Summary
Meningioma is a neoplastic growth originating from the leptomeninges. Although meningiomas are usually benign, malignant meningiomas with distant metastases occur infrequently. There is little precise information in the literature regarding the frequency of metastases in meningiomas; their incidence has been vaguely reported to be less than 1 per 1,000. Furthermore, most of the previous studies have also included haemangiopericytomas which most recent authorities do not consider meningiomas. In our experience with the management of 396 meningiomas over the past 18 years, 7 meningiomas were classified as malignant by defined histological criteria. After initially presenting as solitary intracranial neoplasms, three of the malignant meningiomas metastasized to extracranial tissues. Collectively, the metastases involved the vertebral bodies, liver, pelvis, long bones, and the spinal cord. This confers an incidence of metastasis of 0.76% when considering all the meningiomas, and an incidence of approximately 43% when considering only malignant meningioma; both percentages are significantly higher than reported previously. This high incidence of metastasis in the malignant meningioma indicates a worse prognosis than formerly assessed and also characterizes the malignant meningioma as a primary central nervous system neoplasm with one of the highest rates of metastasis. In addition, when malignant meningioma is classified by following strict criteria, the risk of metastasis in the ensuing clinical course can be predicted with a higher reliability.
Similar content being viewed by others
References
Akimura T, Orita T, Hayashida O, Nishizaki T, Fudaba H (1992) Malignant meningioma metastasizing through the cerebrospinal pathway. Acta Neurol Scand 85: 368–371
Carella RJ, Ransohoff J, Newall J (1982) Role of radiation therapy in the management of meningioma. Neurosurgery 10: 332–339
Celli P, Palma L, Domenicucci M, Scarpinati M (1992) Histologically benign recurrent meningioma metastasizing to the parotid gland: case report and review of the literature. Neurosurgery 31: 1113–1116
Couldwell WT, Fankhause H, de Tribolet N (1992) Osseous metastases from a benign intraventricular meningioma. Acta Neurochir (Wien) 117: 195–199
Cushing H, Eisenhardt L (1938) Meningiomas: their classification, regional behavior, life history, and surgical end results. Thomas, Springfield, IL
de Vries J, Wakhloo AK (1993) Repeated multifocal recurrence of grade I, grade II, and grade III meningiomas: regional multicentricity (primary new growth) or metastases? Surg Neurol 41: 299–305
Goellner JR, Laws ER Jr, Souel EH, Okazaki H (1978) Hemangiopericytoma of the meninges: Mayo clinic experience. Am J Clin Pathol 70: 375–380
Grant FC (1947) Intracranial meningiomas, surgical results. Surg Gynecol Obstet 85: 419–431
Guthrie BL, Ebersold MJ, Scheithauer BW (1990) Neoplasms of the intracranial meninges. In: Youmans JR (ed) Neurological surgery. A comprehensive reference guide to the diagnosis and management of neurosurgical problems. Saunders, Philadelphia, pp 3250–3315
Hoessly GF, Olivercrona H (1955) Report on 280 cases of verified parasagittal meningiomas. J Neurosurg 12: 614–626
Inoue H, Tamura M, Koizumi H, Nakamura M, Naganuma H, Ohye CH (1984) Clinical pathology of malignant meningiomas. Acta Neurochir (Wien) 73: 179–191
Ishibashi Y, Okada H, Mori T, Suzuki J (1983) Meningioma with extracranial multiple metastases — a case report (Japanese). No Shinkei Geka — Neurol Surg 11: 203–208
Iwaki T, Fukui M, Takeshita I, Tsuneyashi M, Tateishi J (1988) Hemangiopericytoma of the meninges: a clinicopathologic and immunocytochemical study. Clin Neuropathol 7: 93–99
Iwaki T, Takeshita I, Fukui M, Kitamura K (1987) Cell kinetics of the malignant evolution of meningothelial meningioma. Acta Neuropathol (Berl) 74: 243–247
Kabus D, Sidhu GS, Wieczorek RL, Choi H-SH (1993) Metastatic meningioma. Hemangiopericytoma or angioblastic meningioma? Am J Surg Pathol 17: 1144–1150
Karasick JL, Mullan SF (1974) A survey of metastatic meningiomas. J Neurosurg 39: 206–212
