When Meningioma Travels: Rare Extracranial Metastasis-Case and Review.

Meningiomas are the most common primary intracranial tumors; extracranial metastases occur in < 1% of cases, most often to the lungs or bone. Hepatic spread is exceptionally rare and is more common in atypical or recurrent disease. A 73-year-old man with a recurrent left frontal atypical meningioma (Grade II, 2016 WHO CNS classification) developed a 4 × 3 cm hepatic lesion 12 years after initial diagnosis. Liver biopsy revealed spindle-cell proliferation positive for EMA and negative for S100 protein, consistent with metastatic meningioma. Subsequent intracranial resection showed focal anaplastic transformation (Grade 3, 2021 WHO CNS classification) with Ki-67 up to 20%. Treatment with Sandostatin and Everolimus stabilized the hepatic lesion, although intracranial recurrences persisted and the patient died during a surgical brain resection of a recurrence from a massive intraoperative hemorrhage. This exceptionally rare hepatic metastasis from an atypical meningioma emphasizes the possible need for long-term systemic surveillance. Repeated recurrences, high mitotic activity, and histologic transformation may predict metastatic potential. Our review of the last decade identified only a few similar extracranial cases, supporting targeted imaging and individualized therapy in high-risk meningiomas.