Multiple Pulmonary and Pleural Metastases in Recurrent Intracranial Meningioma with Genetic Changes: Case Report and Review of the Literature

Background: According to the 2016 World Health Organization classification of central nervous system tumors, meningiomas are classified into 3 grades: I, II, and III. It has been reported that 2%-10% of meningiomas exhibit aggressive behavior, and 0.1%-1% of all patients with primary meningiomas develop distant metastases. Past studies have shown that genomic instability is strongly correlated with the risk of meningioma recurrence. Because of the rarity of this tumor, few papers have reported the prognosis and treatment of anaplastic meningioma. Under these circumstances, we present a case of multiple pulmonary and pleural metastases from a recurrent intracranial meningioma with some genetic changes.

Case Description: In the case, a previously healthy man aged 39 years was diagnosed with anaplastic meningioma. Postoperatively, due to multiple pulmonary and pleural metastases, adjuvant radiation, chemotherapy, and Gamma knife radiosurgery was subsequently performed. Molecular genetic examination with chromosomal microarray analysis showed that there were chromosomal abnormalities, including amplification in 1q and chr12; loss in 1p, 9p, and 22q; and catastrophe in chr8 and chr17 in both the previous brain meningioma and lung tissues, confirming the diagnosis of pulmonary metastasis of the initial grade III meningioma.

Conclusions: The molecular characterization of meningiomas has identified genetic biomarkers that influence tumor characteristics, such as tumor behavior, malignancy, and location. The combined analyses of genetic and epigenetic changes in meningiomas may allow researchers to unveil a more comprehensive understanding of tumor progression mechanisms.