Recommended Citation
Patel R, Macklis J. A Rare Case of Pulmonary Metastasis from Malignant Intracranial Meningioma. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Meningiomas are the most common primary central nervous system (CNS) tumors arising from the meninges. Although typically benign, extracranial metastasis is rare, occurring in less than 1% of cases, most often involving the lungs, bones, or liver. We present a case of recurrent meningioma with malignant transformation and pulmonary metastases in an elderly patient following multiple resections and radiation treatments.
Description:
An 86-year-old male was diagnosed in 2013 with a WHO grade I meningioma treated with bifrontal craniotomy and resection. In 2020, he developed progression along the superior sagittal sinus and received radiation therapy. Imaging in 2024–2025 revealed recurrent right frontal convexity and parasagittal lesions invading the superior sagittal sinus and sphenoid wing. In May 2025, he underwent embolization and gross total resection. Pathology demonstrated transformation to anaplastic (WHO grade III) meningioma with skeletal muscle invasion. Postoperative proton radiation therapy was administered for progression. Systemic therapy with abemaciclib was initiated in October 2025. In November 2025, computed tomography obtained during hospitalization for abdominal pain and anemia revealed a left lower-lobe pulmonary mass with multiple bilateral pulmonary nodules. Biopsy confirmed metastatic malignant meningioma.
Discussion:
Extracranial metastasis from meningioma is uncommon but more frequently reported in high-grade tumors. The lungs are the most common site of distant spread. Proposed mechanisms include hematogenous dissemination through venous sinuses, particularly in tumors involving the superior sagittal sinus, vascular invasion, and possible surgical seeding. In this patient, recurrent disease, sinus invasion, malignant transformation, and multiple surgical interventions likely contributed to systemic dissemination. Management of anaplastic meningioma remains challenging. Surgical resection followed by adjuvant radiation therapy is standard; however, recurrence is common. No established systemic therapy exists for metastatic disease, and treatment decisions rely on limited evidence. Targeted agents such as CDK inhibitors are under investigation. Prognosis for metastatic grade III meningioma remains poor despite multimodal therapy. This case illustrates the aggressive clinical course of recurrent meningioma with malignant transformation and pulmonary metastasis, underscoring persistent challenges in surveillance, risk stratification, and therapeutic management of metastatic meningioma.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
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Available to all.
A Rare Case of Pulmonary Metastasis from Malignant Intracranial Meningioma
Introduction/Background:
Meningiomas are the most common primary central nervous system (CNS) tumors arising from the meninges. Although typically benign, extracranial metastasis is rare, occurring in less than 1% of cases, most often involving the lungs, bones, or liver. We present a case of recurrent meningioma with malignant transformation and pulmonary metastases in an elderly patient following multiple resections and radiation treatments.
Description:
An 86-year-old male was diagnosed in 2013 with a WHO grade I meningioma treated with bifrontal craniotomy and resection. In 2020, he developed progression along the superior sagittal sinus and received radiation therapy. Imaging in 2024–2025 revealed recurrent right frontal convexity and parasagittal lesions invading the superior sagittal sinus and sphenoid wing. In May 2025, he underwent embolization and gross total resection. Pathology demonstrated transformation to anaplastic (WHO grade III) meningioma with skeletal muscle invasion. Postoperative proton radiation therapy was administered for progression. Systemic therapy with abemaciclib was initiated in October 2025. In November 2025, computed tomography obtained during hospitalization for abdominal pain and anemia revealed a left lower-lobe pulmonary mass with multiple bilateral pulmonary nodules. Biopsy confirmed metastatic malignant meningioma.
Discussion:
Extracranial metastasis from meningioma is uncommon but more frequently reported in high-grade tumors. The lungs are the most common site of distant spread. Proposed mechanisms include hematogenous dissemination through venous sinuses, particularly in tumors involving the superior sagittal sinus, vascular invasion, and possible surgical seeding. In this patient, recurrent disease, sinus invasion, malignant transformation, and multiple surgical interventions likely contributed to systemic dissemination. Management of anaplastic meningioma remains challenging. Surgical resection followed by adjuvant radiation therapy is standard; however, recurrence is common. No established systemic therapy exists for metastatic disease, and treatment decisions rely on limited evidence. Targeted agents such as CDK inhibitors are under investigation. Prognosis for metastatic grade III meningioma remains poor despite multimodal therapy. This case illustrates the aggressive clinical course of recurrent meningioma with malignant transformation and pulmonary metastasis, underscoring persistent challenges in surveillance, risk stratification, and therapeutic management of metastatic meningioma.
Affiliations
Advocate Lutheran General Hospital