Williamson B E, Stanton C A, Levine E A
Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA.
Am Surg. 2001 Oct;67(10):966-8.
Meningiomas are generally considered benign lesions. A minority, however, are capable of metastasis. The ones most likely to do so are commonly recurrent or frankly malignant in nature. The optimal management of such metastases is unclear. This is the first reported case of meningioma presenting as an isolated metastasis to the chest wall. This case involves a 64-year-old woman without significant medical or family history who underwent resection of a meningioma of the right cerebral hemisphere. She was treated 10 years later for recurrence by stereotactic radiosurgery. Three years after that, the patient's family noticed a mass on the left chest wall. A CT scan revealed destruction of the ninth rib laterally and subpleural extension. The patient subsequently underwent resection of full-thickness chest wall for a presumed soft-tissue sarcoma. Further pathologic evaluation including electron microscopy and immunohistochemistry revealed metastatic meningioma. The patient received adjuvant radiation to the chest wall and is currently free of disease at the chest wall one year after surgery. This case illustrates the difficulty in establishing an accurate diagnosis of metastatic meningioma. Consequently in selected patients with a history of the disease the diagnosis of metastatic meningioma must at least be considered. Resection of an isolated metastasis in this setting appears warranted.
脑膜瘤通常被认为是良性病变。然而，少数脑膜瘤能够发生转移。最有可能发生转移的脑膜瘤通常本质上是复发性的或明显恶性的。此类转移瘤的最佳治疗方法尚不清楚。这是首例报告的以孤立性转移至胸壁为表现的脑膜瘤病例。该病例为一名64岁女性，无重大病史或家族史，曾接受右大脑半球脑膜瘤切除术。10年后，她因复发接受了立体定向放射外科治疗。此后三年，患者家属发现左胸壁有一肿块。CT扫描显示第九肋骨外侧破坏及胸膜下延伸。患者随后因疑似软组织肉瘤接受了全层胸壁切除术。进一步的病理评估，包括电子显微镜检查和免疫组织化学检查，显示为转移性脑膜瘤。患者接受了胸壁辅助放疗，术后一年目前胸壁无疾病。该病例说明了准确诊断转移性脑膜瘤的困难。因此，对于有该疾病病史的特定患者，至少必须考虑转移性脑膜瘤的诊断。在这种情况下，切除孤立性转移瘤似乎是必要的。
