Zhao Peng, Li Ning, Cao Jinfeng, Lin Xiangtao, Liang Changhu
Department of Radiology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China.
Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China.
World Neurosurg. 2017 Nov;107:1046.e17-1046.e22. doi: 10.1016/j.wneu.2017.07.181. Epub 2017 Aug 7.
Rhabdoid meningioma (RM) is an unusual variant of meningioma, classified as World Health Organization grade III. Although its recurrence is common, extracranial metastasis is rare and usually misdiagnosed. The transfer mechanism and pathway are ambiguous; once the metastasis occurs, the prognosis is poor, and there is no effective management. The present case is the first report of concurrent intracranial and pulmonary RM with rapid and widespread metastasis. We hope this report can serve as a helpful reference for clinicians and radiologists.
A 39-year-old woman presented to our hospital complaining of headache and memory disturbances. Magnetic resonance imaging (MRI) of the brain revealed a well-defined, inhomogeneous signal tumor with intense enhancement and severe peritumoral edema. Postoperatively, RM (grade III) was confirmed by histopathology. A chest CT performed 2 weeks later revealed an isolated lung mass, which was confirmed as RM on subsequent surgery. Three months after the first radiotherapy, the cancer had progressed uncommonly rapidly with widespread metastasis to the cerebellum, lung, kidney, and thigh. Gamma knife radiosurgery, chemotherapy, and molecular-targeted therapy were performed; however, the patient's condition continued to worsen, and she died 1 year after the initial operation.
Intracranial RM is a relatively rare tumor with the potential for wide intracranial and extracranial transfer. Cystic components and necrosis can be seen in this type of meningioma. Metastatic meningioma should be kept in mind when dealing with isolated lung lesions. This case report may serve as a helpful reference for clinicians and radiologists.
横纹肌样脑膜瘤（RM）是脑膜瘤的一种罕见变异型，被归类为世界卫生组织III级。尽管其复发常见，但颅外转移罕见且常被误诊。转移机制和途径尚不明确；一旦发生转移，预后较差，且没有有效的治疗方法。本病例是首例同时发生颅内和肺部RM且伴有快速广泛转移的报告。我们希望本报告能为临床医生和放射科医生提供有用的参考。
一名39岁女性因头痛和记忆障碍前来我院就诊。脑部磁共振成像（MRI）显示一个边界清晰、信号不均匀的肿瘤，强化明显且瘤周水肿严重。术后，组织病理学证实为RM（III级）。2周后进行的胸部CT显示一个孤立的肺部肿块，后续手术证实为RM。首次放疗3个月后，癌症进展异常迅速，广泛转移至小脑、肺、肾和大腿。进行了伽玛刀放射外科治疗、化疗和分子靶向治疗；然而，患者病情持续恶化，在初次手术后1年死亡。
颅内RM是一种相对罕见的肿瘤，具有广泛的颅内和颅外转移潜能。这种类型的脑膜瘤可见囊性成分和坏死。处理孤立性肺部病变时应考虑转移性脑膜瘤。本病例报告可为临床医生和放射科医生提供有用的参考。
