Parasagittal Meningioma in a Middle-aged Female Harbouring Metastatic Ductal Carcinoma: A Rare Case of Incidentally Detected Tumour-to-tumour Metastasis
Nadia Shirazi, Sanjeev Pandey, Meena Harsh, Siddhartha Tyagi
1. Professor, Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
2. Associate Professor, Department of Neurosurgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
3. Professor, Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
4. Junior Resident, Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
Correspondence Address :
Dr. Nadia Shirazi,
Professor, Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun-248140, Uttarakhand, India.
E-mail: shirazinadia@gmail.com
Abstract
Metastasis of a tumour particularly coming from breast into an intracranial meningioma is a rare phenomenon. Several factors related to tumour microenvironment have been suggested in the pathophysiology of these lesions, particularly the rich vascular network of meningiomas, expression of common hormonal receptors like Oestrogen Receptor (ER) and Progesterone Receptor (PR), local immunosuppression, and presence of cell adhesion molecules. Here, we present a clinicoradiologically unsuspecting case of intracranial, parasagittal meningioma who was operated for relief of symptoms of mass effect and was incidentally detected with tumour metastasis within the meningioma. A 50-year-old female presented with seizures, headache and visual disturbances since last one month. Radiology revealed a parasagittal mass which was likely to be meningioma. The patient was operated. On histopathology, a low-grade meningioma was seen with areas of metastatic adenocarcinoma. The metastatic foci were surrounded by fibroblastic meningioma cells. On Immunohistochemistry (IHC), the metastatic tumour cells were strongly positive for PR and Cytokeratin 7 (CK7) and a diagnosis of fibroblastic meningioma with intratumoural metastasis of ductal carcinoma was rendered. The patient was given radiotherapy for brain tumour and also started on chemotherapy for breast carcinoma with brain metastasis. Since the entity of “Tumour-to-tumour Metastasis (TTM)” is uncommonly thought of and its detection is not easy, it is important that both clinicians and pathologists should adequately examine tissue samples of excised meningioma, as detecting the presence of any metastatic foci within the main mass will alter the prognosis and treatment plan considerably.
Keywords
Breast carcinoma, Chemotherapy, Hormonal receptors, Immunohistochemistry, Intracranial, Occult
DOI and Others
DOI: 10.7860/JCDR/2024/68565.19232
Date of Submission: Nov 10, 2023
Date of Peer Review: Dec 05, 2023
Date of Acceptance: Feb 22, 2024
Date of Publishing: Apr 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 14, 2023
• Manual Googling: Dec 13, 2023
• iThenticate Software: Feb 19, 2024 (5%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6