Rare pulmonary metastases of atypical meningioma diagnosed on total-body 18F-FDG PET/CT.

Here we reported a 59-year-old male who had undergone brain surgery three times and the pathological results showed atypical meningioma (2015, WHO grade I; 2018, WHO grade II; 2019, WHO grade II-III), with multiple pulmonary nodules, which arose during follow-up. A total-body ¹⁸F-FDG PET/CT showed multiple solid nodules with increased ¹⁸F-FDG metabolism (SUVmax = 8.6). The patient underwent a CT-guided lung biopsy and the histopathological study showed positive staining of epithelial membrane antigen (EMA), vimentin (VIM), SSTR2, Ki67 (20%), and negative staining of CK, TTF-1, CD34, SY, PR, P40, respectively. Based on the history and immunohistology results, multiple pulmonary metastases from atypical meningioma were finally diagnosed, since double positive staining of EMA and VIM supported the diagnosis of meningioma and negative staining excluded primary lung cancers. The patient has given up any treatment because of personal reasons. Pulmonary metastasis from meningioma is rare, accurate diagnosis should be based on medical history, imaging characteristics, and histopathological findings.