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Tumor to tumor metastasis causing rapid meningioma enlargement: a case report

Metastasis of systemic malignancies to primary intracranial tumors is uncommon. Occasional reports have seen meningiomas as hosts for metastatic carcinomas, especially from lung and breast. We report a case of a 46 year‐old woman who presented with headache and a rapidly enlarging right frontal dural‐based lesion. She had been diagnosed at birth with bilateral retinoblastoma, treated with left enucleation and Co‐60 radiation to the right eye. She was subsequently diagnosed with papillary thyroid carcinoma in 2000 and invasive ductal carcinoma with solitary sentinel lymph node metastasis in 2004. In 1997, she underwent the first of three resections for a meningioma of the right sphenoid wing and orbit; gamma knife radiosurgery was utilized for control of residual tumor. Serial imaging studies revealed growth of two additional presumptive meningiomas in parasellar and right frontal locations, the later showing recent rapid enlargement in 2007 necessitating surgical intervention. Microscopic and immunohistochemical assessment of this lesion revealed a WHO grade I meningioma harboring metastatic invasive ductal carcinoma. Further work‐up revealed extensive metastasis to axial skeleton, liver and spleen. This case emphasizes the need for surgical evaluation of rapidly enlarging dural‐based lesions in patients with systemic malignancies as these lesions may represent meningiomas, metastases, or both.