Case report
A 69-year-old man with history of relapsing encephalic meningioma treated since 1994 to 2008 with three surgical interventions and brain radiotherapy underwent a left hemicolectomy in June 2015 for colon carcinoma, AJCC staging pT3 N2 (5 of 23 positive nodes). Tumor markers were negative and basal CT scan showed a suspected nodule in the left lower lung lobe. Chemoimmunotherapy with FOLFIRI and panitumumab was administered, yielding stable disease. A resection of the known lung nodule was performed in June 2016 and allowed to diagnose a rare form of extracerebral rhabdoid meningioma of grade 3 as WHO classification. In December 2019 patient reported severe pain in the left chest wall. PET/CT scan revealed two metabolic active nodules beside the fourth and seventh ribs (Figure 1). Histological and immunohistochemical (H&E, EMA, and Ki67 staining) diagnosis of thoracic anaplastic meningioma was confirmed by a new biopsy (Figure 2). Patient was treated with VMAT radiotherapy in the both nodules and oral chemotherapy with temozolomide, but he experienced a rapid and impressive intrathoracic disease progression (CT scan in Figure 3). An empiric second line antiangiogenic therapy with intravenous bevacizumab at 10 mg/Kg every two weeks led to stable disease lasting 19 months, until the lung mass caused pressure against the left cardiac ventricle, ejection fraction decrease and final heart failure.
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Figure 1