A case of multiples liver metastases from a grade 2 brain meningioma: a rare entity with comprehensive literature review.

Introduction and importance: Meningiomas are primary benign extra-axial central nervous system neoplasms that originate in meningothelial cells. Extra-neurological metastases are quite rare and occur in 0.1% of cases. The main metastatic sites are usually the lungs, bones, pleura, mediastinum and lymph nodes. Hepatic locations are quite rare and account for ~3% of all extracranial metastases. The dissemination route is still a subject of debate. Suggested routes of dissemination include the venous system, lymph nodes, or even cerebrospinal fluid. The treatment is based on complete surgical excision or on radiosurgery and adjuvant radiotherapy in case of subtotal resection.

Case presentation: The authors present the following clinical case of a 31-year-old healthy male patient with surgical history of meningioma excisions, who presents, 3 years later, evidence of liver masses on tomography and confirmed diagnosis of liver metastases from brain meningioma after biopsy with favorable outcomes after chemotherapy.

Clinical discussion: The overall incidence of extra-neurological metastases of meningiomas remains low. The vast majority of these metastases concern those of high grade, namely WHO grade 2 and 3 as it was reported in our case. Hepatic metastases remain quite rare and account for ~3% of all extracranial locations. Due to these characteristics of having low recurrence and its rare frequency of metastasis to extracranial sites, the authors, through their case, will dig into the literature to dissect this rare entity.

Conclusion: In the report of liver lesions, the first differential diagnosis in mind should be metastatic lesions, if there is a prior clinical history of primary tumors.