Katsura S, Suzuki J, Wada I (1959) A statistical study of brain tumors in the neurosurgical clinics in Japan. J Neurosurg 16: 570–579
Kepes JJ (1982) Meningiomas. Biology, pathology, and differential diagnosis. Masson, New York, pp 190–200
Kepes JJ (1990) Review of the WHO's new proposed classification of brain tumors. Proceedings of the XIth International Congress of Neuropathology, Kyoto, Japan, pp 87–97
Mahmood A, Caccamo DV, Tomecek FJ, Malik GM (1993) Atypical malignant meningiomas: a clinicopathological review. Neurosurgery 33: 955–963
Mahmood A, Qureshi N, Malik GM (1994) Intracranial meningiomas: analysis of recurrence after surgical treatment. Acta Neurochir (Wien) 126: 53–58
Miller DC, Ojemann RG, Proppe KH, McGinnis BD, Grillo HC (1985) Benign metastasizing meningioma. J Neurosurg 62: 763–766
Mori H, Sugiyama Y, Terabayashi T, Niida H, Yamamoto K, Kitazawa T, Wakaki K (1988) Recurrent meningioma with malignant change and extracranial multiple metastases (Japanese). No Shinkei Geka — Neurol Surg 16: 899–902
Moss TH (1987) Immunohistochemical characteristics of hemangiopericytic meningiomas: comparison with typical meningiomas, hemangioblastomas, and hemangiopericytomas from extracranial sites. Neuropathol Appl Neurobiol 13: 467–480
Nakamura K, Hawkin S, Aizawa M, Maekubo H, Kobayashi N, Ozasa T. Kunieda Y, Hokari I, Matsushima T, Miyazaki T (1986) Extracranial metastases of brain tumors — a case report and survey of patients with extracranial metastasis sampled from a report on pathological autopsy cases in Japan. Gan No Rinsho — Jpn J Cancer Clinics 32: 281–286
Ng THK, Wong MP, Chan KW (1990) Benign metastasizing meningioma. Clin Neurol Neurosurg 92: 152–154
Orlowska J, Jedrzewska-Iwanowska A, Rozycki M (1976) Malignant meningioma with extracranial metastases (Polish). Neurol Neurochir Polska 10: 595–597
Repola D, Weatherbee L (1976) Meningioma with sarcomatous change and hepatic metastasis. Arch Pathol Lab Med 100: 667–669
Rohringer M, Sutherland GR, Louw DF, Sima AAF (1989) Incidence and clinicopathological features of meningioma. J Neurosurg 71: 665–672
Russell T, Moss T (1986) Metastasizing meningioma. Neurosurgery 19: 1028–1030
Salcman M (1991) Malignant meningiomas. In: Al-Mefty O (ed) Meningiomas. Raven, New York, pp 75–85
Shuangshoti S, Hongsaprabhas C, Netsky MG (1970) Metastasizing meningioma. Cancer 26: 832–841
Slavin ML (1989) Metastatic malignant meningioma. J Clin Neuroophmalmol 9: 55–59
Som PM, Sacher M, Strenger SW, Biller HF, Malis LI (1987) “Benign” metastasizing meningiomas. Am J Neuroradiol 8: 127–130
Stoller JK, Kavuru M, Mehta AC, Weinstein CE, Estes ML, Gephardt GN (1987) Intracranial meningioma metastatic to the lung. Cleve Clin J Med 54: 521–527
Strang RR, Tovi D, Nordenstam H (1964) Meningioma with intracerebral, cerebellar, and visceral metastases. J Neurosurg 21: 1098–1102
Tognetti F, Donati R, Bollini C (1987) Metastatic spread of benign intracranial meningioma. J Neurosurg Sci 31: 23–27
Wara WM, Shelline GE, Newman H, Townsend JJ,et al (1975) Radiation therapy of meningiomas. Am J Roentgenol 123: 453–458
Winek RR, Scheithauer BW, Wick MR (1989) Meningioma, meningeal hemangiopericytoma (angioblastic meningioma), peripheral hemangiopericytoma, and acoustic schwannoma. A comparative immunohistochemical study. Am J Surg Pathol 13: 251–261
Wu JK, Kasdon DL, Whitmore EL (1985) Metastatic meningioma to cervical vertebra: case report. Neurosurg 17: 75–79
Yamashita J, Handa H, Iwaki K, Abe M (1990) Recurrence of intracranial meningiomas, with special reference to radiotherapy. Surg Neurol 14: 33–40
Zulch KJ (ed) (1979) Histologic typing of tumors of the central nervous system. Geneva, World Health Organization
Iwaki T, Takeshita I, Fukui M, Kitamura K (1987) Cell kinetics of the malignant evolution of meningothelial meningioma. Acta Neuropathol (Berl) 74: 243–247
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ather Enam, S., Abdulrauf, S., Mehta, B. et al. Metastasis in meningioma. Acta neurochir 138, 1172–1178 (1996). https://doi.org/10.1007/BF01809747
Issue Date:
DOI: https://doi.org/10.1007/BF01809747