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ANAPLASTIC MENINGIOMA
Authored By: Keith Fischer and Shane Inoue.
Patient: 49 year old female
History: 49 year old female: with malignant anaplastic meningioma status post surgical resection with recurrence now involving the cavernous sinus. We are asked to evaluate for somatostatin-receptor positivity prior to confirm that somatostatin treatment of the meningioma might be efficatious
Image Size:[small][as-submitted]

Fig. 1
Planar images

Fig. 2
Axial SPECT images

Fig. 3
Coronal SPECT images

Fig. 4
Saggital SPECT images

Fig. 5
T1 post contrast MR demonstrating progression of the lesion
Image Size:[small][as-submitted]

Findings:

There is an area of intense radiotracer uptake in the cranium, centrally just to the left of midline, corresponding to the nodular enhancement noted adjacent to the left cribriform plate and within the left cavernous sinus, seen on the recent MRI examination. There are two other areas of mild radiotracer uptake seen more anteriorly and superiorly relative to the lesion described above, in the region of the left frontal lobe.

Opinion:
1. Intense radiotracer uptake corresponding to nodular enhancement adjacent to the left cribriform plate and cavernous sinus seen on recent MRI. This almost certainly represents somatostatin-receptor positive tumor.

2. Two areas of mild radiotracer uptake in the region of the left frontal lobe. Although tumor cannot be excluded, octreotide has been known to concentrate in areas of prior radiation treatment.

DDx: Somatostatin-receptor positive meningioma given the combination of nuclear medicine and MRI findings.
Diagnosis: Somatostatin-receptor positive meningioma.
Specific Discussion: A study published in Neurology found that of patients with recurrent meningiomas that demonstrated overexpression of somatostatin receptors, monthly treatment with long-acting somatostatin yeilded a partial radiographic response in 31% of patients with 44% achieving progression-free survival at 6 months.
References: Thank you to Joseph Mettenburg, M.D., Ph.D. for submitting this case.

Neurology 2007;69:969-973.
Comments:
No comments posted.
Additional Details:

Case Number: 123649Owner(s): Keith Fischer and Shane InoueLast Updated: 02-07-2013
Anatomy: Cranium and Contents   Pathology: Neoplasm
Modality: MR, Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: meningioma

Case has been viewed 41 times.
Certified by Keith Fischer on 11-02-2010

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