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Disorders of the Pleura |

Primary Pleural Meningioma

Rajani Jagana, MD; Nikhil Meena, MD; Thaddeus Bartter, MD; Brendon Colaco, MD
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UAMS, Little Rock, AR


Chest. 2013;144(4_MeetingAbstracts):488A. doi:10.1378/chest.1704300
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Abstract

SESSION TITLE: Pleural Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Metastatic Pleural and Pulmonary Parenchymal involvement is rare with intra-cranial or extra-cranial meningioma. Cases of Primary Pulmonary meningioma as solitary pulmonary nodule have been reported(1). We are presenting a case of primary pleural cavity meningioma.

CASE PRESENTATION: 50 year old female with history of right upper extremity lymphedema for 8 years presented with gradual onset of shortness of breath and right sided pleural effusion (Figure 1). Initial diagnostic and therapeutic thoracentesis revealed an exudative pleural effusion. No lung parenchymal lesions were visible after thoracentesis. Lymphscintigraphy showed distal obstruction in her right upper extremity. Patient presented with recurrence of the pleural effusion at 4 weeks. A high suspicion for malignancy led to pleuroscopy and pleural biopsy. Pathology demonstrated nodular neoplastic proliferation of small spindled to ovoid cells with eosinophilic cytoplasm and bland nuclei within a predominantly myxoid stroma (Figure 2). On Immunohistochemistry a soft tissue meningioma was suspected due to the expression of epithelial membrane antigen and progesterone receptor (PR) (2). No brain and spine lesions were evident. Due to lymphedema of right upper chest and poor wound healing, complete pleurectomy was deferred.

DISCUSSION: Soft tissue Meningioma tumors are formed by Neoplastic growth of ectopic arachnoid cells. Pleural involvement has been reported with metastatic meningioma with intracranial or extracranial primary tumors. Primary Pleural or Pulmonary menigioma is a rare occurence. Surgery is the mainstay of treatment with pleurectomy and Pleurodesis.

CONCLUSIONS: Our case may represent a Primary Pleural Cavity Meningioma. Treatment options were limited in our case due to lymphedema. Early intervention in these cases with closed pleural biopsy or Pleuroscopy guided biopsy could lead to early therapy.

Reference #1: 1) Lung Cancer. 2008 Dec Primary pulmonary meningioma: report of a case and review of the literature. Incarbone M et al

Reference #2: 2) Jayson R. Miedema, Daniel Zedek, (2012) Cutaneous Meningioma. Archives of Pathology & Laboratory Medicine: February 2012, Vol. 136, No. 2, pp. 208-211.

Reference #3: 3) Meningioma. Fathi AR, Roelcke U. Current Neurology and Neuroscience Reports. 2013 Apr

DISCLOSURE: The following authors have nothing to disclose: Rajani Jagana, Nikhil Meena, Thaddeus Bartter, Brendon Colaco

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