We present the case of a 59 year old male with multiple pulmonary metastases from a previously resected and irradiated atypical WHO grade-2 intracranial meningioma. Grade-2 meningioma is known to have malignant potential although this is rare and accounts for less than 1% of the total cases of meningioma. The lung is the most common organ of metastases accounting for 61% of documented cases.
Introduction: Meningiomas are considered the most common intracranial tumours. Most are benign, accounting for 94% of meningiomas and rarely metastasise (<1% of meningiomas). They can be divided into three grades, typical/benign (WHO grade-1), atypical (WHO grade-2) and anaplastic (WHO grade-3).
Case description: We present the case of a 59-yearold male with a background of previously excised meningioma followed by radiotherapy, who presented with bilateral metastatic lung lesions 7 years after primary treatment, which was subsequently confirmed to represent metastatic meningioma through histological examination.
Discussion: Multiple pulmonary metastases from intracranial meningiomas are rare. Only 11 cases of pathologically confirmed WHO grade-2 intracranial meningiomas with multiple pulmonary metastases have been documented in the literature. Surgical resection is the treatment of choice for accessible intracranial meningiomas with radiotherapy currently recommended for prevention of local recurrence. WHO grade-2 meningiomas, often require adjuvant treatment with radiotherapy or stereotactic radiosurgery. New approaches which combine the use of chemotherapy and targeted treatments are currently ongoing in clinical trials.
Conclusion: Long-term outcomes for patients with meningioma pulmonary metastases are difficult to study due to its rarity. However, metastatic meningioma should be included in the differential diagnosis of cannon ball pulmonary lesions where there is a history of meningioma, especially with local intra-cranial recurrence.