Intracranial meningiomas associated with glial tumours: a review based on 54 selected literature cases from the literature and 3 additional personal cases

A sequential occurrence of neurocysticercosis and concomitant benign and malignant brain lesions: A case report of a 43-year-old Indian male

Background

The occurrence of multiple brain tumors of different cellular origins in a single individual is extremely rare. There is limited documentation regarding the incidence of intracranial neoplasms in individuals with preexisting neurocysticercosis (NCC).

Case Description

We report the case of a 43-year-old male who had been under our care since he first suffered from seizures 2½ years ago when he was diagnosed with NCC. A year after the diagnosis of NCC, he presented to the emergency room with seizures, when he was found to have a new small left frontal meningioma, which was managed conservatively. In the next year, the patient was admitted to the emergency room in a disoriented state, and his imaging revealed a new lesion - a left frontal glioma, for which he was operated. Six months later, another glioma was found in the right frontal region, which was excised surgically. Four months after the second surgery, the patient was brought with intractable seizures when he was diagnosed with cerebrospinal fluid spread of NCC. During this admission, the patient expired due to a pulmonary infection.

Conclusion

This case report presents the sequential occurrence of neurocysticercosis, meningioma, and glioma in an Indian male patient. The occurrence of NCC with brain tumors is rarely reported in the literature; further research is needed to understand the occurrence of multiple brain tumors, especially in the setting of preexisting NCC.

Case report: Two unique cases of co-existing primary brain tumors of glial origin in opposite hemispheres

Background

Primary CNS tumors are rare. Coexistence of two glial tumors of different histological origins in the same patient is even rarer. Here we describe two unique cases of coexisting distinct glial tumors in opposite hemispheres.

Cases

Patient 1 is a 38-year-old male who presented with a seizure in February/2016. MRI showed a left parietal and a right frontal infiltrating nonenhancing lesions. Both lesions were resected revealing an oligodendroglioma WHO grade-2 and an astrocytoma WHO grade-2. Patient 2 is a 34-year-old male who presented with a seizure in November/2021. MRI showed a left frontal and a right mesial temporal lobe infiltrating nonenhancing lesions. Both lesions were resected revealing an oligodendroglioma WHO grade-2 and a diffuse low-grade glioma, MAPK pathway-altered (BRAF V600E-mutant). Patient 1 underwent adjuvant treatment. Both patients are without recurrence to date.

Discussion

Two histologically distinct glial tumors may coexist, especially when they are non-contiguous. Pathological confirmation of each lesion is imperative for appropriate management. We highlight the different management of gliomas based on the new CNS WHO 2021 classification compared to its 2016 version, based on NCCN guidelines. Although more molecular markers are being incorporated into glioma classification, their clinical impact of it is yet to be determined.

Coincidental Nasopharyngeal Carcinoma and Ventral Foramen Magnum Meningioma: Case Report and Review of the Literature

Multiple primary tumors at adjacent site are rare. We report a rare case of coincidentally found nasopharyngeal cancer and ventral foramen magnum meningioma. The 68-year-old male patient presented with a year history of ataxia. Radiological examination revealed lesions in the nasopharyngeal space and ventral foramen magnum. A needle aspiration biopsy for nasopharyngeal space and surgical removal for foramen magnum lesion were performed. The pathological diagnoses were nasopharyngeal cancer and meningioma, respectively. The concomitant occurrence of these two tumors is very rare and there is no known association between these two tumors. We report a case of ventral foramen magnum meningioma simultaneously present with nasopharyngeal carcinoma.

A collision tumor of solitary fibrous tumor/hemangiopericytoma and meningioma: A case report with literature review

An intracranial collision tumor is a rare lesion composed of two histologically different neoplasms in the same anatomic location. Even more rare is the collision tumor of a solitary fibrous tumor/hemangiopericytoma (SFT/HPC) and meningioma. The patient was a 46-year-old woman who had a 40 × 35 × 30-mm mass in the vermis of the cerebellum. Histologically, the mass consisted of two different components. One component showed the morphology of meningioma (World Health Organization (WHO) grade I), and the other component exhibited small round cell proliferation with hypercellular density, which was revealed to be SFT/HPC (WHO grade III) based on STAT6 immunohistochemistry. STAT6 showed completely different immunohistochemistry results in these two components (nuclear-negative in meningioma and nuclear-positive in SFT/HPC). Since these two neoplasms are associated with different prognoses, they should be distinguished from each other. When meningioma and an SFT/HPC-like lesion are identified morphologically, it is important to recognize the presence of such a collision tumor composed of meningioma and SFT/HPC, and identify the SFT/HPC component by employing STAT6 immunohistochemistry.

