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    1208 Case 1

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    willygope
    A 72-year-old man presented abruptly with a grand mal seizure while dancing. He was admitted to our hospital and physical examination detected mild left upper limb paresis. Histological examination showed a large central soft area that consisted of polyhedral cells with clear cytoplasm and mild atypia.

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    1208 Case 1

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    willygope
    43 views2 pages
    A 72-year-old man presented abruptly with a grand mal seizure while dancing. He was admitted to our hospital and physical examination detected mild left upper limb paresis. Histological examination showed a large central soft area that consisted of polyhedral cells with clear cytoplasm and mild atypia.

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    A 72-year-old man presented abruptly with a grand mal seizure while dancing. He was admitted to our hospital and physical examination detected mild left upper limb paresis. Histological examination showed a large central soft area that consisted of polyhedral cells with clear cytoplasm and mild atypia.

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    43 views2 pages

    1208 Case 1

    Uploaded by

    willygope
    A 72-year-old man presented abruptly with a grand mal seizure while dancing. He was admitted to our hospital and physical examination detected mild left upper limb paresis. Histological examination showed a large central soft area that consisted of polyhedral cells with clear cytoplasm and mild atypia.

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    of 2

    doi:10.1111/j.1750-3639.2009.00280.

    x
    CASE OF THE MONTH DEC. 2008 CASE 1

    72 YEAR-OLD MAN WITH NEW SEIZURE WHILE DANCING

    arranged in alveolar and glandular patterns with scarce fibrovascu-


    CLINICAL DETAILS lar stroma (Fig 2). The peripheral zone was composed of uniform
    A 72-year-old man presented abruptly with a grand mal seizure sheets of polygonal and spindle cells (fig 2 and 3). Psammoma
    while he was dancing. He was admitted to our hospital and physical bodies were also identified in the tumor (Fig. 3). Immunohis-
    examination detected mild left upper limb paresis. His medical tochemical staining for cytokeratin 8 (Fig. 4) and CD 10 (Fig. 5)
    history included idiopathic hypertension and non insulin- showed positivity only in the clear cell component.
    dependent diabetes, both under specific drug therapy. Cranial mag-
    netic resonance imaging (MRI) revealed a 4 ¥ 4 ¥ 3-cm extraaxial
    lesion, isointense on T1-weighted images and hyperintense on
    T2-weighted images, with heterogenous enhancement. It was
    located in the posterior right frontal convexity with poorly defined
    boundaries and remarkable perilesional edema (Fig. 1). The patient
    then underwent total microsurgical resection of the hypervascular
    intracranial mass. During operation, the tumor was found to be a
    mass partially encapsulated with dural attachment. The surgical
    appearance was felt to be atypical for meningioma. The dissection
    showed a prominent and arterialized venous drainage and no
    evident cleavage plane in some areas. A small piece of tumor was
    submitted for frozen section (Fig 2).

    PATHOLOGICAL EXAMINATION
    On macroscopic examination, the tumor was irregularly spherical Figure 2.
    (17 gm weight and 4 ¥ 4 ¥ 3 cm mass). Under a rough gray
    surface, an extensive solid and soft yellowish area emerged. Serial
    sections showed that this area occupied two-third of the tumor.
    Histological examination showed a large central soft area that con-
    sisted of polyhedral cells with clear cytoplasm and mild atypia,

    Figure 3.

    Figure 1. Figure 4. Figure 5.

    Brain Pathology 19 (2009) 347–348 347


    © 2009 The Authors; Journal Compilation © 2009 International Society of Neuropathology
    Correspondence

