Chest wall metastasis from recurrent meningioma

Meningiomas are generally considered benign lesions. A minority, however, a re capable of metastasis. The ones most likely to do so are commonly recurr ent or frankly malignant in nature. The optimal management of such metastas es is unclear. This is the first reported case of meningioma presenting as an isolated metastasis to the chest wall. This case involves a 64-year-old woman without significant medical or family history who underwent resection of a meningioma of the right cerebral hemisphere. She was treated 10 years later for recurrence by stereotactic radiosurgery. Three years after that, the patient's family noticed a mass on the left chest wall. A CT scan reve aled destruction of the ninth rib laterally and subpleural extension. The p atient subsequently underwent resection of full-thickness chest wall for a presumed soft-tissue sarcoma. Further pathologic evaluation including elect ron microscopy and immunohistochemistry revealed metastatic meningioma. The patient received adjuvant radiation to the chest wall and is currently fre e of disease at the chest wall one year after surgery. This case illustrate s the difficulty in establishing an accurate diagnosis of metastatic mening ioma. Consequently in selected patients with a history of the disease the d iagnosis of metastatic meningioma must at least be considered. Resection of an isolated metastasis in this setting appears warranted.