title: Metastatic Atypical and Anaplastic Meningioma: A Case Series and Review of the Literature.
abstract: BACKGROUND
  Atypical (World Health Organization grade II) and anaplastic (World Health Organization grade III) meningiomas are rare, accounting for less than 5% of all meningiomas. Histologic grading has a significant impact on prognosis, risk of recurrence, and the need for adjuvant radiation or chemotherapy. Extracranial metastases are even more infrequent and occur in 0.1% of all cases.
  
  
  METHODS
  Retrospective chart review of 168 patients with diagnosis of WHO grade II and III meningiomas was performed. Six patients with histologically confirmed metastatic disease were identified.
  
  
  RESULTS
  We discuss the clinical, radiologic, and histopathologic clinical course of 6 patients with metastasis to the lung, liver, and spine from all patients with atypical or anaplastic meningioma treated at Johns Hopkins Hospital from 1993 to 2014.
  
  
  CONCLUSIONS
  We reviewed the literature pertaining to this phenomenon and subsequently assessed the clinical benefits of adjuvant chemotherapeutic agents in patients with meningioma with metastatic disease.
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Remi A
authors.initials: RA
authors.lastname: Kessler
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Tomas
authors.initials: T
authors.lastname: Garzon-Muvdi
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Wuyang
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Weingart
authors.affiliation: Department of Neurosurgery, Policlinico Universitario A. Gemelli, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.affiliation: Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. Electronic address: mlim3@jhmi.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Lim
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D008579:Meningioma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D039781:PubMed / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
keywords: Anaplastic; Atypical; Meningioma; Metastasis; Resection