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