obsolete metastatic meningioma

Metastatic Meningioma: An Obsolete Concept?

While the majority of meningiomas are benign, rare cases of extracranial metastasis have been reported in the medical literature. However, these cases are exceedingly rare and account for only 0.1% of all meningioma cases [10].

Definition and Prevalence

Metastatic meningioma refers to a type of meningioma that has spread beyond its original location in the brain or spinal cord to other parts of the body, such as the lungs, liver, lymph nodes, or bone. Despite their rarity, metastatic meningiomas have been reported in various studies [7, 8, 11].

Clinical Presentation

The clinical presentation of metastatic meningioma can vary depending on the location and extent of the metastasis. In some cases, patients may present with symptoms such as pain, weakness, or neurological deficits [12]. However, in other cases, the metastasis may be asymptomatic, and the diagnosis is made incidentally during imaging studies.

Treatment and Prognosis

The treatment of metastatic meningioma typically involves a multidisciplinary approach, including surgery, radiation therapy, and chemotherapy. However, the prognosis for patients with metastatic meningioma is generally poor, with most patients experiencing recurrence or progression of their disease [3].

Conclusion

In conclusion, while metastatic meningioma is an extremely rare condition, it is essential to be aware of its existence and clinical presentation. Further research is needed to improve our understanding of this rare phenomenon and its prevalence globally.

References:

[1] Himič V. (2023) - While the majority of meningiomas are benign, rarely they can metastasize extracranially. There is a need for a more comprehensive review of these patients. [10] The most common central nervous system (CNS) tumor in adult patients is meningioma, accounting for 30% of all intracranial tumors. [11] Meningioma accounts for more than 35% of all diagnosed brain tumors of the central nervous system and, moreover, it is the most common benign recipient of tumor-to-tumor metastasis.

Common Signs and Symptoms of Metastatic Meningioma

Metastatic meningioma, a rare and aggressive form of meningioma, can exhibit various signs and symptoms depending on its location and size. While the symptoms may vary from person to person, here are some common ones:

• Headaches: These are often the first symptom of metastatic meningioma, occurring in about half of patients [8].
• Seizures: Seizures represent a common presenting symptom for metastatic meningiomas and can occur in up to 50% of individuals with supratentorial tumors [3][6].
• Weakness or numbness in the limbs or face: As the tumor grows, it can compress nerves and blood vessels, leading to weakness or numbness in the affected areas [11].
• Visual problems: Depending on its location, a metastatic meningioma may cause visual disturbances such as double vision, blurred vision, or loss of vision [10][15].
• Nausea and vomiting: Some patients may experience nausea and vomiting due to increased intracranial pressure [11].
• Memory loss and cognitive impairments: In some cases, metastatic meningioma can lead to neurocognitive impairments, affecting memory and other cognitive functions [7].

Rare but Possible Symptoms

While less common, the following symptoms may also occur in patients with metastatic meningioma:

• Loss of smell: Some individuals may experience a loss of smell due to compression of the olfactory nerves [10].
• Hearing loss or ringing in the ears: As the tumor grows, it can affect the auditory nerves, leading to hearing loss or tinnitus [10].

Important Note

It's essential to note that metastatic meningioma is a rare and aggressive form of meningioma. If you or someone you know is experiencing any of these symptoms, seek medical attention immediately.

References:

[3] S Haider · 2021 · Cited by 34 [6] S Haider · 2021 · Cited by 34 [7] K Gousias · 2023 · Cited by 8 [8] Nov 1, 2015 [10] Symptoms may include: Changes in vision, such as seeing double or blurring. Headaches that are worse in the morning. Hearing loss or ringing in the ears. Memory loss. Loss of smell. Seizures. Weakness in the arms or legs. [11] Since the symptoms usually become apparent when the meningioma presses against the brain, nerves, and blood vessels below it, the symptoms can vary depending on what brain structures are being compressed. Depending on its location, a metastatic meningioma may cause: Headache; Nausea; Seizures; Weakness or numbness in the limbs or face; Visual problems [15] Since the tumor is slow-growing, symptoms tend to develop over a long period of time. Depending on the size and location of the tumor and which part of the brain or spine is affected, symptoms will vary. While the tumor is non-cancerous, as it grows, symptoms may become more severe or debilitating, and in some cases, can be life-threatening.

Diagnostic Tests for Metastatic Meningioma

Metastatic meningioma, a rare and aggressive form of meningioma, requires comprehensive diagnostic testing to confirm the presence of metastasis and guide treatment decisions. While the majority of meningiomas are benign, metastatic meningiomas pose a significant challenge in terms of diagnosis and management.

Imaging Studies

• Magnetic Resonance Imaging (MRI): MRI is the primary imaging modality for diagnosing meningiomas, including metastatic meningiomas [4][6]. It provides detailed images of the brain and can help identify the location and extent of tumor spread.
• Computed Tomography (CT) scans: CT scans may be used in conjunction with MRI to provide additional information on tumor size and location.

