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Published on: July 5, 2014
A Rare Case of Femur Metastasis from Brain Meningioma
Yuki Mitani1, Toshihiro Matsuo1, Takashi Nishisaka2
1Department of Orthopaedic Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
Background/Aim:
Metastases of meningiomas are infrequent, and extracranial bone involvement is extremely rare. We describe a patient with femoral metastasis originating from an atypical brain meningioma.
Case Report:
A 55-year-old male had undergone five surgical procedures and Gamma Knife® radiosurgery for brain meningioma over five years. Four months after the final treatment he presented with spontaneous right-hip pain. Radiography showed a radiolucent lesion at the lesser trochanter; computed tomography confirmed cortical bone destruction. Positron emission tomography-computed tomography demonstrated abnormal uptake in the femur [Standardized Uptake Value (SUV) 3.3] and in residual intracranial tumor (SUV 9.9). Magnetic resonance imaging revealed low T1- and high T2-weighted signal intensities at the lesion. Open biopsy identified metastatic WHO grade II meningioma positive for epithelial membrane antigen and somatostatin receptor 2A, with a Ki-67 labelling index of approximately 10%. Wide resection of the proximal femur with endoprosthetic reconstruction was performed. Postoperatively, the patient experienced intracranial tumor recurrence and received radiation therapy. No local recurrence or additional metastases were observed during the three-year follow-up; the Enneking functional score was 60%.
Conclusion:
We report on an extremely rare instance of metastasis to the femur in a case of atypical brain meningioma.
Insights
This case report details an extremely rare femoral metastasis from an atypical brain meningioma. Surgical intervention and radiation therapy were employed to manage this uncommon extracranial bone involvement.
Area of Science:
- Neuro-oncology
- Orthopedic Oncology
- Radiology
Background:
- Meningiomas are primary brain tumors, with extracranial metastases being exceptionally rare.
- Atypical meningiomas (WHO grade II) carry a higher risk of recurrence and metastasis compared to typical meningiomas.
- Femoral metastasis from a brain meningioma represents an extremely infrequent oncological event.
Purpose of the Study:
- To document and analyze an exceedingly rare case of femoral metastasis originating from an atypical brain meningioma.
- To highlight the diagnostic and therapeutic challenges associated with extracranial meningioma metastases.
- To contribute to the limited literature on bone metastases from intracranial tumors.
Main Methods:
- A 55-year-old male with a history of atypical brain meningioma underwent extensive treatment, including surgery and radiosurgery.
- Diagnostic imaging modalities such as radiography, CT, PET-CT, and MRI were utilized to characterize the femoral lesion.
- Histopathological examination of an open biopsy confirmed metastatic WHO grade II meningioma.
- The patient was treated with wide resection of the femur and endoprosthetic reconstruction.
Main Results:
- The patient presented with hip pain, which was diagnosed as a femoral metastasis from his atypical brain meningioma.
- PET-CT revealed abnormal uptake in both the femur and residual intracranial tumor.
- Histology confirmed metastatic meningioma with specific molecular markers (EMA, SST2A) and a Ki-67 index of ~10%.
- Post-surgical management included radiation therapy for intracranial recurrence, with no local recurrence or further metastases observed during a three-year follow-up.
Conclusions:
- This case underscores the potential for atypical meningiomas to metastasize to distant bone sites, specifically the femur.
- Multimodality imaging and histopathology are crucial for diagnosing such rare metastatic lesions.
- Aggressive surgical management combined with adjuvant therapies can achieve favorable outcomes in select cases of extracranial meningioma metastasis.
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