A 30-year-old woman presented with progressive headache she had experienced for 1 month. Brain computed tomography results showed a hyperdense frontal mass arising from the left olfactory groove, with marked homogeneous enhancement after contrast injection. She reported cessation of her headache after complete tumor removal (Simpson grade I). A histopathologic diagnosis of meningothelial meningioma (World Health Organization [WHO] grade I) was made.
Fifteen years later, the patient reported left retro-orbital pain. Brain computed tomography findings revealed local tumor recurrence with left superior orbit involvement. Macroscopically, total tumor resection (Simpson grade III) was achieved, and the histological diagnosis was, again, meningothelial meningioma (WHO grade I).
Gadolinium-enhanced T1-weighted magnetic resonance image shows a left orbital meningioma also involving the ethmoidal sinus, the clinoidal region, and the left cavernous sinus (arrows, A), several subcutaneous scalp meningiomas (arrowheads, A and B), and 1 meningioma in the skull (arrow, B). Thoracoabdominal computed tomogram shows multiple pulmonary and hepatic masses (arrows, C and D).
Biopsy of the subcutaneous nodular scalp lesion (arrow, A) and pulmonary lesion (arrow, D) demonstrated, via hematoxylin-eosin stain, atypical meningiomas in the hypoderm (arrows, B [original magnification, ×40] and C [original magnification, ×100]) and in the pulmonary tissue (arrows, E [original magnification, ×40] and F [original magnification, ×100]).
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