Next-generation sequencing reveals novel mutations in a collision tumor of glioblastoma and meningioma

Primary intracranial collision tumors are rare in patients without predisposing factors. We report such a case in a 42-year-old female who presented with headaches and altered mental status. Imaging revealed a single heterogeneous, rim-enhancing lesion in the left parieto-occipital periventricular region, involving the corpus callosum. Stereotactic biopsy demonstrated glioblastoma. Subsequent tumor resection showed histologic evidence of glioblastoma and meningioma. Next-generation sequencing was performed on both tumor components. The glioblastoma exhibited a CDKN2A homozygous deletion and novel missense mutations in TAF1L and CSMD3, while no definitive genetic alterations were identified in the meningioma. Next-generation sequencing may yield insight into molecular drivers of intracranial collision tumors and aid in identifying future therapeutic targets.

Next-generation sequencing (NGS) reveals novel mutations in a collision tumor of GBM and meningioma. NGS has the potential to yield insight into molecular drivers of intracranial tumors and identify therapeutic targets.

Collision Tumors: A Rare Case Report

The presence of collision tumors without any evidence of phacomatoses, genetic syndromes, or any history of previous radiation to the brain is extremely rare. We report a case with two diverse primaries, a tentorial meningioma and a colloid cyst found in the same patient occurring in the absence of these conditions. To the best of our knowledge, a single case of a colloid cyst and meningioma found together in the same patient has been reported till date. In such cases, the surgical dilemma as to which tumor to operate first has been addressed in our case report.

Multiple, Primary Brain Tumors with Diverse Origins and Different Localizations: Case Series and Review of the Literature

Background:

Multiple, primary brain tumors with different histological types occurring in the same patient are extremely rare. Several hypotheses have been proposed, and the pathophysiology of coexisting tumors has long been debated; however, due to low incidence, standard practices for this scenario are still inconclusive.

Case Description:

The authors describe 6 cases of coexisting tumors. By conducting a literature research focused on the computed tomography (CT) era and patients without prior radiation or phakomatosis. Sixty-five such reported cases were identified. In addition, the authors summarize their experience in 6 patients including histopathological features, chronological presentations, outcomes, mortality, and management from their series as well as from previous cases from the reported literature.

Conclusion:

The coexistence of multiple, primary brain tumors is an interesting condition. Surgical management remains the major treatment; malignant histology has a poor prognostic factor.

Glioma Simultaneously Present with Adjacent Meningioma: Case Report and Literature Review

A 51-year-old male patient presented to us with an episode of generalized tonic-clonic seizure. Magnetic resonance imaging revealed a dural-based contrast-enhancing lesion in the right temporal lobe and another heterogeneously contrast-enhancing intra-axial lesion in the right insula adjacent to it. Histopathology confirmed it as a meningioma adjacent to an anaplastic oligodendroglioma. This is only the second such case reported in literature. Literature on "adjacent site" gliomas and meningioma was also reviewed.

Collision Occurrence of Meningioma and Astrocytoma: A Case Report and Literature Review

A case of collision tumors occurring between two distinct primary brain tumors is reported. A 61-year-old female without history of radiotherapy or phakomatosis presented with progressive ly increasing headache and left hemiparesis. Investigation revealed a meningioma and a Grade II astrocytoma in the right frontal lobe. Simultaneous development of a meningioma and a low-grade glioma at adjacent sites is extremely rare. This is the third case reported in the literature. Some hypotheses are proposed to explain this phenomenon but most likely represent a coincidental event.

Primary Central Nervous System Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type Colliding with Meningioma

BACKGROUND

Collision tumors are defined as coexistence of 2 histologically different neoplasms occurring in the same anatomic location. Such co-occurrence of tumors in the brain is uncommon. To our knowledge, meningioma colliding with extranodal natural killer/T-cell lymphoma has not been described previously.

