Diseminación meníngea atípica en meningiomas anaplásicos / Atypical meningeal dissemination in anaplastic meningioma

ABSTRACT

Objective. To present two cases of aplastic meningiomas refractory to surgical and radiotherapeutic tretement, with torpide evolution and clinical deterioration. Descpription. Case 1. 61, female. Left extraaxial temporo-occipital formation enhancing with gadolinium, tentorial implantation. Simpson II resection. PA atypical metaplasic meningioma, EMA, VIM and PGR positive, Ki-67; 13%. Without parenchimal infiltration. Local 3D radiotherapy. Visual deterioration, walk disturbance. Relapse with compromise of rectus and transverse sinuses. Simpson II resection. In 12 months, progression of the disease along the convexity. Paliative treatement with hidroxiurea. Case 2 69, female. Rt. Occipito-parietal meningioma 1995 subtotal resection in other center. Radiotherapy of remnant tumor. 2001 reoperated. Simpson II resection. PA meningtheliomatous meningioma Ki-67 5%. Dec. 2006 total resection of relapsing anaplastic meningioma. June 2007, extensive FPT dural dissemination. Medical treatement. Discussion. Anaplasic meningiomas present an exponential growing pattern that differenciates them from better grade lesions, possibly mediated by genetic factors (10q, 14q, 9p deletions). However, the only independent predictor seems to be the cellular kinetic index Ki-67. 5yr. 95% and 10yr. 79% survival rates are reported for anaplastic meningiomas with shorter relapse delays. Conclusion. High aggressive recurrent dissemination of anaplastic meningiomas is uncommon. Simpson´s I or II total resection is the initial tratement complemented as second line treatement by radiotherapy. Chemotherapy is of scant utility.