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Watanabe G, Young K, Rauber E, Khan MF, Suzuki R, Riestenberg R, Umana GE, Palmisciano P. A systematic review of extraneural meningioma metastasis: timing, evolution and outlook. J Neurooncol 2024:10.1007/s11060-024-04659-6. [PMID: 38530549 DOI: 10.1007/s11060-024-04659-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Extraneural meningioma metastasis is a rare occurrence and may pose a clinical challenge due to its unclear prognosis. In this systematic review, we analyze patient demographics, clinical characteristics, management strategies, and outcomes. METHODS PubMed, EMBASE, Scopus, Cochrane, and Web of Science databases were searched from inception to February 23, 2024 for cases of metastatic meningioma according to PRISMA guidelines. Descriptive statistics, Mann-Whitney U test, Fisher's exact tests, Kaplan-Meier curves, and log-rank tests were used for selected analyses. RESULTS A total of 288 patients (52% male) were included with an average age of 49 years at meningioma diagnosis. Tumors were distributed across WHO grade 1 (38%), 2 (36%), and 3 (26%). Most patients experienced intracranial recurrence (79%) and mean time to first metastasis was approximately 8 years. No change in WHO grade between primary and metastasis was observed for most cases (65%). Treatment of the initial metastasis was most often with surgery (43%), chemotherapy (20%), or no treatment (14%). Half of the patients were alive (50%) with an average follow-up of 3 years following metastasis. Overall median survival was 36 months for the entire cohort. This differed significantly between WHO grade 1 versus 2/3 meningioma primaries (168 vs. 15 months, p < 0.005). CONCLUSION Metastatic meningioma appears to be associated with more positive prognosis than other brain tumor types with extra-neural metastasis or metastasis in general. This is particularly true for cases arising from a WHO grade 1 meningioma.
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Affiliation(s)
- Gina Watanabe
- John A. Burns School of Medicine, University of Hawaii at Manoa, 5080 Likini St #417, Honolulu, HI, 96818, USA.
| | - Kurtis Young
- Department of Otolaryngology, University of Nevada, Las Vegas, NV, USA
| | - Erin Rauber
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | | | - Reannon Suzuki
- John A. Burns School of Medicine, University of Hawaii at Manoa, 5080 Likini St #417, Honolulu, HI, 96818, USA
| | - Robert Riestenberg
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
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Xu K, Khine KT, Ooi YC, Quinsey CS. A systematic review of shunt-related extraneural metastases of primary central nervous system tumors. Clin Neurol Neurosurg 2018; 174:239-243. [PMID: 30292900 DOI: 10.1016/j.clineuro.2018.09.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/24/2018] [Accepted: 09/26/2018] [Indexed: 11/19/2022]
Abstract
Extraneural metastasis (ENM) of primary central nervous system (CNS) tumors is an uncommon occurrence. Case reports and case series describe ENM after shunting, but this phenomenon has not been well characterized. In this review we aim to better understand the risk factors and clinical implications of ENM associated with shunting. A literature search of cases of ENM related to shunt placement in patients with primary CNS tumors reported through January 2018 was performed using PubMed and Google Scholar. We identified 106 cases of ENM of primary CNS tumors related to shunt placement. The three most common tumor histologies resulting in ENM were germinoma (24%), medulloblastoma (21%), and glioblastoma (11%). Of the patients with ENM, 48% had leptomeningeal spread and 37% had brain or spinal cord metastasis. Mean survival time from shunt placement was 13 months. Ventriculoatrial-shunted cases had higher rates of widespread metastasis and shorter average survival time from shunt placement (2 months) than the average of all types of shunts. Given the known association with ENM, careful consideration should be given to shunt placement in patients with primary CNS tumors, especially germinomas, medulloblastomas, and glioblastomas. Appropriate surveillance should be instituted after shunt placement, and leptomeningeal or neural metastasis should prompt the consideration of potential ENM. When considering distal shunt options, our review suggests that ventriculoatrial shunts should be avoided if possible. For truly obstructive pathologies, the risk of ENM is a further indication to consider other treatment options such as endoscopic third ventriculostomy rather than shunt placement.
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Affiliation(s)
- Kali Xu
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States
| | - Kay T Khine
- Department of Ophthalmology, Kittner Eye Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Yinn Cher Ooi
- Department of Neurosurgery, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, United States
| | - Carolyn S Quinsey
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States.
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Rosen J, Blau T, Grau SJ, Barbe MT, Fink GR, Galldiks N. Extracranial Metastases of a Cerebral Glioblastoma: A Case Report and Review of the Literature. Case Rep Oncol 2018; 11:591-600. [PMID: 30283316 PMCID: PMC6167720 DOI: 10.1159/000492111] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/15/2018] [Indexed: 01/09/2023] Open
Abstract
The glioblastoma, a malignant human brain tumor, is known for its devastating intracranial progress and its dismal prognosis. Whereas treatment and research are most prominently focused on the primary tumor lesion, in recent years evidence has accumulated that points to the rare occurrence of extracranial glioblastoma metastases. We here present a case of a female patient with a known glioblastoma who was detected to harbor multiple metastases in the bones, lung, pleura, liver, mesentery, and the subcutaneous soft tissue. Pathogenetically, these metastatic lesions developed most probably after a local progression of the left temporal glioblastoma through the skull base, thus getting access to the systemic lymphatics. Similar cases of extensive glioblastoma metastization, their putative underlying mechanisms, and implications for clinical care are discussed.