CASE DESCRIPTION

A 50-year-old man presented with a 1-year history of progressive memory decline and 2 weeks of drowsiness, bradykinesia, and aphasia. Magnetic resonance imaging revealed a heterogeneously enhanced mass beside the left frontal cerebral falx resulting in midline shift. The left frontal lobe mass was resected. Pathologic examination showed the tumor consisted of whorled spindle cells and diffuse medium-sized lymphoid cells. The spindle cells were positive for epithelial membrane antigen and negative for S-100. The lymphoid cells expressed CD3ε, CD56, TIA-1, and granzyme B. Epstein-Barr virus encoded small RNAs were detected by in situ hybridization. No monoclonal T-cell receptor gamma gene rearrangement was detected. Four weeks after surgery, the patient was treated with polychemotherapy and intrathecal methotrexate, but he died 2 months later.

CONCLUSIONS

This is the first report of a unique brain collision tumor consisting of a meningioma and an extranodal natural killer/T-cell lymphoma. Diagnosis depends on histopathology. Awareness of this entity is important to distinguish it from other intracranial tumors.

Collision Tumor of Glioblastoma and Meningioma: Case Report and Literature Review

BACKGROUND

Intracranial primary collision tumors of different histologic types are rare, and their occurrence is still unclear.

CASE DESCRIPTION

We describe a 66-year-old female who presented with headache, nausea, and vomiting. Magnetic resonance imaging scan showed that there were 2 primary intracranial tumors occurring simultaneously at adjacent sites of the right cerebral hemisphere. Tumor pathology showed 2 distinct tumors: meningioma (World Health Organization I) and glioblastoma. This is a rare case in which 2 different intracranial primary tumors occurred at adjacent sites, but the patient had no history of head trauma, neurologic surgery, or radiation therapy.

CONCLUSIONS

According to previous and present reports, the most common type of intracranial primary collision tumor is composed of a benign meningioma and a glioblastoma. During the occurrence of collision tumors, 1 tumor can play a role in the formation and growth of the other.

Glioblastoma Secondary to Meningioma: A Case Report and Literature Review

BACKGROUND

The pathophysiologies underlying meningioma and glioma are distinct. The coexistence of those 2 lesions in the same patient is rare, and at the same location, it is even more exceptional.

CASE DESCRIPTION

We report a case of a 79-year-old man initially presenting with a meningioma that was treated by complete excision of the lesion. The patient had 2 relapses at the same site, in which glioblastoma was confirmed histopathologically.

CONCLUSIONS

Glial transformation meningiomas remain a contentious issue, with coincidental occurrence being the most prevalent explanation. Nevertheless, impairment of the same molecular signaling pathways in both tumor types suggests a common origin. Another hypothesis is that perilesional parenchymal damage from radiotherapy or surgery may lead to glial transformation in the tissues surrounding the original meningioma lesion. Further research is needed to determine if the original tumor or surgery has an oncogenic effect on the adjacent tissue.

One-Stage Resection of a Giant Petrous Bone Osteoma Associated with a Contiguous Meningioma Via a Modified Anterior Transpetrous Approach

BACKGROUND

In addition to the previous 5 cases of skull base osteoma with radiologic information reported in the English literature, this is the sixth case report of this rare disease.

CASE DESCRIPTION

This is the first report of a skull base osteoma with concurrent intracranial tumors.

CONCLUSION

A satisfactory 1-stage resection of the 2 contiguous lesions via a modified anterior transpetrous approach was performed.

A solitary fibrous tumor with concurrent meningioma at the same site: A case report and review of the literature

The present study describes a case of a solitary fibrous tumor (SFT) concurrent with meningioma in the same anatomical region. The patient was admitted to Tianjin Huanhu Hospital (Tianjin, China) presenting with progressive eyesight impairment, dizziness and right hemiparesis. Cranial magnetic resonance imaging revealed two primary tumors co-occurring at the same site. One lesion was a solid lesion located in the left frontal convex with homogeneous enhancement, and was closely associated with the dura mater; thus, it was suspected that the lesion was a meningioma. The second lesion was cystic and solid with an irregular shape, and was located next to the first tumor; this lesion was believed to be a hemangiopericytoma or astrocytoma. The patient underwent a left temporoparietal craniectomy and a complete excision of the two tumors was achieved. Subsequent pathological examination of the resected tissues confirmed that the two tumors were a secretory meningioma and a SFT, respectively. Immunohistochemistry is important in differentiating SFTs from other tumors. Currently, a total tumor resection is the optimal treatment strategy when managing these rare lesions, often with no requirement for adjuvant post-operative therapy; however, long-term follow-up is essential to detect any signs of recurrence. The possibility of multiple tumors should be taken into consideration when performing clinical examination. To further understand the mechanisms underlying the occurrence of multiple intracranial tumors, further research is required, alongside an increased number of case reports.

