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CC BY 4.0 · Indian Journal of Neurosurgery
DOI: 10.1055/s-0044-1788801
Case Report

Multiple Meningiomas with Different Histological Patterns in the Same Patient: Do They Exist? A Case Report and Literature Review

Saranraj M.K 
1   Neurosurgery Department, Apollo Hospitals, Vanagaram, Chennai, Tamil Nadu, India
,
Salapathi Shanmugam
2   Pathology Department, Apollo Hospitals, Vanagaram, Chennai, Tamil Nadu, India
,
Yatin Raiyani
1   Neurosurgery Department, Apollo Hospitals, Vanagaram, Chennai, Tamil Nadu, India
,
Adrian Jacob 
1   Neurosurgery Department, Apollo Hospitals, Vanagaram, Chennai, Tamil Nadu, India
,
Siddhartha Ghosh
1   Neurosurgery Department, Apollo Hospitals, Vanagaram, Chennai, Tamil Nadu, India
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Abstract

Meningiomas are the most common form of primary intracranial tumors, accounting for 13 to 26% of total neoplasms arising from arachnoid cap cells of the meningeal layer covering the central nervous system. Multiple intracranial meningiomas, which often have a syndromic association, account for less than 10% of total meningiomas. Multiple meningiomas with different histological patterns or grades in the same patient are very rare. Here we report such a rare case of meningioma with different histological patterns in the same patient. A 56-year-old lady presented to us with complaints of progressive right-sided weakness and speech disturbances, and her magnetic resonance imaging (MRI) showed two distinct extra-axial lesions over left frontal convexity and left fronto-temporo-parietal convexity. She underwent left fronto-temporo-parietal craniectomy and Simpson grade 1 excision of the lesions. Her histopathological examination revealed two different histological patterns: lesion 1 (left fronto-temporo-parietal convexity) was reported as a transitional World Health Organization (WHO) grade 1 meningioma and lesion 2 (left frontal convexity) was reported as angiomatous WHO grade 1 meningioma. She recovered well and was discharged in a stable condition after 3 weeks. Multiple meningiomas are defined as at least two spatially separated meningiomas occurring at the same time or more than two meningiomas arising sequentially from two clearly distinct regions. The exact mechanism of multicentricity is unknown. The treatment protocol for different histological types in the same patient is not clear. The extent of surgical resection remains the mainstay of the treatment and these patients should be followed up closely to watch for recurrence or malignant transformation. The role of radiotherapy in multiple meningiomas is yet to be established.

Keywords

dual pathology in multiple meningioma - intratumoral variation - multiple meningioma - Simpson 1 excision - transitional and angiomatous meningioma


Publication History

Article published online:
27 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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