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LETTER TO EDITOR  
Year : 2022  |  Volume : 65  |  Issue : 4  |  Page : 949-951
Tumor-to-tumor metastasis—Metastasis of pulmonary adenocarcinoma to intracranial meningioma: A case report


1 Department of Pathology, Uludag University Faculty of Medicine, Bursa, Turkey
2 Department of Neurosurgery, Uludag University Faculty of Medicine, Bursa, Turkey
3 Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey

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Date of Submission14-Apr-2021
Date of Acceptance13-Oct-2021
Date of Web Publication06-Jun-2022
 

How to cite this article:
Ozsen M, Tolunay &, Yılmazlar S, Parlak M, Karadağ G. Tumor-to-tumor metastasis—Metastasis of pulmonary adenocarcinoma to intracranial meningioma: A case report. Indian J Pathol Microbiol 2022;65:949-51

How to cite this URL:
Ozsen M, Tolunay &, Yılmazlar S, Parlak M, Karadağ G. Tumor-to-tumor metastasis—Metastasis of pulmonary adenocarcinoma to intracranial meningioma: A case report. Indian J Pathol Microbiol [serial online] 2022 [cited 2022 Nov 30];65:949-51. Available from: https://www.ijpmonline.org/text.asp?2022/65/4/949/346699




Editor,

Tumor-to-tumor metastasis is a rare entity in which a focus of donor tumor metastasizes to another recipient tumor. The most common recipient tumors are renal cell carcinoma and meningioma, whereas the donor tumors are generally lung and breast carcinomas.[1]

In our report, a case with metastasizing pulmonary adanocarcinoma into meningotheliomatious meningioma (WHO Grade I) was presented and its clinicopathological features were briefly discussed.

A 65-year-old male patient was admitted to external center with complaints of loss of vision in the left eye and droopy eyelid. A mass in the sellar region was detected radiologically and the patient was referred to our center's neurosurgery clinic for investigation of etiology, further diagnosis, and treatment.

Radiological appearance suggested a primary neoplastic lesion similar to a pituitary macroadenoma of sellar origin [Figure 1]a.
Figure 1: (a). Imaging examinations of the brain before surgery. Preoperative contrast-enhanced MRI, dynamic contrast-enhanced magnetic resonance examination of the brain reveals a mass. The mass markedly elevated the optic chiasm, obliterating the prepontine and premedullary cystern, showed intense contrast enhancement and marked diffusion restriction. (b). Imaging examinations of the lungs before surgery. Preoperative computed tomography scan of the chest shows a 2 × 1.6 cm mass in the left upper lobe. (c). Polygonal cells with pale chromatin, eosinophilic cytoplasm, round–oval smooth contoured nuclei, and in some areas, atypical cells with hyperchromatic nuclei, prominent pleomorphism without a distinct pattern

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Preoperative radiological evaluation also showed multiple foci favoring a malignant tumor in the apicoposterior segment of left upper lobe of the lung [Figure 1]b, mediastinum, liver, and left femur.

Intraoperative histopathological evaluation revealed polygonal cells with pale chromatin, eosinophilic cytoplasm, round–oval smooth contoured nuclei without nucleolus forming prominent whorls and solid sheets. Mitosis or necrosis was not present, but some areas revealed atypical cells with hyperchromatic nuclei, irregular nuclear contours, prominent pleomorphism without a distinct pattern [Figure 1]c. The surgical team was informed that the tumor may be compatible with atypical meningioma and wide excision was performed accordingly.

Histopathological examination predominantly showed tumor cells forming tight whorls and concentric groups. The cells had eosinophilic cytoplasm, ambigious cytoplasmic borders, round–oval nuclei, and inconspicuous nucleoli [Figure 2]a. Focal areas revealed atypical cells with eosinophilic cytoplasm, pleomorfic nuclei, and prominent nucleoli, forming gland-like structures in some areas. Intracytoplasmic mucin were noted in certain areas [Figure 2]b,[Figure 2]c,[Figure 2]d. Immunohistochemical study results are given in the legend of [Figure 3].
Figure 2: Microscopic images. (a). The meningothelial meningioma of no carcinoma-bearing area (H&E, ×100). (b). In carcinoma-bearing areas, carcinoma cells are in the meningothelial meningioma (H&E, ×100). (c) and (d). Higher magnification shows the meningothelial meningioma of carcinoma-bearing area (H&E, ×200, H and E, ×400)

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Figure 3: Microscopic images. (a). Immunohistochemical staining for ck7 shows strong positivity in glandular structures (×200). (b). Immunohistochemical staining for TTF-1 shows strong nuclear positivity in glandular structures (×40). (c). Immunohistochemical staining for EMA shows strong positivity in meningioma (×40). (d). Immunohistochemical staining for ki67 shows high proliferation index in glandular structures (×100)

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The most common neoplasm receiving metastasis in the central nervous system is meningioma; however reports of pituitary prolactinoma, schwannoma, cavernoma, paraganglioma; hemangioblastoma, neurocytoma, oligodendrioglioma, pilocytic astrocytoma, astrocytoma, ependymoma, glioblastoma, and glioma as recipient tumors are found.[2],[3] Histopathologically, collision tumor is the most common entity that can be confused with tumor-to-tumor metastasis. If a tumor has metastasizes but does not invade another neoplasia in the area where it metastasizes, it should be called collision tumor. The gold standard diagnosis of tumor-to-tumor metastasis is histopathological evaluation.[4] Assessing the widest possible area of the lesion will make the diagnosis easier. However, small biopsies may be problematic.[5] In cases where wide excision of the tumor cannot be performed or in situations where sampling is insufficient, metastatic tumor foci can be missed.

The clinical course and treatment modalities of meningioma with intratumoral metastasis have not been clarified yet.[5] The main factor determining the prognosis is the component with the most malignant behavior, and the clinical course of these cases may be worse compared to a typical case of meningioma.

Clarification of unknown points about this rare entity and development of patient management guidelines will be possible by gathering more information through case series.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mansour S, Luther E, Echeverry N, McCarthy D, Eichberg DG, Shah A, et al. Rare tumor-to-tumor metastases ınvolving lung adenocarcinoma to petroclival meningiomas. World Neurosurg 2020;144:125-35.  Back to cited text no. 1
    
2.
Erdogan H, Aydin MV, Tasdemiroglu E: Tumor-to-tumor metastasis of the central nervous system. Turk Neurosurg 2014;24:151-62.  Back to cited text no. 2
    
3.
Başaran AE, Kiesel B, Frischer JM, Furtner J, Wöhrer A, Dieckmann K, et al. Intrameningioma metastasis: A wolf in sheep's clothing? Experience from a series of 7 cases. World Neurosurg 2019;132:169-72.  Back to cited text no. 3
    
4.
Sayegh ET, Burch EA, Henderson GA, Oh T, Bloch O, Parsa AT. Tumor-to-tumor metastasis: Breast carcinoma to meningioma. J Clin Neurosci 2015;22:268-74.  Back to cited text no. 4
    
5.
Kim KH, Hong EK, Lee SH, Yoo H. Non small cell carcinoma metastasis to meningioma. J Korean Neurosurg Soc 2013;53:43-5.  Back to cited text no. 5
    

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Correspondence Address:
Mine Ozsen
Department of Pathology, Uludag University Faculty of Medicine, Bursa
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_375_21

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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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