De novo glioblastoma in the territory of a recent middle cerebral artery infarction and a residual meningioma: pathogenesis revisited

Background

The pathogenesis of glioblastoma is complex, and the implicated molecular mechanisms are yet to be understood. There are scattered reports describing a possible relationship between meningioma and glioblastoma and more rarely a relationship between infarction and glioblastoma.

Case presentation

We are reporting a 32-year-old male who developed left middle cerebral artery (MCA) infarction as a surgical complication for sphenoid meningioma. He developed recurrent symptoms 4 months later due to development of a glioblastoma adjacent to both the territory of the prior MCA infarct and the residual meningioma.

Conclusions

This case adds further contribution to the literature of the possible pathological association between glioblastoma and brain infarction on a background of meningioma.

An intraventricular meningioma and recurrent astrocytoma collision tumor: a case report and literature review

BACKGROUND

Intracranial meningioma and glioma collision tumors are relatively uncommon and are even more rarely located within the ventricles.

CASE PRESENTATION

Here, we report a case of a patient with an intraventricular meningioma and astrocytoma collision tumor. A 39-year-old man previously underwent excision of an astrocytoma in the triangle area of the lateral ventricle and exhibited good post-surgery recovery. The astrocytoma recurred in situ six years after the surgery, and the case was complicated by a malignant meningioma. The patient recovered well after surgery to treat the recurrence and was administered radiotherapy after discharge. In addition to reporting on this case, we conducted a literature review of collision tumors; based on this review, we propose several hypotheses regarding the formation of collision tumors.

CONCLUSIONS

We conclude that a possible cause of the collision tumor formation between the intracranial meningioma and the astrocytoma was the recurrence of an astrocytoma-induced malignancy of the arachnoid cells in the choroid plexus.

Surgical management of diffuse low-grade gliomas associated with other intracranial diseases

BACKGROUND

The association of diffuse, low-grade glioma (DLGG) with other intracranial pathologies is a rare condition, raising the question of what constitutes its most effective therapeutic management. It is not known whether this is a simple coincidence or whether there is a higher significant risk involved with the co-existence of DLGG and another disease. We report the first consecutive series of nine patients who underwent surgical resection for such a glioma.

METHOD

We reviewed DLGGs removed between 1998 and 2013 that were associated with another intracranial pathology. For all cases, we collected and analyzed information regarding clinico-radiological features, surgical procedures, and clinical outcomes.

RESULTS

Nine consecutive patients (four men, five women, mean age: 38.8 years) presented with a conjunction of DLGG and another disease: two cases of vestibular schwannoma, two pituitary adenomas, two meningiomas, one lymphoma, one arteriovenous malformation, and one case of multiple sclerosis. The DLGG was diagnosed because of seizures in four patients and incidentally in the other five patients. The average delay between the diagnosis of the glioma and its resection was 40.8 months (range 1-84 months). The mean follow-up after surgery was 43 months (6-120 months). Gross-total or subtotal resection was achieved in all cases. There were no cases of mortality or permanent morbidity associated with surgery. The Karnofsky Performance Scale score was 90 or 100 in all cases. The associated pathology was treated surgically in three cases, medically in four cases, and tracked under observation in two cases. These intracranial diseases, especially meningiomas and pituitary adenomas, might have a significant higher risk to be associated with DLGGs in comparison with their incidence and prevalence in the general population.

CONCLUSIONS

Active management of this rare, dual pathology allows patients to enjoy a normal and prolonged quality of life. We therefore suggest considering early and maximal surgical resection as the first therapeutic option for DLGGs combined with another intracranial disease, as is done in the case of isolated DLGGs.

