J Korean Neurosurg Soc.  2012 Mar;51(3):151-154. 10.3340/jkns.2012.51.3.151.

Two Cases of Primary Osteolytic Intraosseous Meningioma of the Skull Metastasizing to Whole Skull and the Spine

• Kim H
• Jung TY
• Kim IY
• Lee JK

• KMID: 2018189
• DOI: http://doi.org/10.3340/jkns.2012.51.3.151

Abstract

We report here two cases of primary intraosseous meningioma with aggressive behavior. A 68-year-old man presented with a one year history of a soft, enlarging mass in the right parietal region. Magnetic resonance image (MRI) revealed a 6 cm sized, heterogeneously-enhancing, bony expansile mass in the right parietal bone, and computed tomograph (CT) showed a bony, destructive lesion. The tumor, including the surrounding normal bone, was totally resected. Dural invasion was not apparent. Diagnosis was atypical meningioma, which extensively metastasized within the skull one year later. A 74-year-old woman presented with a 5-month history of a soft mass on the left frontal area. MRI revealed a 4 cm sized, multilobulated, strongly-enhancing lesion on the left frontal bone, and CT showed a destructive lesion. The mass was adhered tightly to the scalp and dura mater. The lesion was totally removed. Biopsy showed a papillary meningioma. The patient refused adjuvant radiation therapy and later underwent two reoperations for recurred lesions, at 19 and at 45 months postoperative. The patient experienced back pain 5 years later, and MRI showed an osteolytic lesion on the 11th thoracic vertebra. After her operation, a metastatic papillary meningioma was diagnosed. These osteolytic intraosseous meningiomas had atypical/malignant pathologies, which metastasized to whole skull and the spine.

Keyword

Intraosseous; Meningioma; Metastasis; Osteolysis

MeSH Terms

Aged
Back Pain
Biopsy
Dura Mater
Female
Frontal Bone
Humans
Magnetic Resonance Spectroscopy
Meningioma
Neoplasm Metastasis
Osteolysis
Parietal Bone
Scalp
Skull
Spine

Figure

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  Fig. 1 Case 1 : Preoperative radiologic findings. A : CT image shows a bony, destructive lesion, in the right parietal bone abutting the scalp and dura. B : Coronal MRI revealing a heterogeneously-enhancing, bony, expansile mass in the right parietal bone, extending into intracranial epidural space.

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  Fig. 2 Case 1 : Pathologic findings (atypical meningioma). A : Cellular whorl formation (H&E, original magnification ×100). B : Immunopositive for epithelial membrane antigen (original magnification ×400). C : Frequent mitosis, (H&E, original magnification ×400). D : Necrosis (H&E, original magnification ×100)

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  Fig. 3 Case 1 : Follow-up radiologic findings. One year later, follow-up brain MRI shows multiple variable sized nodules and masses in whole skull, causing epidural and subgaleal extraosseous mass formations.

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  Fig. 4 Case 2 : Preoperative radiologic findings. A : CT image shows a bony, destructive lesion in the left frontal bone. B : MRI revealing a 4-centimeter, multilobulated, strong-enhancing mass on the left frontal bone, with thickening of adjacent scalp and meninges.

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  Fig. 5 Case 2 : Pathologic findings (papillary meningioma). A : Papillary structures mixed with meningothelial sheets (H&E, original magnification ×100). B : Tumor cells in papillary pattern (original magnification ×200). C : Immunopositive for epithelial membrane antigen (original magnification ×200). D : Three percent of Ki-67 labeling index (H&E, original magnification ×100).

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  Fig. 6 Case 2 : Follow-up radiologic findings. A : Follow-up MRI demonstrates a 1 cm, homogenously-enhancing, recurred lesion on the skull, adjacent to the previous lesion. B : Spinal MRI shows the osteolytic lesion on the body and posterior element of the 11th thoracic vertebra.

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