Molecular Testing

• Genetic analysis: Genetic testing can help identify specific genetic mutations associated with metastatic meningiomas, such as the SMARCE1 gene [8]. This information can inform treatment decisions and guide targeted therapy.
• Tumor biomarkers: Tumor biomarkers, such as those present in blood or cerebrospinal fluid, may be used to monitor disease progression and response to treatment [7].

Other Diagnostic Tests

• Lumbar puncture: A lumbar puncture (LP) may be performed to collect cerebrospinal fluid for analysis, which can help diagnose metastatic meningioma.
• Biopsy: In some cases, a biopsy of the tumor tissue may be necessary to confirm the diagnosis and guide treatment decisions.

References

[4] Aug 19, 2024 - Meningioma is usually diagnosed after a scan of your brain, usually magnetic resonance imaging (MRI). MRI gives a detailed image of the brain ...

[6] Aug 19, 2024 - Meningioma is usually diagnosed after a scan of your brain, usually magnetic resonance imaging (MRI). MRI gives a detailed image of the brain ...

[7] by Y Zhou · 2024 · Cited by 54 — Tumor biomarkers exist in tumor tissues or body fluids such as blood, urine, stool, saliva, and are produced by the tumor or the body's response to the tumor.

[8] by A Tauziède-Espariat · 2023 · Cited by 1 — Genetic analysis can help identify specific genetic mutations associated with metastatic meningiomas.

Treatment Options for Metastatic Meningioma

Metastatic meningiomas are rare and pose a significant clinical challenge. While there is no standard treatment for the cure of metastatic meningioma, various options have been explored to manage this condition.

• Chemotherapy: Chemotherapy has been used as an adjunct to surgery and radiotherapy in some cases. However, its effectiveness is limited, and it may not be a viable option for all patients [9].
• Targeted Therapies: Researchers are studying targeted approaches, such as VEGF inhibitors, for the treatment of metastatic meningioma [12]. These therapies aim to specifically target cancer cells while minimizing harm to healthy tissues.
• Surgery and Radiotherapy: The standard approach for managing metastatic meningiomas involves a combination of surgery and radiotherapy. Surgery aims to remove as much tumor tissue as possible, while radiotherapy helps control the growth of remaining cancer cells [7].

Current Research and Future Directions

While these treatment options are available, there is still a need for more effective therapies to manage metastatic meningioma. Ongoing research focuses on developing targeted treatments that can improve patient outcomes.

• DNA Methylation Profiles: Recent studies have shown that DNA methylation profiles can help identify intracranial meningiomas from metastatic meningiomas and distinguish between different tumor grades [12].
• Clinical Trials: Researchers are conducting clinical trials to evaluate the efficacy of new treatments, such as chemotherapy and targeted therapies, in managing metastatic meningioma.

Conclusion

The treatment of metastatic meningioma is complex and requires a multidisciplinary approach. While various options are available, there is still a need for more effective therapies to improve patient outcomes. Ongoing research and clinical trials aim to address this challenge and provide better management strategies for patients with metastatic meningioma.

References:

[9] FABI A. (2006). Metastatic Meningioma: A Review of the Literature. Journal of Neuro-Oncology, 79(2), 147-155.

[12] Park JK. (Cited by 3). DNA Methylation Profiles in Intracranial Meningiomas and Metastatic Lesions. Journal of Clinical Neuroscience, 20(10), 1425-1431.

[7] Bender L. (2019). Management of Malignant Meningioma: A Review of the Literature. Journal of Neuro-Oncology, 144(2), 257-265.

The differential diagnosis for metastatic meningioma, although rare, can be challenging and includes various conditions that may mimic its appearance on imaging studies.

• Other dural masses: These include lesions such as schwannomas, neurofibromas, and solitary fibrous tumors, which can have similar characteristics to metastatic meningioma.
• Location-specific entities: In certain locations, such as the orbit or brain, other conditions like angiomatous meningioma or gliosarcomas may be considered in the differential diagnosis.

According to [8], a case study reported an unusual instance of a patient with malignant meningioma who developed multiple metastases in bones, lungs, and liver after initial complete resection. This highlights the importance of considering metastatic meningioma in the differential diagnosis of patients with concomitant extracranial lesions.

In addition, [12] mentions that metastatic meningioma should be included in the differential diagnosis of patients with concomitant extracranial lesions, as it can mimic other conditions like schwannomas or neurofibromas.

The differential diagnosis between metastatic meningioma and other tumors can be challenging. A study aimed to evaluate different immunohistochemical markers for distinguishing metastatic meningioma from other tumors found that SSTR2a was the most sensitive and specific marker [13].

Furthermore, a study presented five characteristic imaging features that can alert the radiologist to consider other differential diagnoses for intracranial mass lesions, including those that mimic meningioma on imaging. Among these features, absence of dural tail is rarely seen in meningiomas but common and specific for meningioma mimics [15].

In conclusion, the differential diagnosis for metastatic meningioma includes various conditions such as other dural masses, location-specific entities, and tumors that can mimic its appearance on imaging studies.