Pulmonary Metastatic Meningioma with Coincident Lung Cancer: a case report

Meningiomas with distant metastases rarely occur. We report a patient with coincident primary lung cancer and metastatic meningiomas. The presence of distinct imaging features and a differential response to chemotherapy enabled us to distinguish the primary lung cancer from the metastatic lesions. Previous studies suggest that several factors can enhance the propensity of meningioma for metastasis. Thus, if a patient presents with multiple lung nodules and a history of meningioma with certain predisposing factors, metastatic meningioma should be considered in the differential diagnosis. Correspondence Author to: I-Chang Lin Department of Radiology, E-DA Hospital / I-Shou University, Kaohsiung, Taiwan No. 1, Yi-Da Road, Yan-Chao, Kaohsiung 82445, Taiwan J radiol sci 2014; 39: 127-130 Pulmonary metastatic meningioma with lung cancer 128 J Radiol Sci December 2014 Vol.39 No.4 than 5%. Therefore, the primary diagnosis was lung cancer with separated tumor nodules in the ipsilateral lung, and paraesophageal metastasis. Chemotherapy for lung cancer was initiated. On the follow-up chest CT scan taken 6 months later, the main tumor in the left upper lobe had significantly regressed, but the other tumor nodules and the paraesophageal soft tissue mass were still in a stationary status. Positron emission tomography-computed tomography (PETCT) showed FDG uptake by the residual main tumor, but not by adjacent pulmonary nodules or the paraesophageal mass. On MRI, the paraesophageal mass was shown to have similar signal intensity to the muscle tissues as observed on T1-weighted images, slightly hyperintense on T2-weighted images; it showed homogeneous enhancement and high signal intensity on diffusion-weighted images (Fig. 3). The patient then underwent surgical resection of all the tumor masses and nodules. The pathology report indicated that the residual main tumor was indeed squamous cell carcinoma, while the other lung nodules and the paraesophageal mass were all metastatic meningioma. The patient’s post-surgical recovery went well, and there was no obvious recurrent tumor found during the course of a 2-year follow-up period. Figure 2 Figure 2. A post-contrast enhanced coronal T1-weighted image of the brain reveals an enhanced dural mass in the right parasagittal region, which proved to be a meningioma, with superior sagittal sinus invasion (arrow). 1a