A Primary Intraosseous Meningioma: A Rare Case of Malignancy with High Proliferative Ability

Abstract

Primary intraosseous meningioma (PIM) is a rare tumor that arises in the skull. Histopathologically, it is generally described as a slow-growing, benign lesion. However, on rare occasions, PIM presents as a malignancy with high proliferative ability, which requires maximal resection, adjuvant radiotherapy, and subsequent careful follow-up. Because of the rarity of such cases, they present a diagnostic challenge with unusual pathological findings. Herein, we report a case of a primary intraosseous anaplastic meningioma with extensive invasion inside and outside the skull, along with the results of whole-genome analysis. Histopathological diagnosis was a World Health Organization grade 3 anaplastic meningioma. In the literature, only two cases of anaplastic PIM have been reported, so its characteristics and treatment are poorly understood. Our patient was successfully treated with tumor resection, followed by intensity-modulated radiation therapy. Follow-up imaging studies revealed no recurrence or distant metastasis, including to lung, liver, and bone, at 8 months after the surgery.

Keywords

meningioma - intraosseous - anaplastic - extensive invasion - genetic analysis

Publication History

Received: 12 January 2023

Accepted: 06 August 2023

Accepted Manuscript online:
29 August 2023

Article published online:
27 September 2023

• References

• 1 Kwon SM, Ko Y, Bang SS. Primary intraosseous osteolytic meningioma: a case report and review of the literature. BMC Neurol 2019; 19 (01) 176
• 2 Agrawal V, Ludwig N, Agrawal A, Bulsara KR. Intraosseous intracranial meningioma. AJNR Am J Neuroradiol 2007; 28 (02) 314-315
• 3 Omofoye OA, Huynh T, Jhun R, Ashfaque H, Cronk K. Primary intraosseous meningioma of the calvarium: a systematic review. Clin Neurol Neurosurg 2020; 199: 106283
• 4 Elder JB, Atkinson R, Zee CS, Chen TC. Primary intraosseous meningioma. Neurosurg Focus 2007; 23 (04) E13
• 5 Nagashima T, Yamaguchi K, Urakami K. et al. Japanese version of The Cancer Genome Atlas, JCGA, established using fresh frozen tumors obtained from 5143 cancer patients. Cancer Sci 2020; 111 (02) 687-699
• 6 Louis DN, Perry A, Wesseling P. et al. The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro-oncol 2021; 23 (08) 1231-1251
• 7 Fujita T, Nakagawa H, Tsuruzono K, Izumoto S, Kadota T, Wada A. Extradural temporal meningioma directly extended to cervical bone–case report. Neurol Med Chir (Tokyo) 1993; 33 (07) 458-462
• 8 Bassiouni H, Asgari S, Hübschen U, König HJ, Stolke D. Dural involvement in primary extradural meningiomas of the cranial vault. J Neurosurg 2006; 105 (01) 51-59
• 9 Ilica AT, Mossa-Basha M, Zan E. et al. Cranial intraosseous meningioma: spectrum of neuroimaging findings with respect to histopathological grades in 65 patients. Clin Imaging 2014; 38 (05) 599-604
• 10 Maas SLN, Stichel D, Hielscher T. et al; German Consortium on Aggressive Meningiomas (KAM). Integrated molecular-morphologic meningioma classification: a multicenter retrospective analysis, retrospectively and prospectively validated. J Clin Oncol 2021; 39 (34) 3839-3852
• 11 Maggio I, Franceschi E, Di Nunno V. et al. Discovering the molecular landscape of meningioma: the struggle to find new therapeutic targets. Diagnostics (Basel) 2021; 11 (10) 1852
• 12 Lang FF, Macdonald OK, Fuller GN, DeMonte F. Primary extradural meningiomas: a report on nine cases and review of the literature from the era of computerized tomography scanning. J Neurosurg 2000; 93 (06) 940-950
• 13 Liu Y, Wang H, Shao H, Wang C. Primary extradural meningiomas in head: a report of 19 cases and review of literature. Int J Clin Exp Pathol 2015; 8 (05) 5624-5632
• 14 Nanto M, Tsuji N, Miki J, Tanaka S, Uematsu Y, Itakura T. [A case of intraosseous meningioma with extracranial progression having difficulty in making a preoperative diagnosis]. No Shinkei Geka 2005; 33 (01) 51-56
• 15 Chen TC. Primary intraosseous meningioma. Neurosurg Clin N Am 2016; 27 (02) 189-193
• 16 Sakakibara Y, Taguchi Y, Nakamura H. et al. A case of primary extradural meningioma located at the high convexity: a case report and review of the literature. No Shinkei Geka 2018; 46 (06) 523-528
• 17 Mattox A, Hughes B, Oleson J, Reardon D, McLendon R, Adamson C. Treatment recommendations for primary extradural meningiomas. Cancer 2011; 117 (01) 24-38
• 18 Enam SA, Abdulrauf S, Mehta B, Malik GM, Mahmood A. Metastasis in meningioma. Acta Neurochir (Wien) 1996; 138 (10) 1172-1177 , discussion 1177–1178