Crossroads of Two Malignancies: Metastatic Atypical Meningioma to an Isolated Supraclavicular Lymph Node Coexisting with Malignant B Cell Lymphoma: A Rare Case Report
Shrinjay Vyas1, Clarissa Henson2, Michelle Cholankeril3, Heidi Fish4
1Neuroscience Institute, JFK Medical Center, 2Radiation Oncology, 3Hemato-Oncology, 4Pathology, Rutgers Health Trinitas Regional Medical Center
Objective:

To present a rare case of metastatic meningioma to supraclavicular lymph node with concomitant CD5+ B-cell Lymphoma upon commencing bevacizumab therapy after multiple failed resections and radiation therapy.

Background:

Meningiomas account for approximately 15% of all primary CNS tumors and are the most common extra-axial tumors. Distant metastases of meningiomas are rare with less than 1% occurrence, but have been described to lung, bone, liver and rarely to lymph nodes.

Design/Methods:
NA
Results:

88-year-old Cuban male after incidentally being diagnosed with a right parietal meningioma in April 2014, underwent initial craniotomy with placement of a mesh. Subsequently he had recurrence with progression showing nodular dural enhancement of the right parietal region. He then underwent re-resection showing atypical meningioma with initiation of radiation therapy to the right parietal region of 59.4 Gy with volumetric arc radiation therapy (33 fractions) and IGRT from 11/17 to 12/17. In January 2020, he was found out to have re-recurrence in the right parieto-occipital region and underwent re-resection showing anaplastic meningioma. Bevacizumab therapy was started in 03/2020 but discontinued when he suffered from pulmonary embolism in 02/22. Later he was found out to have re-recurrence involving the mastoid with thrombosis of distal right transverse sinus which was treated with SRT radiation (5.0 Gy/5 fractions, total dose: 25.0 Gy) from 10/22 to 11/22. Most recently in 07/23, patient presented with an asymptomatic enlarging fixed right supraclavicular neck mass and its biopsy revealed metastatic malignant meningioma grade III similar to the prior tumors with flow cytometry demonstrating CD5+ B-cell lymphoma. Palliative radiation therapy to the right supraclavicular mass was started but he progressed on treatment and was placed on hospice.

Conclusions:

Physicians must remain aware of the possibility of distant, often isolated spread in patients with a long history of recurrent atypical meningiomas presenting with lymphatic adenopathy.

10.1212/WNL.0000000000208385
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.