- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
- Tokyo Women's Medical University Institute for Integrated Medical Sciences, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
- Kofu Neurosurgery Hospital, 1-16-18 Sakaori, Kofu, Yamanashi, 400-0805, Japan
Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan
DOI:10.4103/2152-7806.132957Copyright: © 2014 Hirota K This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Hirota K, Fujita T, Akagawa H, Onda H, Kasuya H. Spontaneous regression together with increased calcification of incidental meningioma. Surg Neurol Int 21-May-2014;5:73
How to cite this URL: Hirota K, Fujita T, Akagawa H, Onda H, Kasuya H. Spontaneous regression together with increased calcification of incidental meningioma. Surg Neurol Int 21-May-2014;5:73. Available from: http://sni.wpengine.com/surgicalint_articles/spontaneous-regression-together-with-increased-calcification-of-incidental-meningioma/
Background:Regression of meningioma has been reported after hemorrhage or hormonal withdrawal. However, meningioma regression is rarely observed spontaneously.
Case Description:A right falx meningioma was incidentally diagnosed and was followed at every one-year by magnetic resonance imaging (MRI) for over 7 years. The tumor, with a maximum diameter of 4 cm, showed a slightly high density and was enhanced on computed tomography (CT), and a high intensity with a low-intensity core on T2 MRI, with significant edema. The meningioma gradually shrank together with a decrease of edema and increase of calcification. The initial volume, 25.5 cm3, regressed linearly to less than half, 9.9 cm3.
Conclusion:Here, we report a case of an incidentally diagnosed meningioma that regressed spontaneously. The pattern of the regression was similar to that following gamma knife radiosurgery.
Keywords: Calcification, incidental, meningioma, regression
Regression of meningioma has been reported after hemorrhage or hormonal withdrawal.[
A 66-year-old female patient with an incidentally diagnosed meningioma was introduced to our hospital. A right falx meningioma with a maximum diameter of 4 cm showed a slightly high density and was enhanced on CT, and a high intensity with a low-intensity core on T2 MRI, with significant edema. There were no neurological deficits nor subjective complaints related to the tumor. She is a carrier of hepatitis C, infected by blood transfusion during surgery for uterine myoma when she was 30 years old. She was diagnosed with diabetes mellitus (DM) at the age of 64 (HbA1c: 7.4%), and treatment with insulin started 18 months before the diagnosis of meningioma. Blood sugar has been poorly controlled (last HbA1c: 8.5%). The meningioma was followed by MRI every year. The size of the tumor gradually reduced with a decrease of edema and increase of calcification over 7 years. The length, depth, and width were measured by coronal and axial T2-weighted MRI. The initial volume (=length × depth × width × 0.5),[
The length, depth, and width were measured at every one-year follow-up MRI. The initial tumor volume, 25.5 cm3 (3.8 × 4.2 × 3.2 cm), regressed linearly to less than half, 9.9 cm3 (2.9 × 3.1× 2.2 cm). The right falx meningioma with calcification and surrounding edema (a) reduced in size, with less edema, along with an increase of calcification on CT and MRI over 7 years (b)
The natural history of meningiomas has been studied extensively.[
CT and MRI of the present patient showed a trace of calcification at the beginning of follow-up, and the level of calcification increased gradually. It is well-known that meningiomas not associated with calcification on imaging are more likely to progress than calcified meningiomas.[
The etiology of peritumoral brain edema associated with meningiomas is multifactorial.[
It has been reported that almost all types of malignant tumors can regress spontaneously, although some histological types regress more frequently than others. The processes involved in the spontaneous regression are mainly related to the process of apoptosis and activity of the immune system, as well as to conditions in the tumor microenvironment. Such processes are occasionally linked more or less directly to oncogenic suppressors of DNA.[
Insulin treatment was started 18 months before and continued during the follow-up period. Insulin is a hormone that plays a key role in the regulation of blood glucose levels, and a number of roles and functions in metabolism and cell growth.[
Follow-up periods of meningioma patient in the literature are mostly within 5 years.[
Here, we report a case of an incidentally diagnosed meningioma that regressed spontaneously. The pattern of the regression was similar to that following GKRS.
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