P11.03 Anaplastic meningioma with extracranial metastases

Abstract

BACKGROUND: Anaplastic meningioma is exceedingly rare, and its clinicopathological features are distinctive. Distant meningioma metastases have been reported previously to be very rare. The most common site of metastasis is the lung, which accounts for 61% of all meningioma metastases. The standard therapy for meningiomas is total resection and/or radiation therapy. CASE REPORT: A 71-year-old man was admitted with a headache and left hemiparesis. Magnetic resonance imaging (MRI) revealed mass lesions at the right frontal convexity and left occipital lobe. Following surgery, pathological examinations demonstrated an anaplastic meningioma. After 3 month from the operation and radiation therapy, the lung cancer was removed. Pathological findings of lung cancer resembled his brain tumor. The diagnosis of the lung cancer was metastatic lung cancer from anaplastic meningioma. 2 months later from the lung surgery, he had focal recurrence at frontal convexity area and progress into cavernous sinus revealed by MRI. Abdominal CT was detected new metastatic lesion at his liver. He received adjuvant reirradiation consisting of whole brain radiotherapy. In addition, he received the chemotherapy using angiogenesis receptor (bevacizumab). Chemotherapy with hydroxyurea was initiated after 2 course of chemotherapy of bevacizumab, because of his hepatic lesions were more aggressive. Intracranial mass was redeuced by 50% after 8weeks of initiated of chemotherapy with hydroxyurea. However, there were no significant change in liver and lung metastasis. DISCUSSION: Extracranial metastases are extremely rare, being estimated to occur in 0.1% of all meningiomas and most often in association with anaplastic meningiomas. The standard therapy for meningiomas is total resection and/or radiation therapy. The use of chemotherapy for meningiomas has been limited to distance metastases or out of surgical criteria. Several reports demonstrated hydroxyurea was effective chemotherapy for meningiomas including grade I cases. Hydroxyurea arrests meningioma cell growth through arrest of the S-phase of the cell cycle, thus inducing apoptosis.