Simultaneous discovery of bifrontal meningiomas and a glioblastoma multiforme.

To cite: Woodley-Cook J, Bharatha A, Spears J. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013203296 DESCRIPTION A 63-year-old woman presented to her general practitioner with progressive cognitive impairment and chronic headache. MRI of her brain demonstrated bilateral extra-axial enhancing frontal lobe masses of similar morphology and enhancement pattern (white arrows, figure 1) causing midline shift to the left and hydrocephalus. There was mild transependymal flow of cerebrospinal fluid from the atrium of the right lateral ventricle (arrow, figure 2). Further MRI showed a dilated right middle meningeal artery supplying the larger of these two bifrontal masses (arrow, figure 3). A third intra-axial rim-enhancing left parietal mass (black arrow, figure 1) was also identified. The two frontal lesions were surgically resected and approximately 1 week later, the left parietal mass was biopsied. Pathological evaluation diagnosed the bifrontal masses as meningiomas and the left parietal mass a glioblastoma multiforme (GBM). Following biopsy diagnosis, she underwent surgical resection and radiation of her GBM. Meningiomas arise from arachnoid meningothelial cells and are typically benign WHO grade I neoplasms with a metastatic rate of approximately 0.1–0.2%. 2 There has been little research focusing on the genetic basis of meningioma development, with the most significant finding of the neurofibromatosis-2 gene mutation on chromosome 22q12 being linked to approximately half of all meningiomas. They are slow-growing lesions, more common in women, and have an approximate 1% prevalence in autopsy series. GBMs are the most common primary brain tumours and are highly malignant WHO grade IV neoplasms of astrocytic origin with a poor prognosis. They may be primary, arise de novo or may