Scalp metastasis from atypical meningioma: A case report and literature review

Abstract

Key clinical message: Scalp metastasis from atypical meningioma, though rare, underscores the importance of meticulous surgical techniques to prevent tumor cell implantation. Early detection and comprehensive management, including surgery and adjuvant therapy, are crucial for optimal outcomes.

Abstract: Meningiomas are tumors of the meninges that originate in the arachnoid layer from arachnoid cap cells. Atypical meningiomas, classified as WHO grade 2 tumors, tend to metastasize and recur if not surgically managed properly. Scalp metastasis is a rare occurrence that presents as a subcutaneous elevation. A 33-year-old patient presented with a complaint of a constant, dull pressure headache persisting for the past 12 months, exacerbated by exertion, along with seizures and neuropsychiatric symptoms. The patient had no significant medical history but had undergone surgery 4 years ago for a WHO grade 2 meningioma. The current brain MRI revealed a dural tail sign, along with masses on both the left and right sides of the frontal lobe, extending to involve the skin on the forehead and scalp. The patient underwent surgical resection and adjuvant radiation therapy. At the 12-month follow-up, no neurological deterioration or tumor recurrence was observed. A literature review on scalp metastasis in patients with atypical meningioma was also conducted, including eight articles published up to September 2023. The mechanism of metastasis development appears to be consistent in all eight reported cases, involving the implantation of tumor cells during resection. Therefore, there is a critical need for meticulous intra- and post-operative surgical techniques to prevent such implantation.

Keywords: atypical; meningioma; metastatic recurrence; radiation therapy; scalp metastasis; surgical resection.

FIGURE 1

Image showing the extensive scalp metastatic lesion due to atypical meningioma (A). Preoperative axial and sagittal brain CT scan images showing bone and skin involvement (B). Preoperative T1‐weighted MRI sagittal sequence showing tumor invasion and aggressiveness (C).

FIGURE 2

Postoperative day‐1 brain CT scan after Cranioplasty and postoperative image of patient's head after skin grafting (A). Histopathology – hematoxylin–eosin staining (×100): The tumor cells are arranged in a lobular or nest‐like shape, with a vortex‐like structure in the local area. The tumor nucleus is of medium size, mitotic images are (>4/10 HPF), and necrosis is seen in the local area (B).