Small-cell lung carcinoma presenting with otalgia and hearing impairment
Journal
Journal of Clinical Oncology
Journal Volume
26
Journal Issue
28
Pages
4690-4692
Date Issued
2008
Abstract
Grade 1 tumors almost never metastasize or invade adjacent structures. However, as this case demonstrates, a subset of grade 1 meningiomas can have malignant potential. One potential predictor of aggressive meningioma is the Ki-67 index, a marker of cell proliferation. The Ki-67 proliferative index (PI) has been identified as an independent predictor of both survival and tumor recurrence in meningiomas, 14 but is not part of the WHO staging system. In a retrospective study by Ohta et al, 14 recurrent meningiomas had a mean PI of 5.7%, metastatic meningiomas had a mean PI of 14.7%, and nonrecurrent, nonmetastatic meningiomas had a mean PI of 1%. In addition to PI, primary tumor appearance on imaging may be useful. One study indicated that multiple lobulations and a "mushrooming" appearance may correlate with malignant potential. 2 Based on these criteria, our patient's initial imaging studies (Figs 1A and 1B) may have been an early clue to the aggressive nature of her disease, though the prolonged time course between initial surgery and symptoms of recurrent disease is not compatible. In summary, most meningiomas are benign and never undergo malignant transformation. However, a small subset of meningiomas, usually those with atypical histological features, can metastasize. For this reason, we emphasize the importance of considering the possibility of metastasis in patients with a history meningioma who present with symptoms that cannot be explained solely by tumor mass effect in the brain. This is especially true for patients with recurrent meningiomas. The clinician should also consider performing additional tests, like staining for Ki-67, to identify those histologically benign-appearing meningiomas with increased malignant potential.
SDGs
Type
journal article