Tumor-to-tumor metastasis inside a meningioma [Neurosurgery Wiki]

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====== Tumor-to-tumor metastasis inside a meningioma ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1ZK2-GOkRV8NseH4dWaluCQs1ctoET_13PWy1N90JnSir0kQKv/?limit=15&utm_campaign=pubmed-2&fc=20230608024606}}
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There is a difference between [[Tumor-to-tumor metastasis]] and [[collision tumor]]s. The former implies a recipient role of the [[host]] tumor, and the latter refers to a co-[[localization]] of two different tumors that grow into one another, both being in the same organ.
[[Tumor]]-to-tumor [[brain metastasis]] is a well-described phenomenon but with unclear [[pathophysiology]]. Deeper knowledge could be beneficial for its management
((Papadakis BK, Vorrias E, Bräutigam K, Chochlidakis N, Koutsopoulos A, Mavroudis D, Vakis A, Tsitsipanis C. Intrameningioma metastasis: A case-based literature review. J Clin Neurosci. 2021 Nov;93:168-173. doi: 10.1016/j.jocn.2021.08.028. Epub 2021 Sep 21. PMID: 34656242.)).
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A [[tumor]]-to-tumor metastasis inside a [[meningioma]] is a rare phenomenon. [[Malignant]] [[neoplasm]]s of the [[breast]] and [[lung]] are the most common [[primary tumor]]s. Other sites of origin include [[prostate]], [[renal]] and [[gastric]] neoplasms.  A [[literature review]] was conducted in March 2020 via [[PubMed]]. Relevant search results were few
((Papadakis BK, Vorrias E, Bräutigam K, Chochlidakis N, Koutsopoulos A, Mavroudis D, Vakis A, Tsitsipanis C. Intrameningioma metastasis: A case-based literature review. J Clin Neurosci. 2021 Nov;93:168-173. doi: 10.1016/j.jocn.2021.08.028. Epub 2021 Sep 21. PMID: 34656242.))

Since some metastatic tumors have [[osteoblast]]ic imaging pattern, it is not always easy to differentiate them from meningioma on [[preoperative]] studies
((Hosseinzadeh M, Ketabchi SM, Ahmadi SA, Hendi K, Alimohamadi M. Meningioma as the host for metastatic breast cancer: A rare occurrence with important therapeutic impact. Surg Neurol Int. 2021 Jun 28;12:314. doi: 10.25259/SNI_148_2021. PMID: 34345455; PMCID: PMC8326081.)).

===== Systematic review =====
Turner et al. located 124 [[article]]s, describing 152 cases of patients with Tumor-to-tumor metastasis inside a meningioma. The mean (± SD) age of all patients was 62.21 ± 10.8 years, with even distribution above and below the mean. Of the cases, 65.9% were reported in women. The most common cancer origins of TTMM were breast and [[lung carcinoma]], followed by kidney, prostate, and GI tract carcinoma. Cancer status is not a good marker of TTMM when managing a meningioma. In 36.69% of cases, TTMM was the presentation of an unknown [[cancer]]. In nearly 60% of the known cases, cancer was considered in remission for at least 1 year. [[Meningioma]] parameters are unhelpful when considering a TTMM. The distribution of meningioma location is similar to other series of meningioma reported in the literature. Meningioma grade is similar to meningiomas without TTMM. In 57.89%, the patient presented with a focal deficit. Presenting factors were [[seizure]]s, elevated [[ICP]], and others. Over 95% of cases were [[symptomatic]] at presentation
((Turner N, Kaye AH, Paldor I. Metastases to meningioma-review and meta-analysis. Acta Neurochir (Wien). 2021 Mar;163(3):699-709. doi: 10.1007/s00701-020-04661-7. Epub 2021 Jan 3. PMID: 33389125.))

===== Case reports =====

A 73-year-old female patient diagnosed with breast cancer was found to have convexity meningioma. Since the size of tumor and peritumoral brain edema increased during follow-up period, the meningioma was treated with surgical resection. Postoperatively, histopathologic examination confirmed metastasis of invasive ductal carcinoma within a secretory meningioma. The final diagnosis was TTM of breast cancer in meningioma. Here, we report a rare case of intra-meningioma metastasis and a review of literature to provide a better understanding of this rare phenomenon
((Joe WH, Lee CY, Kim CH, Ko YS, Kim SP, Kwon SM. Breast Cancer to Meningioma: A Rare Case of Tumor-to-Tumor Metastasis. Brain Tumor Res Treat. 2023 Jan;11(1):73-78. doi: 10.14791/btrt.2022.0042. PMID: 36762811; PMCID: PMC9911711.))

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A 60-year-old female referred complaining about a progressive [[headache]], [[nausea]], and [[vomiting]] for the past month. She had a history of [[breast cancer]] treated with radical [[mastectomy]] (5 years ago) and [[adjuvant]] [[chemotherapy]] (until 1 year ago). Workups revealed a [[dura]]l-based mass in the left temporobasal and midline subfrontal [[region]]s. Histopathological study showed breast cancer metastasis nests within the primary meningioma

As the diagnosis of metastatic nests inside a [[benign tumor]], drastically alters [[postoperative]] [[adjuvant]] [[treatment]]s, a high index of suspicion is needed evaluating tumors from patients with a history of systemic neoplasms
((Hosseinzadeh M, Ketabchi SM, Ahmadi SA, Hendi K, Alimohamadi M. Meningioma as the host for metastatic breast cancer: A rare occurrence with important therapeutic impact. Surg Neurol Int. 2021 Jun 28;12:314. doi: 10.25259/SNI_148_2021. PMID: 34345455; PMCID: PMC8326081.))
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A 66-year-old [[female]], with known [[Small-Cell Lung Cancer]], who presented with left-sided [[hemiparesis]]. The [[Magnetic Resonance Imaging]] scan revealed a right frontal [[extraaxial]] mass. The patient underwent a [[craniotomy]] and a [[gross total resection]] of the tumor. Histological examination of the excised mass revealed metastatic [[adenocarcinoma]] deposits inside a meningioma: [[Tumor-to-tumor metastasis inside a meningioma]]. Reviewing the available [[literature]], it has been hypothesized that the following factors play a role in the [[pathophysiology]] of this phenomenon: [[progesterone]] and [[estrogen receptor]]s, cell-to-cell adhesion molecules, rich vascularization, favorable metabolic, micro-and immunological environment. Meningiomas seem to be the most common type of intracranial neoplasm to host a [[metastasis]]. 
((Papadakis BK, Vorrias E, Bräutigam K, Chochlidakis N, Koutsopoulos A, Mavroudis D, Vakis A, Tsitsipanis C. Intrameningioma metastasis: A case-based literature review. J Clin Neurosci. 2021 Nov;93:168-173. doi: 10.1016/j.jocn.2021.08.028. Epub 2021 Sep 21. PMID: 34656242.)).

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Two patients are reported, with breast and renal carcinoma metastases in an intracranial meningioma
((Lanotte M, Benech F, Panciani PP, Cassoni P, Ducati A. Systemic cancer metastasis in a meningioma: report of two cases and review of the literature. Clin Neurol Neurosurg. 2009 Jan;111(1):87-93. doi: 10.1016/j.clineuro.2008.07.011. Epub 2008 Oct 19. PMID: 18930586.))


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