Extracranial metastases of anaplastic meningioma

Anaplastic meningioma is a World Health Organization (WHO) Class III lesion representing 2-3% of all meningiomas, with more aggressive spread, increased mortality and increased likelihood of recurrence. Metastases outside the blood-brain barrier are uncommon but can occur to the lungs, liver, bone and skin.Definitive diagnosis is obtained with pathological analysis. The World Health Organization classifies meningiomas into benign (Grade I), atypical (Grade II) and anaplastic/malignant (Grade III) based on histological findings including number of mitoses, cellularity, nucleus to cytoplasm etc. This case presents a 58-year-old female with history of treated anaplastic meningioma with new onset headache, nausea and vomiting. Workup demonstrated multiple new bilateral pulmonary nodules, which subsequent biopsy proved to be metastasis from recurrent anaplastic meningioma, with extensive intrathoracic involvement.