    2. Benedetto N, Perrini P, Scollato A, Buccoliero AM, Di Lorenzo N


    DIAGNOSIS (2007) Intracranial meningioma containing metastatic colon
    Metastatic clear-cell type of renal carcinoma in a meningothelial carcinoma. Acta Neurochir 149:799–803.
    meningioma. 3. Breadmore R, House R, Gonzales M (1994) Metastasis of renal cell
    carcinoma to a meningioma. Australas Radiol 38:141–3.
    He had an uneventful post-operative period. The postoperative
    4. Campbell LV, Gilbert E, Chamberlein CR Jr, Watne AL (1968)
    evaluation was completed with a body CT-scan, which revealed a Metastasis of cancer to cancer. Cancer 22:635–643.
    mass-lesion in the right kidney and two nodules in the right lung. 5. Han HS, Kim EY, Han JY, Kim YB, Hwang TS, Chu YC (2000)
    He underwent whole brain radiotherapy, right radical nephrectomy Metastatic renal cell carcinoma in a meningioma: a case report. J
    and adjuvant chemotherapy. The patient was neurological Korean Med Sci 15:593–7.
    symptom-free on follow-up after 3 months. 6. Kimiwada T, Motohashi O, Kumabe T, Watanabe M, Tominaga T
    (2004) Lipomatous meningioma of the brain harboring metastatic
    renal-cell carcinoma: a case report. Brain Tumor Pathol 21:47–52.
    DISCUSSION 7. Sadatomo T, Yuki K, Migita K, Taniguchi E, Kodama Y, Kurisu K
    Tumor to tumor metastasis is a rare pathological event. Meningio- (2005) Solitary brain metastasis from renal cell carcinoma carcinoma
    15 years after nephrectomy: case report. Neurol Med Chir 45:423–7.
    mas have been found to be the most common intracranial tumor to
    8. Storberg DH (1957) Metastases of carcinoma to meningioma. J
    host a metastatic neoplasia. Among these, breast followed by lung Neurosurg 14:337–343.
    carcinoma were the most common primary sites (1). Several theo- 9. Stortbecker TP (1951) Metastatic hypernephroma of the brain from a
    ries and biological factors (metabolic, hemodynamic, hormonal, neurosurgical point of view. J Neurosurg 8:185–197.
    immunological and molecular) have been advanced concerning the 10. Tagle P, Villanueva P, Torrealba G, Huete I (2002) Intracraneal
    genesis of this unusual event (2). Radiologic techniques cannot metastasis or meningioma? A uncommon clinical diagnostic dilemma.
    reliably exclude the presence of metastatic tumor within a menin- Surg Neurol 58:241–5.
    gioma, nor can they establish a definitive diagnosis between men-
    ingioma and dural metastasis (10). Both possibilities should be Contributed by:
    considered in those patients presenting with a solitary intracranial Julio César Gutiérrez Morales, MD, PhD1,
    lesion suggestive of meningioma whether or not they harbor an Sandra Eugenia Gutiérrez Morales, Biol. Sci.2, and
    extracranial primary tumor at the same time. Aurora Astudillo González, MD, PhD3
    1
    Brain metastases in renal cell carcinoma are not rare events, Department of Neurosurgery, Hospital Universitario Central de
    although it is very rare from a renal cell carcinoma staged T1-2 Asturias, Oviedo, Spain
    2
    without systemic metastases. Both metastases in advanced staging Faculty of Biological Sciences, University of Oviedo, Spain
    3
    cases and isolated metastasis discovered some years after nephrec- Department of Clinical Neuropathology, Hospital Universitario
    tomy have been reported (7). Only a few cases of renal cell carci- Central de Asturias, Oviedo, Spain
    noma metastasizing to an intracranial meningioma have been Oviedo, Spain
    reported (3, 5, 6, 8, 9). In those cases, a primary renal tumor was
    known before the neurosurgical procedure. Our case is the first
    reported metastatic renal cell carcinoma within a meningothelial
    ABSTRACT
    meningioma without previous knowledge of the existence of the
    primary malignant tumor. Metastasis of an extracranial malignant neoplasm to a meningioma
    Therefore, this case could be considered unique: tumor-to tumor is a rare event. We report a case of a 72-year-old man who presented
    metastasis as the clinical onset of an extracranial neoplasia. Due to abruptly with a grand mal seizure. Neuroradiological examination
    the overlapping in clinical presentation and despite advances in revealed an extraaxial lesion located in the posterior right frontal
    imaging, pathological examination is still required for its correct convexity with poorly defined boundaries. Histological and immu-
    diagnosis. In such cases it is imperative to exclude the occurrence nohistochemical examination showed that the lesion was a menin-
    of collision between tumors. In order to assess a true metastasis in gothelial meningioma harboring metastatic renal cell carcinoma.
    the tumor, criteria suggested by Campbell et al could be used (4). The MRI could be indicative but not specific of this type of lesion.
    Some cases of intracranial meningiomas containing metastatic car-
    cinomas have been published, but to our knowledge only five cases
    REFERENCES
    of renal cell carcinoma metastasizing to a meningioma have been
    1. Altinoz MA, Santaguida C, Guiot MC, Del Maestro RF (2005) Spinal reported. Possible explanations for this type of “tumor in tumor”
    hemangioblastoma containing metastatic renal cell carcinoma in von lesion are reviewed.
    Hippel-Lindau disease. Case report and review of the literature. J
    Neurosurg Spine 2005 3:495–500.

    348 Brain Pathology 19 (2009) 347–348


    © 2009 The Authors; Journal Compilation © 2009 International Society of Neuropathology

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