Metastases to Meningiomas: A Comprehensive Literature Review Including Mediating Proteins

Abstract

Approximately 5-15% of solid tumors metastasizing to the central nervous system metastasize to the leptomeninges. Less common, is metastasis to leptomeningeal meningiomas. These are primarily carcinomas of the breast and lung. Awareness of this phenomenon is critical to the evaluation of meningiomas, especially since the metastases may be the first indication of an occult tumor elsewhere in the body. Lack of clear demarcation between the metastasis and meningioma parenchyma, as well as histological features similar to the meningioma, may hinder recognition. The mechanisms underlying metastases anchoring and spread along the leptomeninges are not established. However, several cell adhesion molecules are thought to contribute to this phenomenon. E cadherin is a cell adhesion molecule present in meningioma cells. Binding to endothelium by adhesion molecules such as ICAM, B1 integrin, P-selectin, PECAM-1, CXCL12 and SDF-1 have also been proposed as part of the mechanisms underlying breast carcinoma metastases. In addition, the leptomeninges and meningiomas express mesothelin that acts as an anchoring protein coupling with mucin-16. Consequently, metastatic tumor cell mucin and mesothelin may also facilitate the anchoring of metastases to meningiomas.

Keywords: cell adhesion molecules; meningioma; mesothelin; tumor-to tumor metastasis.

Figure 1

(a) Small cell carcinoma metastasis to meningioma (upper right corner) (b) Larger focus of metastatic small cell carcinoma in the meningioma. ((a) Hematoxylin and eosin original magnification 400× and (b) Hematoxylin and eosin original magnification 200×).

Figure 2

Metastatic plasma cell neoplasm to meningioma. (a) Foci of plasma cells (right) in sections of meningioma may suggest a lymphoplasmacytic variant unless, (b) the sample is completely submitted. All figures: Hematoxylin counterstain (Hematoxylin and eosin, Original magnification 400×).

Figure 3

(a) Meningioma, WHO grade 2, with metastatic adenocarcinoma (arrow). (b) Same meningioma with mesothelin immunoreactivity and (c) MUC16 in adenocarcinoma (top) metastatic to the meningioma. (Hematoxylin and eosin original magnification 400×) (a) Hematoxylin counterstain. and diaminobenzidine chromagen. Original magnification 400×) (b,c).