背景:转移性脑膜瘤(MMs)很少见(100例病例中有0.1例)。他们的治疗需要多模式方法,通过手术,放射治疗,化疗,和放射外科,这允许长期局部控制(LC)和延长自由生存。在这项研究中,作者对文献进行了回顾,报道了2例颅外MMs患者,长期随访。
方法:案例1:一名48岁女性因切除轴外镰状病灶(脑膜瘤G1)而入院。两年后,病灶局部复发,经组织学诊断为脑膜瘤G3切除。在接下来的9年里,患者因局部复发接受了5次伽玛刀放射外科(GKRS)手术.56岁时,她因手术局部复发而再次入院(组织学定义:间变性脑膜瘤G3).在62岁时,该患者接受了右叶切除术以治疗肺部肿块(组织学诊断:间变性脑膜瘤G3)。之后,发现了somaL5和肾上腺的多个病变,然后进行了监测。病例2:一名48岁的妇女因涉及周期性疱疹(脑膜瘤G2)的病变而接受手术。三年后,局部复发需要GKRS联合他莫昔芬.在接下来的7年里,她因局部复发接受了5次GKRS手术.患者还接受了奥曲肽化疗。61岁时,她发现双肺有多处病变,肝脏,还有肾.肝活检显示间变性脑膜瘤G3。该患者也没有任何神经或临床缺陷。
结论:恶性脑膜瘤的LC可以通过多模式方法实现;GKRS使LC成为可能,但是这些病变的一个新的方面是开放的讨论:转移。这些报告表明,多模式治疗MMs是一种有效的方法,具有良好的LC和改善总体生存率。然而,长期存活可以使疾病全身扩散,特别是,当矢状窦受累时。
BACKGROUND: Metastatic meningiomas (MMs) are rare (0.1 of 100 cases). Their treatment requires a multimodal approach, with surgery, radiotherapy, chemotherapy, and radiosurgery, which allows a long-term local control (LC) and an extension of free survival. In this study, the authors performed a review of the literature and reported 2 cases of patients affected by extracranial MMs, with long-term follow-up.
METHODS: Case 1: A 48-year-old woman was admitted for resection of an extra-axial falx lesion (meningioma G1). After 2 years, the lesion got a local recurrence, resected with a histologic diagnosis of meningioma G3. During the next 9 years, the patient underwent 5 Gamma Knife radiosurgery (GKRS) procedures for local recurrence. At 56 years, she was readmitted for a surgical local recurrence (histologic definition: anaplastic meningioma G3). At the age of 62, the patient underwent a right lobectomy for a lung mass (histologic diagnosis: anaplastic meningioma G3). After that, multiple lesions at soma L5 and adrenal gland were discovered and then monitored. Case 2: A 48-year-old woman was operated for a lesion involving torcular herophili (meningioma G2). After 3 years, a local recurrence requires GKRS combined with tamoxifen. In the next 7 years, she underwent 5 GKRS procedures for local recurrence. The patient also underwent chemotherapy with octreotide. At the age of 61, she discovered multiple lesions in both lungs, liver, and kidney. A hepatic biopsy showed anaplastic meningioma G3. Also this patient does not suffer from any neurologic or clinical deficits.
CONCLUSIONS: LC in malignant meningioma is achievable through a multimodal approach; GKRS makes possible LC, but a novel aspect of these lesions is opened to discussion: the metastases. These reports show that multimodal treatment for MMs is an effective approach with good LC and improvement of overall survival. However, a long survival may allow systemic diffusion of the disease, in particular, when sagittal sinus is involved.