative complications. Recurrences were confirmed in 4 patients (26.7%) during follow-up, the median recurrence time was 35 months (range 12-61), and further procedures were performed. Two of the recurred patients were treated with radiosurgery after secondary tumor resection, and other two patients were treated with radiosurgery alone. There was no more recurred disease patients in the follow-up period after then. CONCLUSION: We report the outcomes of the aggressive surgery with radiation of malignant meningiomas. Although the data is limited, we found that radiosurgery treatment had favorable tumor control on recurred patients from our experience.

Clinical diagnostic analysis of simpson intracranial malignant meningioma in 29 cases / 中国综合临床

Objective To explore the methods for diagnosis and treatment of malignant meningioma.Methods The clinical data of twenty-nine patients with malignant meningioma were retrospectively analyzed.Results Among the 29 patients,15 underwent Simpson Ⅰ resection,8 underwent Simpson Ⅱ resection and 6 had Simpson Ⅲ resection.Among these patients,Twenty-five cases were successfully followed up for 20-100 months.There are 11 cases who occurred relapse (44％),of whom 2 received Simpson Ⅰ resection,3 received Simpson Ⅱ resection and all the 6 cases receiving Simpson Ⅲ cases.Conclusion Head CT and MRI examination is helpful to diagnose malignant meningioma.The treatment mainly involved surgical resection combined with radiation and chemotherapy,with high postoperative recurrence rate and short survival time depending on the differentiation of the tumor.

Intraventricular Malignant Meningioma with CSF-Disseminated Spinal Metastasis : Case Report and Literature Review

The authors report a case of 42-year-old woman with an intraventricular tumor in the trigone of the left lateral ventricle. The first operation achieved a microscopically complete resection. The tumor was histologically atypical meningioma. After 26 months, there were recurrences of intraventricular meningioma. Complete resection of the tumor and adjuvant radiation therapy were performed, and the histological diagnosis was malignant meningioma. Sixteen months after the second operation, spinal metastasis in cervicolumbar lesion was diagnosed and a subtotal removal of cervical intradural extramedullary mass was performed. We describe an unusual case of intraventricular malignant meningioma with cerebrospinal fluid-disseminated spinal metastases with review of the clinical courses of previous reports.

Pulmonary Metastasis of Malignant Meningioma

We report a case of 41-year-old male with pulmonary metastasis from a recurrent intracranial malignant meningioma, which had two more recurrence, multiple intracranial metastasis. Pulmonary metastasis was developed five years after resection of primary lesion. The metastatic routes and treatment of pulmonary metastatic malignant meningiomas were described.

Intraventricular Malignant Meningioma

The authors present a case of intraventricular malignant meningioma located in the frontal horn of lateral ventricle and extended into the third ventricle in a 39-year-old man. Subtotal removal was done by the interhemispheric transcallosal approach and the histology revealed malignant meningioma with brain invasion. The clinical features, radiological findings, histological features and surgical approach are presented here.

Rapid Regrowth and Spinal Metastasis of Malignant Meningioma: Case Report

A case of malignant meningioma which has grown rapidly after gross total removal and metastasized to thoracic spines after second operation is reported. We recommend that early spinal magnetic resonance image should be performed in patient with spinal symptoms and signs after the treatment of intracranial meningioma and intensive treatment combined with operation and radiosurgery should be performed for the reduction of growth rate in the recurred malignant meningoma.

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.

Clinical Analysis of Atypical and Malignant Meningiomas: A study of 52 Cases

OBJECTIVE: Atypical and malignant meningiomas(AM, MM) are known to be rare and show aggressive behavior. Limited data are available concerning the clinical features, effectiveness of surgical removal and role of radiation therapy with AM, MM. The authors report our experience of AM, MM, with respect to clinical features. METHODS: Twenty-four cases of AM and 28 cases of MM, who were operated between 1988 and 1999 were retro-spectively studied review of medical records and radiological findings. These were compared with control group of 24 cases of menigiomas manifestating usual clinical course, which are selected arbitrarily among operative cases between Apr. 1999 and Dec. 1999. Mean follow-up periods were 26(1-91) months for AM and 23(1-62) for MM. Authors analyzed the prognostic factors for survival, and statistical analysis were accomplished by Kaplan-Meier method and log-rank test. RESULTS: Differences of clinical features between control groups and these atypical and malignant meningioma group were not significant. However, the location of MM was frequent in non-basal area(p<0.01). In AM, there were 4 patients of recurrence, and 3 patients of mortality. Among mortality cases, only one patient died of tumor progression, the other patients died of other causes. The survival at 2 year and 5 year in this group were 88% and 74% respectively, and in MM, 11 patients died due to tumor progression and 2 had spinal metastasis. The survival at 2 year and 5 year were 72% and 20%, respectively. For extent of resection, total removal(Simpson grade 1 or 2) was less often achieved in MM compared with AM(50% vs. 83%). Extent of resection of tumor and postoperative radiation therapy did not affect survival in both AM, MM. CONCLUSIONS: Clinical behavior of AM showed more benign than that of MM. Prognostic factor for survival is not related extent of resection of tumor and postoperative radiation therapy. However, further investigation with long-term follow-up and additional cases is mandatory.

