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Published on: September 9, 2020
Malignant primary pulmonary meningioma with bone metastasis
Yusuke Minami1, Shingo Sato1, Hirotaka Koyanagi1
1Division of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Abstract:
Primary pulmonary meningioma is extremely rare and only <45 cases have been reported since its first report by Kemnitz and Heinrich (Meningioma of lung: first report with light and electronmicroscopic findings. Ultrastruct. Pathol. 1982;3:359-65). Among these cases, only five cases were malignant or atypical. A 67-year-old female with primary pulmonary meningioma underwent thoracoscopic pulmonary wedge resection of the left lower lobe a year before. She had been aware of left thigh pain for 9 months, then she was referred to our division. Positron emission tomography-computed tomography suspected multiple bone metastasis including frontal bone, mandible, left scapula, rib, vertebra, pubis, left femur and sternum. We performed a needle biopsy of the sternum. Histopathological diagnosis was metastasis of primary pulmonary meningioma, World Health Organization grade III. We treated her with denosumab and radiation therapy targeting the left femur. Two months after the treatment, the pain had decreased and she could walk with no cane. No case of malignant extracranial meningioma with bone metastasis have been reported.
Insights
Malignant primary pulmonary meningioma, a rare lung tumor, metastasized to bone. This case highlights the first report of malignant extracranial meningioma with bone metastasis, successfully treated with denosumab and radiation therapy.
Area of Science:
- Oncology
- Pathology
- Radiology
Background:
- Primary pulmonary meningioma is an exceptionally rare lung neoplasm, with fewer than 45 reported cases globally.
- Malignant or atypical variants are even rarer, accounting for only five previously documented instances.
- This study focuses on a unique case of a 67-year-old female with a history of primary pulmonary meningioma.
Observation:
- The patient presented with persistent left thigh pain, prompting further investigation.
- Positron emission tomography-computed tomography revealed widespread bone metastasis, including the sternum.
- A sternal needle biopsy confirmed metastatic disease consistent with World Health Organization grade III primary pulmonary meningioma.
Findings:
- This case represents the first documented instance of malignant extracranial meningioma with bone metastasis.
- The patient received a treatment regimen including denosumab and targeted radiation therapy to the left femur.
- Significant pain reduction and improved mobility (walking without a cane) were observed two months post-treatment.
Implications:
- This case expands the known metastatic potential of primary pulmonary meningioma.
- It underscores the importance of considering rare diagnoses in cases of unexplained bone pain and metastasis.
- The successful treatment outcome suggests potential therapeutic strategies for similar rare oncological presentations.
