Low-grade intracranial meningioma with bilateral pulmonary metastases incidentally detected postpartum: a case report and review of the literature.

INTRODUCTION: Meningiomas are the most commonly encountered intracranial tumors, usually showing indolent behavior. Extra-axial spreading and distant metastases are seldom detected in these tumors, and lung metastasis from a low-grade meningioma is a rare event. CASE PRESENTATION: This case report aimed to present the clinical, imaging, and pathological features of a 37-year-old Caucasian pregnant woman with bilateral lung metastases incidentally detected during preoperative workup ahead of surgery for a primary intracranial meningioma. The possible metastatic routes and risk factors of dissemination to the pulmonary circulation were discussed as well. CONCLUSION: Metastasis must be considered in patients with intracranial meningiomas accompanied by venous sinus invasion and extension through the calvarium. Thorough paraclinical investigations are suggested in such cases.

Eosinophilic granuloma at the cerebellopontine angle in an adult; a rare case report and literature review.

INTRODUCTION: Langerhans cell histiocytosis (LCH) is a rare immunologic disorder, identified by immature proliferation of histiocytes which may present as systemic or focal lesions. Eosinophilic granuloma (EG) is localized from of LCH mainly involving bones such as skull, femur, spine, ribs, mandible and pelvis. Cerebello-pontine (CP) angle is a rare anatomic location for involvement by EG. PRESENTATION OF CASE: A 32 year old man was being evaluated in our neuro-oncology clinic due to diplopia since 4 months ago. On physical examination he had left sided abducens paresis, hyposthesia over left half of his face and a decreased corneal reflex on left side. A magnetic resonance imaging (MRI) study revealed a lesion at left CP angle measuring 30×25×25mm in size which was isointense in T1, hypointense on T2 with homogenous enhancement in post-contrast study. A standard retrosigmoid approach was carried out for resection of this lesion. Pathology report of the frozen section depicted infiltration of eosinophils and large mono-nuclear cells. The infiltrative nature of the lesion encouraged us not to attempt further resection. Permanent pathology report was in favor of EG. Patient was referred to an oncology clinic for proceeding with the steroid therapy. DISCUSSION: To the best of authors' knowledge, this is the first report of EG at CP angle in an adult, in the literature. Infiltration of eosinophils and positivity for CD1a and S-100 renders the diagnosis unmistakable. CONCLUSION: When the diagnosis is suggestive of EG, incompletely excised lesions can be further managed by steroid therapy.

Case report of skull metastasis from hepatocellular carcinoma after a liver transplant.

A solitary skull metastasis from hepatocellular carcinoma is rare. A 38-year-old man with hepatocellular carcinoma presented to our institution with a palpable temporal scalp mass. We took a magnetic resonance image, and discovered an enhanced and osteolytic skull tumor. The tumor was removed by an occipital craniectomy, and the histologic diagnosis was a cranial metastasis owing to hepatocellular carcinoma. A skull metastasis owing to hepatocellular carcinoma should be considered in the differential diagnosis in patients with a subcutaneous scalp mass. Although a distant metastasis can affect the prognosis of the patient, early treatment may improve survival.