Doxtader Erika E, Butts Sydney C, Holsapple James W, Fuller Christine E
Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA.
Pediatr Dev Pathol. 2009 May-Jun;12(3):244-8. doi: 10.2350/08-07-0501.1.
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, and involuntary eye flickering. Magnetic resonance imaging (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 with regions of hypercellularity, small cell morphology, sheeting architecture, increased mitoses, and brain invasion. Surveillance MRI studies showed growth of residual tumor and enlarging cervical soft tissue masses with posterior triangle lymphadenopathy. Radiation and surgical resection were employed for the intracranial tumor burden; resection of the soft tissue masses revealed metastatic meningioma, with soft tissue infiltration and metastasis to 8 lymph nodes. This case demonstrates the aggressive biologic potential of pediatric meningiomas, with potential for distant spread via cerebrospinal fluid leakage and lymphatic invasion.
转移性脑膜瘤极为罕见，估计发生率为0.1%。我们报告一例小儿脑膜瘤转移至颈部软组织和淋巴结的病例。一名8岁男孩出现头痛、头晕和不自主眼球颤动。磁共振成像（MRI）显示一个7.5厘米的矢状旁、硬膜下肿块，包绕静脉窦。先行治疗性栓塞，随后进行双侧开颅手术，实现次全切除。组织病理学检查显示为非典型脑膜瘤，具有细胞增多区域、小细胞形态、片状结构、有丝分裂增加及脑侵犯。监测性MRI研究显示残留肿瘤生长，颈部软组织肿块增大并伴有后三角淋巴结病。对颅内肿瘤负荷采用了放疗和手术切除；软组织肿块切除显示为转移性脑膜瘤，伴有软组织浸润并转移至8个淋巴结。该病例显示了小儿脑膜瘤具有侵袭性的生物学潜能，有通过脑脊液漏和淋巴侵袭发生远处转移的可能。
