Artikel
Occipital cutaneous mass – a rare metastasis of an operated and γ-knife treated meningioma
Okzipitale kutane Masse – eine seltene Metastasierung eines operierten und mit γ-Messer behandelten Meningeoms
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Veröffentlicht: | 25. Mai 2022 |
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Objective: Cutaneous meningiomas are rare tumors derived from meningo-epithelial cells which are ectopically located in the dermis or subcutaneous tissue. The majority of lesions are on the scalp over the occipital area or along cranial suture lines. After removal of a meningioma in the patient’s history, scalp metastasis from the previously resected meningioma should be considered. The suggested most common mechanism is intraoperative seeding. On the other hand presentation of a cutaneous meningioma several years later may have been as a result of the low dose radiotherapy. From a histopathological point of view, metastases of meningiomas have to be differentiated mostly from squamous cell carcinoma, giant cell fibroblastoma and cellular fibrous histiocytoma. For a definitive diagnosis especially in large masses total excision should be the method of choice.
Methods: A 76-year old patient presented with a large local swelling over occipital bone and no other symptoms. Six years earlier we resected a right occipital parasagittal meningioma Grade II and few months later we place a VPS because of NPH. The patient had preoperatively visual disturbances that they do not change until today. After 4 years appeared with multiple meningiomas over tentorium and falx. He received γ-knife treatment and the growth rate of intracranial masses was restricted. After 2 years follow-up MRI revealed a 6,9 x 5 x 3,5 cm scalp mass over occipital bone and recurrence of the intracranial multiple meningiomas. The mass was resected under general anesthesia.
Results: Histopathology revealed a Grade II meningioma, with similar characteristics as the old intracranial one and was characterized as metastasis. As the tumor was well-localised, without an intra-cranial connection and with typical histological features of a meningioma, it has a good prognosis. The patient was treated with a new γ-knife session in order to restrict intracranial recurrence sites and he remains clinically stable.
Conclusion: Cutaneous metastases of meningiomas are a rare entity. Risk factors include multiple surgeries, immunosuppression, CSF fistula, radiation therapy and wound healing problems. However, if patient history reveals removal of a meningioma and additional radiotherapy treatment, meningioma metastasis should be in the differential diagnosis even years after the initial surgery.