A Case of Metastasizing Meningioma.

Primary intracranial neoplasms rarely give rise to distant extracranial metastases despite the fact that many of them possess the other attributes of malignant neoplasms. Paradoxically it appears that extra-cranial metastases are more liable to originate from the less rather than the more malignant primaryintra-cranial neoplasms (Russell and Rubinstein, 1963). Cushing and Eisenhardt (1938) reported only one example of metastasizing meningioma, while Kerno-han and Sayre (1952) found none in their series of 794 meningiomas. We describe in the following case report an intra-cranial meningioma which metastasized to the thyroid gland and lungs. A man aged 42 presented in December 1952 with a short history of intermittent motor and sensory disturbances in the right limbs and more recently headache, right homo-nymous hemianopia, and dysphasia. Clinical and angio-graphic examination indicated a left parietal lesion. In January 1963, through a left parieto-occipital craniotomy a tumour approximately 7 x 5 x 5 cm. arising from the falx and embedded in the left parietal lobe was removed. A small extension through the falx to the right of the midline was left. The tumour, received in two portions, was lobulated, partially encapsulated, firm, haemorrhagic in some areas and greyish white in others. It was highly cellular in most areas, composed of oval or spindle-shaped cells (Fig. 1). The cell boundaries were indistinct, the cytoplasm moderate in amount and sometimes clear. The cells were arranged in sheets traversed by numerous thin-walled vascular channels; small, ill-defined whorls were de-lineated by a reticulin network (Fig. 2). There were no psammoma bodies. Parts were composed of fibrous tissue containing a few strands of tumour cells. A few mitotic figures were present but pleomorphism was not conspicuous. Post-operatively, radiotherapy (4,750 r) was given. The patient made an excellent recovery and was able to resume his normal work. He remained practically symptom free except for slight proprioceptive difficulties in the right foot until 1960 when over a period of four months this deficit became severe and extended to involve both lower limbs and to a less extent the upper limbs. Minor sensory epileptic manifestations were experienced in the right hand, and on one occasion there was a transient loss of consciousness. Examination indicated recurrence of the tumour and in December 1960 a biparietal craniotomy was performed. The tumour, which lay between and embedded in the parietal lobes, arose from either side of the falx, on the right side forming a mass 5 x …