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Aggressive pediatric meningioma with soft tissue and lymph node metastases: a case report
Author(s) -
Doxtader Erika,
Fuller Christine
Publication year - 2008
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.22.1_supplement.706.28
Subject(s) - medicine , soft tissue , meningioma , lymphatic system , craniotomy , pathology , radiology
Metastatic meningioma is extremely rare, occurring in an estimated 0.1% of cases. We report a case of pediatric meningioma metastatic to cervical soft tissue and lymph nodes. An 8‐year‐old boy presented with headaches, dizziness, involuntary eye flickering, and 3‐year history of cervical lymphadenopathy. MRI revealed a 7.5 cm parasagittal dural‐based mass with venous sinus encasement. Therapeutic embolization was followed by bilateral craniotomy, achieving subtotal resection. Histopathologic examination revealed an atypical meningioma (WHO grade II) with regions of hypercellularity, small cell morphology, sheeting architecture, increased mitoses, and brain invasion. Deletions of NF2 and DAL1 (protein 4.1B) were documented by fluorescence in situ hybridization. Subsequent surveillance MRI studies showed growth of residual intracranial tumor, large extra‐axial and subgaleal CSF collections, and enlarging cervical soft tissue masses with posterior triangle lymphadenopathy. Gamma knife and surgical resection were employed for the intracranial tumor burden; resection of the soft tissue masses revealed metastatic meningioma, with diffuse soft tissue infiltration, extensive lymphatic invasion, and metastasis to 8 lymph nodes. This case demonstrates the aggressive biologic potential of pediatric meningiomas, with potential for distant spread via CSF leakage and lymphatic invasion.