Metastatic Atypical and Anaplastic Meningioma: A Case Series and Review of the Literature

BACKGROUND: Atypical (World Health Organization grade II) and anaplastic (World Health Organization grade III) meningiomas are rare, accounting for less than 5% of all meningiomas. Histologic grading has a significant impact on prognosis, risk of recurrence, and the need for adjuvant radiation or chemotherapy. Extracranial metastases are even more infrequent and occur in 0.1% of all cases.METHODS: Retrospective chart review of 168 patients with diagnosis of WHO grade II and III meningiomas was performed. Six patients with histologically confirmed metastatic disease were identified.RESULTS: We discuss the clinical, radiologic, and histopathologic clinical course of 6 patients with metastasis to the lung, liver, and spine from all patients with atypical or anaplastic meningioma treated at Johns Hopkins Hospital from 1993 to 2014.CONCLUSIONS: We reviewed the literature pertaining to this phenomenon and subsequently assessed the clinical benefits of adjuvant chemotherapeutic agents in patients with meningioma with metastatic disease.