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Introduction: Pulmonary metastases from meningioma are rare and present with specific clinical and radiological features. The diagnostic and therapeutic management of metastatic meningioma illustrate the concept of orphan thoracic oncology., Case Report: We report the case of a 58-year-old male, former smoker, with a previous history of atypical meningioma and resected lung adenocarcinoma. During oncologic surveillance, a computed-tomography scan disclosed multiple well-defined homogeneous nodules in the right lung. These nodules were hypermetabolic at positron-emission tomography with fluorodesoxyglucose. Pathological examination of metastasectomy specimens revealed metastatic malignant meningioma., Conclusions: Pulmonary metastases may occur in malignant meningioma. Twenty-one cases have been reported over the past 20 years. As for all rare tumours, multidisciplinary consensus is mandatory, in the absence of evidence-based recommendations based on prospective trials or observational studies., (Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Metastatic spreading is a rare complication of meningioma. We report a subcutaneous metastasis from an atypical meningioma of the tentorium. A 69-year-old man presented with a meningioma of the tentorium. The tumor was totally resected. The histological diagnosis was atypical meningioma. The tumor recurred two years later and was irradiated. Despite irradiation, the tumor progressed and was resected three years later. Five months following the second surgery, an isolated subcutaneous mass developed at the skin incision and was resected. The histological examination of the subcutaneous tumor showed histological features of atypical meningioma. Surgery of atypical meningioma carries the risk of iatrogenic metastasis, despite previous irradiation.

This report describes a case of metastatic meningioma involving the first thoracic vertebral body in a 63-year-old woman. The patient was treated surgically 10 years earlier for a benign meningioma of the right parietal vault. Local recurrence was diagnosed in 1992. Despite the gamma-knife radiosurgery, recurrence required surgical treatment in 1999. Histological findings were compatible with atypical meningioma (grade II WHO). One year later, the patient presented left C8 cervicobrachial neuralgia. Investigation led to discovery of a D1 tumor that was a metastasis of the atypical intracranial meningioma. A resection of the vertebral T1 body with C7-T2 osteosynthesis was performed with an excellent recovery and no postoperative complication.

We report a case of dural metastasis, detailing the neuroradiologic and therapeutic aspects. The clinical presentation was limited to a progressive left hemiparesis. Post-contrast CT scan revealed a heterogeneous high-density mass of the right fronto-parietal convexity. MRI demonstrated dural involvement mimicking meningioma. Chest X-ray showed a right lung opacity, suggesting the diagnosis of dural metastasis. Surgical resection was performed. Histology confirmed the diagnosis of dural metastasis from a poorly differentiated carcinoma. Treatment was completed with radiotherapy and chemotherapy. Dural metastases are rarely reported. A review of the literature revealed principally 2 radiological aspects: hemorrhagic effusion and tumor mass. The pathophysiology of dural metastases is still a subject of debate. Two mechanisms have been put forward involving venous and arterial dissemination. As radiological aspects are confusing, the diagnosis of dural metastasis should be evoked in patients with spontaneous hemorrhagic subdural effusion or a tumor mass involving the dura mater.

Introduction: Neuromas and meningiomas represent by far the most frequent tumors of the cerebellopontine cistern (respectively over 80% and over 10%). Secondary malignant tumors are exceptional., Method: Presentation of four cases of malignant tumors of the cerebellopontine cistern, either revealing or complicating a primary tumor: a bronchial cancer, a cancer of the kidney, a medulloblastoma and a lymphoma. Patients were studied in T2- and T1-weighted high-field MRI sequences before and after gadolinium injection., Results: The four tumors were enhanced by gadolinium and shown to invade the internal auditory canal, including one bilateral involvement. In most cases, the tumors were slightly heterogeneous and had irregular margins., Conclusion: These observations suggest that other diagnoses than acoustic neuroma should be taken into account.

Two cases of meningiomas with metastasis are presented. The first case is typically a fibroblastic meningioma. After a local recurrence, dissemination occurs in the CSF with multiples localizations. The second case is a parasagittal meningioma of meningotheliomatous type. After two recurrences, a lymph node metastasis is discovered. Three modes of dissemination are known: through the blood vessels, the lymphatics or the CSF. The different spreads and mechanisms are discussed.