INTRODUCTION: Lung tumors with the histological appearance of meningioma are very rare. We describe a case of a woman who presented with right lower lobe mass which was diagnosed as meningioma.
CASE PRESENTATION: A 67 year old woman presented to outpatient clinic for right lower lobe mass lesion. The patient went to emergency room with intermittent episodes of right sided chest pain lasting for two to three days prior to the clinic visit. She described pain as dull in nature and mainly located over lower right side of her chest wall. Her chest X-ray at that time reveled the presence of right lower lobe opacity During the clinic visit she denied fever, chiils, further episodes of chest pain, dyspnea at rest or upon exertion, cough, PND, orthopnea and trauma to chest. She had a history of meningioma followed by complete resection five years ago. She denied prior history of cigarette smoking, alcohol or drug abuse and recent travel. On physical examination, the patient appeared comfortable. Her vital signs were: T 37.3, HR 84, RR 18, BP 134/82 and SpO2 96% on room air. Chest examination was unremarkable. Cardiac examination showed a soft S1 and a blowing holosystolic murmur best heard at the apex with radiation into the axilla. Rest of the examination was within normal limits. Initial laboratory parameters were witnin normal limits. Chest X-ray showed a mass lesion in the anterior segment of right lower lobe. Chest CT with IV contrast revealed a non calcified and round 4.4 x 3.2 cm mass with smooth margins in the superior segment of right lower lobe. The PET/CT scan was suggestive of FDG positive mass lesion corresponding to CT chest images with a SUV of 6.9. The patient underwent right lower lobectomy and mediastional lymph node sampling. Light microscopy showed sharply demarcated nests of tumor cells located in the interstitial space. They were often located around small veins but an association with bronchioles or arteries could not be shown. The cells were arranged in whorls, bands, and small clusters. The findings were suggestive of a meningioma.
DISCUSSIONS: Pulmonary meningioma (PM) is an extremely rare tumor. Since the first case was described by Erlandson in 1981, about 30 cases have been reported. Only two of these cases showed malignant characteristics. As is the case in central nervous system meningiomas, PM may grow very slowly without being responsible for any clinical symptoms. Thus, PM presents most often as an asymptomatic solitary pulmonary nodule or mass lesion. Only two cases of persisting cough that motivated specific investigations have been reported. The PM can be primary or metastatic. As in our case and others previously described, it may be difficult to differentiate a primary PM from isolated metastasis by clinical and radiographic criteria; this is especially true in patients with a known primary intracranial tumor. Moreover, it has recently been reported that PM can be responsible for false-positive PET scan with an increased FDG uptake. The treatment of PM is to perform a complete resection, which has been possible in all reported cases. The previous cases also suggest that there is no risk of recurrence if the resection is complete.
CONCLUSION: We describe a rare case of pulmonary meningioma. The differentiation between primary versus secondary lung meningioma represents a challenge for the clinician.
DISCLOSURE: Chirag Pandya, No Financial Disclosure Information; No Product/Research Disclosure Information