Analysis of a synchronous gliosarcoma and meningioma with long survival: A case report and review of the literature

Background:

The simultaneous occurrence of multiple intracranial neoplasms has been reported, especially in genetic familial syndromes and after cranial irradiation. In the absence of these etiologic factors, some reports showed simultaneous occurrence of glioblastoma and meningioma but the association between gliosarcoma and meningioma is unknown.

Case Description:

We report a case of a 51-year-old woman with synchronous gliosarcoma and meningioma in whom extensive immunohistochemical characterization and molecular profile was performed. The gliosarcoma recurred 21 months after the first resection, reaching 3 years of overall survival. A molecular characterization of all three lesions was performed. None of the lesions showed the presence of mutations in TP53 and BRAF genes. MGMT analysis showed the presence of loss of expression associated with promoter hypermethylation in both gliosarcoma lesions. EGFR overexpression and gene amplification was found only in the recurrent gliosarcoma.

Conclusion:

The immunohistochemistry and molecular data of this unique case, suggest the distinct clonal origin of meningioma and gliosarcoma lesions, and the association of MGMT methylation with the presumable favorable prognosis observed.

A glioblastoma arising from the attached region where a meningioma had been totally removed

The co-occurrence of different histological tumors in the nervous system is rare and is mainly associated with phakomatoses or radiation exposure. A 72-year-old man underwent surgery for a frontal convexity meningioma. Four years after the surgery, a new lesion was detected in the attached region where the meningioma had been removed. The second tumor exhibited a high degree of cellularity, atypical mitosis, pseudo-palisading and microvascular proliferation, and was immunohistologically positive for GFAP and was diagnosed as a glioblastoma. Wild-type isocitrate dehydrogenase 1 was found in the second specimen. A genetic analysis using comparative genomic hybridization showed a DNA copy number loss on 1p35, 9pter-21, 10, 11q23, 13q, 14q, 20q, 22q and a gain on 7 in the second specimen. Although the mechanism responsible for the consecutive occurrence of meningioma and glioblastoma has not been elucidated, five hypotheses are feasible: (i) the lesions occurred incidentally; (ii) a low-grade astrocytoma present at the time of the first operation transformed into a high-grade glioma during the next 4 years; (iii) radiation received during the endovascular treatment induced glioblastoma; (iv) a brain scar created at the time of the first operation for meningioma led to the occurrence of a glioblastoma; and (v) the previous meningioma affected the surrounding glial cells, causing neoplastic transformation.

Glioblastoma simultaneously present with adjacent meningioma: case report and review of the literature

The simultaneous occurrence of multiple primary intracranial tumors has been reported previously. However, most of these tumors arise after cranial radiotherapy or in association with familial tumor syndromes. Double tumors of different histologies that are unrelated to radiotherapy or genetic disorders are very rare. We present a case of two primary intracranial tumors occurring simultaneously at adjacent sites. Preoperative gadolinium-enhanced magnetic resonance imaging of these tumors revealed a single continuous lesion. Postoperative histological examination revealed the presence of two distinct tumors, meningioma and glioblastoma multiforme. To elucidate the mechanism of synchronous tumor formation, we performed immunohistochemical analysis of the proteins involved in the receptor tyrosine kinase, Wnt, and Notch signaling pathways. These analyses showed that platelet-derived growth factor (PDGF) receptors-alpha and beta were overexpressed in both tumors, thereby indicating the oncogenic effects of activated signaling of these receptors. The PDGF-mediated paracrine system may induce one tumor from another.

Simultaneous choroid plexus carcinoma and pilocytic astrocytoma in a pediatric patient

Simultaneous primary brain tumors in pediatric patients without prior chemotherapy or radiotherapy, phacomatosis, or known familial history are a rare occurrence. The authors report the case of a 4-year-old boy with simultaneous choroid plexus carcinoma and pilocytic astrocytoma with features of oligodendroglioma. Magnetic resonance imaging studies revealed diffuse heterogeneously enhancing left intraventricular and posterior fossa tumors initially believed most consistent with multicentric choroid plexus carcinomas. A multiple staged resection was carried out for each tumor and gross-total resection was achieved. Upon gross inspection intraoperatively as well as postoperative histological analysis, 2 distinct simultaneous tumors were identified: choroid plexus carcinoma and pilocytic astrocytoma. To the authors' knowledge this is the first case report published identifying 2 distinct tumor types with similar radiological appearances in a pediatric patient with no prior history of radiotherapy, chemotherapy, or phacomatosis.

