gms | German Medical Science

Meningiomas are two to four times more common in women, and show accelerated growth during the luteal phase of the menstrual cycle and pregnancy.Their occurrence has been linked with breast carcinomas. Metastasis to intracranial meningioma is a rare event, despite the high prevalence of systemic breast cancer.

A 58-year old woman was admitted to hospital because of acute onset of left sided facial nerve palsy, spontaneous facial muscle contraction and hypesthesia of the left fingers. Four months before a moderately differentiated, mucous ductal carcinoma had been diagnosed after mastectomy of the right breast. Clincal staging showed involvement of regional lymph nodes and multifocal distant metastasis to the lung and bone. The patient was treated with paclitaxel and doxorubicin in an adjuvant setting.

MRI revealed a dural based tumor mass overlying the right precentral region with intense and homogeneous contrast enhancement, marked perifocal edema, compression of right ventricle and modest midline shift. Signs of infiltration or malignant disease were absent.

Photomicroscopy demonstrated a tumor tissue of medium cellularity, low mitotic activity, whorl formation and psammoma bodies consistent with the diagnosis of a transitional meningioma. However immunohistochemistry was postive for EMA, CK, and Her-2/neu strongly suggestive of diffuse infiltration of carcinoma cells to the meningioma.

In a patient with positive history for breast cancer, a newly diagnosed intracranial mass with typical radiographic features of meningioma should be treated surgically and evaluated pathologically even in the absence of malignant appearance to rule out metastasis.