Ward Ayobami L, Risman Aida, Segar Sharmila, Sharma Suash, Vender John R
Department of Neurosurgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
Department of Pathology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
World Neurosurg. 2019 Feb;122:593-598. doi: 10.1016/j.wneu.2018.11.067. Epub 2018 Nov 20.
Extracranial metastasis, mainly a feature of World Health Organization (WHO) grade III meningiomas, is only rarely reported in grade II meningiomas.
We report a case of a 48-year-old man who was initially diagnosed in 2010 with an occipital convexity meningioma based on computed tomography scan/magnetic resonance imaging (MRI) and treated with surgical therapy and gamma knife. The first operation achieved a macroscopically complete resection. The tumor was histologically classified as an atypical meningioma. The patient had a recurrence in 2014 on the left tentorial leaflet as noted on postcontrast MRI. The patient was asymptomatic, without focal neurologic deficits. In 2016, the patient reported new-onset pain in the neck and left upper extremity. MRI indicated complete replacement of the C7 vertebral marrow, with a soft tissue component extending posteriorly into the epidural space that appeared to be flattening the thecal sac but without evidence of abnormal cord signal. Histopathology of resection confirmed atypical meningioma.
This case represents a rare instance of intraosseous spine as the first site of metastasis of WHO grade II atypical meningioma and is the first reported case of extracranial metastasis of a meningioma to the C7 vertebral body.
颅外转移主要是世界卫生组织（WHO）III级脑膜瘤的特征，在II级脑膜瘤中仅有罕见报道。
我们报告一例48岁男性，2010年最初根据计算机断层扫描/磁共振成像（MRI）诊断为枕叶凸面脑膜瘤，并接受了手术治疗和伽玛刀治疗。首次手术实现了宏观上的完全切除。肿瘤在组织学上被分类为非典型脑膜瘤。2014年，患者在增强MRI上显示左侧小脑幕叶复发。患者无症状，无局灶性神经功能缺损。2016年，患者报告颈部和左上肢出现新发疼痛。MRI显示C7椎体骨髓完全被替代，软组织成分向后延伸至硬膜外间隙，似乎使硬脊膜囊变平，但无脊髓信号异常的证据。切除组织的组织病理学证实为非典型脑膜瘤。
该病例代表了WHO II级非典型脑膜瘤罕见的以脊柱骨内作为首个转移部位的情况，并且是首例报道的脑膜瘤颅外转移至C7椎体的病例。