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Affiliation(s)
- Jurij Rosen
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Tobias Blau
- Institute of Neuropathology, University of Cologne, Cologne, Germany
| | - Stefan J Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany.,Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany
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Mobark NA, Al-Harbi M, Mosleh O, Santagata S, Snuderl M, Abedalthagafi M. A case of molecularly profiled extraneural medulloblastoma metastases in a child. BMC Med Genet 2018; 19:10. [PMID: 29343221 PMCID: PMC5772742 DOI: 10.1186/s12881-018-0526-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/12/2018] [Indexed: 11/17/2022]
Abstract
Background Extraneural metastases are relatively rare manifestations of medulloblastoma. Case presentation We present the case of a young boy with group three MYCN-amplified medulloblastoma. He received multimodal chemotherapy consisting of gross total resection followed by postoperative craniospinal radiation and adjuvant chemotherapy. The patient developed extraneural metastases 4 months after the end of therapy. Literature review identifies the poor prognosis of MYCN-amplified medulloblastomas as well as extraneural metastases; we review the current limitations and future directions of medulloblastoma treatment options. Conclusion To the best of our knowledge, this is the first molecularly characterized report of extraneural metastases of medulloblastoma in a child.
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Affiliation(s)
- Nahla Ali Mobark
- Oncology Department, Cancer Centre, King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Musa Al-Harbi
- Oncology Department, Cancer Centre, King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Othman Mosleh
- Oncology Department, Cancer Centre, King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Harvard Institute of Medicine, HIM-921F, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Matija Snuderl
- Department of Pathology, New York University, Langone Medical Center, 240 E 38th Street, 22nd Floor, New York, NY, 10016, USA
| | - Malak Abedalthagafi
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Harvard Institute of Medicine, HIM-921F, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA. .,Department of Pathology, New York University, Langone Medical Center, 240 E 38th Street, 22nd Floor, New York, NY, 10016, USA. .,Research Centre and Pathology Department, Saudi Human Genome Lab, King Fahad Medical City and King Abdulaziz City for Science and Technology, P.O. Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia.
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Kondoff SI, Milev MD, Laleva LN, Tzekov CC, Kostadinova CP, Kirova-Nedyalkova GI, Dakova PD. A case of early extraneural medulloblastoma metastases in a young adult. Asian J Neurosurg 2015; 10:331-3. [PMID: 26425169 PMCID: PMC4558816 DOI: 10.4103/1793-5482.162723] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extraneural metastases are a relatively rare manifestation of the primary brain tumors, and a major part of the cases has been associated with initial medulloblastoma. Herein, we present the case of a young female adult diagnosed and operated for medulloblastoma. The patient developed extraneural metastases in the first postoperative year. The condition exhibited an aggressive course of development, and the applied treatment approaches were unable to halt its progression. A short literature review identifies the predictive factors determining both prognosis and treatability of the condition; the current limitations and future perspectives of the treatment options are discussed.
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Noh SH, Lim JJ, Cho KG. Intracranial Hemangiopericytomas : A Retrospective Study of 15 Patients with a Special Review of Recurrence. J Korean Neurosurg Soc 2015; 58:211-6. [PMID: 26539263 PMCID: PMC4630351 DOI: 10.3340/jkns.2015.58.3.211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/13/2015] [Accepted: 08/04/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Although surgical resection is used to treat meningeal hemangiopericytoma (MHPC), there is a high risk of subsequent recurrence. This study investigated factors associated with treatment outcomes and recurrence in patients who had undergone surgical resection of intracranial MHPC. METHODS Fifteen patients underwent surgical treatments performed by one senior neurosurgeon between 1997 and 2013. Clinical data, radiologic images, surgical outcomes, recurrence, and other relevant characteristics were reviewed and analyzed. RESULTS Fifteen patients were included in the analysis, 12 (80%) of whom had tumors in the supratentorial region, and 3 (20%) of whom had tumors in the infratentorial region. Complete resection was achieved in all 15 patients, and 3 (20%) patients were administered radiosurgery and conventional radiotherapy after surgery as adjuvant radiotherapy. Three patients developed recurrence, 2 of whom had not received adjuvant radiotherapy. In 1 of the patients who had not received adjuvant radiotherapy, recurrence developed at the original tumor site, 81 months after surgery. The other 2 recurrences occurred at other sites, 78 and 41 months after surgery. The 5- and 10-year overall survival rates were 88.3%, while the 5- and 10-year recurrence-free survival rates were 83% and 52%, respectively. Additionally the mean Ki-67 index differed significantly between patients who did and did not develop recurrence (43% vs. 14%; p=0.001). CONCLUSION Because of the high risk of MHPC recurrence, MHPC tumors should be completely resected, whenever feasible. However, even when complete resection is achieved, adjuvant radiotherapy might be necessary to prevent recurrence.
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Affiliation(s)
- Sung Hyun Noh
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Jae Joon Lim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Kyung Gi Cho
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Korea
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Seo YJ, Cho WH, Kang DW, Cha SH. Extraneural metastasis of glioblastoma multiforme presenting as an unusual neck mass. J Korean Neurosurg Soc 2012; 51:147-50. [PMID: 22639711 PMCID: PMC3358601 DOI: 10.3340/jkns.2012.51.3.147] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 09/14/2011] [Accepted: 03/08/2012] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor and it commonly spreads by direct extension and infiltration into the adjacent brain tissue and along the white matter tract. The metastatic spread of GBM outside of the central nervous system (CNS) is rare. The possible mechanisms of extraneural metastasis of the GBM have been suggested. They include the lymphatic spread, the venous invasion and the direct invasion through dura and bone. We experienced a 46-year-old man who had extraneural metastasis of the GBM on his left neck. The patient was treated with surgery for 5 times, radiotherapy and chemotherapy. He had survived 6 years since first diagnosed. Although the exact mechanism of the extraneural metastasis is not well understood, this present case shows the possibility of extraneural metastasis of the GBM, especially in patients with long survival.
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Affiliation(s)
- Young Jun Seo
- Department of Neurosurgery & Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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