Intracerebral Malignant Meningioma

A case report of an intracerebral parenchymal meningioma in a 28-year old male is presented. Meningiomas without dural attachment and malignant meningiomas are discussed and the pertinent literature is reviewed. The role of radiotherapy and radiosurgery for malignant meningiomas is also stressed.

Malignant(papillary) Meningioma of the Petrous Bone Extending to Cerebellopontine Angle and Infratemporal Fossa: Case Report

The authors present a case of malignant papillary meningioma of the petrous bone involving the whole petrous bone which extended to the left cerebellopontine angle and internal jugular vein extracranially. A 46-year-old male patient was presented with a 3-years history of the left otalgia and subsequent deafness with left facial nerve palsy. Neurological examination revealed a complete palsy of the left eighth nerve, and incomplete palsies of the left 7th, 9th, 11th, and 12th cranial nerves. Magnetic resonance imaging and computerized tomographic scan demonstrate a huge mass in cerebellopontine angle which involved the whole petrous bone, suboccipital bone and internal jugular vein. The tumor was totally resected using the transjugular approach with modified petrous bone resection. Neuropathologic examination revealed a papillary meningioma.

Malignant Intracranial Osteolytic Meningioma Appearing as an Extracranial Soft Tissue Mass: A Cases Report

Malignant intracranial meningioma is a rare pathologic entity. Although the topic is widely discussed, there is little agreement in the literatures as to the histological and radiological features that warrant the diagnosis of malignant meningioma. An osteolytic lesion of the skull may have been suggested in several cases. But in adults, the most commonly suspected lesion is metastatic lesion;while meningioma is rarely suspected. Meningiomas are occasionally associated even with extracranial masses. However, most of these masses are firm, and are caused by hyperostosis. Extracranial soft-tissue masses rarely arise in meningiomas, thus, the presence of both osteolytic skull lesion and soft-tissue mass is exceedingly rare in meningiomas. The authors report a case of osteolytic malignant meningioma located at the frontal fossa extending to the subgaleal space appearing as an extracranial soft-tissue mass in a 19-year-old female. The clinical, radiological, neurosurgical, and histopathological features of these lesions are discussed together with a review of the literatures.

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.

COMBINED ANALYSES OF CT AND CEREBRAL ANGIOGRAPHIC FEATURES OF BENIGN AND MALIGNANT MENINGIOMAS / 重庆医科大学学报

58 meningiomas verified by operation and pathology were reviewed, of them 13 cases had atypical CT findings, 10 cases were malignant meningiomas.The atypical CT manifestations are as follows, heterogeneous enhancement within the tumor mass, a few nonenhancing low density areas, hypocense area adjacent to tumor, ring-like enhancement; intratumoral hemorrhage, pathological basis of atypical-CT features of xmeningioma and CT and angiographic appearances of malignant meningiomas are discussed.For diagnosis of atypical and malignant meningiomas combined CT with angiogr-aphy examinations are recommended

A Case of Extradural Meningeal Sarcoma

Meningeal sarcoma is rare and its clinical course tends to be short. It is a malignant neoplasm arising from connective tissue elements present in meninges. We have experienced a case of 4 years old female patient with headache, palpable mass on left parieto-occipital area. The operation revealed entirely extradurally located, firm, vascular tumor and almost total excision was done. It was histopathologically diagnosed meningeal sarcoma but indisinguishable from malignant meningioma.

A Case of Malignant Meningioma Involving Frontal Bone and Frontal Lobe

Malignant Meningioma is rare and its initial clinical course tends to be short but otherwise indistinguishable from that of benign meningioma. And although it has been noted that many of them have propensities for invading the dural venous sinuses, the skull, and even extracranial tissues by direct spread, there seems little tendency for these to metastases. The changes of recurrence and eventual death are high in malignant meningioma. Recently we have experienced a case of malignant meningioma involving the right frontal bone and frontal lobe with infiltration to the adjacent structures.