First report of the simultaneous occurrence of choroid plexus papilloma and meningioma in a dog

A 7-year-old spayed female English Cocker Spaniel was examined because of a 1-week history of lethargy, stumbling over objects and circling, and the presence of two tonic-clonic generalised seizures two days before presentation. The neurological signs suggested a lesion involving the right forebrain. Computed tomography revealed the presence of two intracranial masses, one located inside the right lateral ventricle and the other located in the right frontal lobe attached to the falx cerebri. Because of the poor prognosis, the owner refused to continue with the therapy and the dog was euthanised. On postmortem examination one mass was diagnosed histologically as a meningioma and the other as a papilloma of the choroid plexus. Information in the veterinary literature on multiple malignancies affecting the central nervous system is very limited. To the best of the authors' knowledge, the association of meningioma and choroid plexus papilloma has never been reported either in the human or in the veterinary medical literature.

Simultaneous presentation of meningiomas with other intracranial tumours

Fifteen patients with simultaneous presentation of meningiomas with other intracranial tumours are reviewed. The associated tumours included a brain metastasis in six cases, glioma in three, pituitary adenoma in two, craniopharyngioma in one,acoustic schwannoma in two and brain lymphoma in one. A correct preoperative radiological diagnosis was made in 12 patients; in three others the associated tumour was discovered at operation and by histological studies. A one-stage removal of both tumours through the same approach was performed in nine patients, whereas six others underwent two-stage operations with an interval of 1 - 13 months. The literature relating to meningiomas associated with other intracranial tumours is reviewed and the possible pathogenetic correlations are discussed. A diagnostic pitfall may occur for metastasis into a meningioma, glioma surrounding a meningioma and different suprasellar lesions. The surgical indication and management of meningiomas may be significantly influenced by the presence of another different intracranial tumour.

Simultaneous occurrence of meningioma and glioma in brain: report of two cases

Two patients who presented with a simultaneous occurrence of meningioma and glioma are described. The authors describe their neuroradiological findings, best surgical treatment of this association, aspects of pathology and aetiology, along with a review of literature.

Retroorbital hemangiopericytoma and cavernous sinus schwannoma--case report

An 18-year-old male presented with severe proptosis and blindness in the right eye. Neuroimaging revealed a large and hypervascular tumor in the right retrobulbar region and a large tumor in the left cavernous sinus. Angiography showed the right tumor was extensively vascular, fed by a hypertrophic ophthalmic artery, and the left tumor was moderately vascular, fed by a large middle meningeal artery. Following embolization of the feeder vessels, the right retrobulbar hemangiopericytoma and the left cavernous sinus schwannoma were uneventfully and successfully resected. Such combinations of different pathological lesions present unusual therapeutic challenges.

Two primary brain tumors, meningioma and glioblastoma multiforme, in opposite hemispheres of the same patient

We report a case with double primary intracranial tumors of different cell types without phacomatosis. The patient was hospitalized due to progressive memory impairment, headaches, dysarthria and right hemiparesis. Initial computed tomographic (CT) examinations revealed a large hyperdense tumor over the right frontal lobe, suggestive of an extra-axial meningioma. Additionally, there was unusual brain edema in the contralateral hemisphere that subsequently proved to originate from an intrinsic tumor. Staged craniotomies were used to treat the patient. Pathological examinations confirmed the two tumors to be a meningioma and a glioblastoma multiforme, respectively. The patient made an uneventful recovery after treatment. Although meningioma and glioma represent two common primary intracranial tumors, the simultaneous development of the two tumors is rare. A randomly occurring event most likely accounted for this linkage in the patient. We suggest that extraordinary brain edema far remote from the primary brain lesion warrants special attention for identifying other potentially undetected lesions.

Two distinct intracranial tumors of different cell types in a single patient. Case report and review of the literature

We report the case of a patient with two distinct brain tumors. A meningioma was resected surgically. Nine months later a glioblastoma appeared in the same region, but at a different site. This was not treated, because the patient died. The clinical significance and etiology of these tumors are considered.