The American Journal of Medicine
Volume 121, Issue 5 , Pages e1-e2, May 2008

Intracranial Meningioma Mimicking a Carcinoid Tumor

  • Arnaud Millet, MD

      Affiliations

    • Department of Internal Medicine, Hopital Sud, Rennes, France
    • Corresponding Author InformationRequests for reprints should be addressed to Arnaud Millet, MD, Department of Internal Medicine, 16 Boulevard de Bulgarie, 35203 RENNES Cedex, France.
    • ,
  • Xavier Morandi, MD

      Affiliations

    • Department of Neurosurgery, Hopital Pontchaillou, Rennes, France
    • ,
  • Mohamed Hamidou, MD

      Affiliations

    • Department of Internal Medicine, Hotel-Dieu, Nantes, France
    • ,
  • Patrick Jego, MD

      Affiliations

    • Department of Internal Medicine, Hopital Sud, Rennes, France

Article Outline

 

To the Editor:

We describe the case of a patient with clinical features suggestive of a gastrointestinal carcinoid tumor that in fact corresponded to complex partial epilepsy caused by an intracranial meningioma.

Back to Article Outline

Case Report 

A 56-year-old woman presented with a 6-month history of sweating, weight loss, diarrhea, palpitations, and mild headache. She had episodes of malaise with profuse sweating and pallor, occurring 2 or 3 times per day and typically lasting a few minutes. An episode of chest pain led her to consult her local hospital. Heart disease was ruled out, and she was admitted to our department. The physical findings were unremarkable. She had lost 7 kg during the previous 6 months and reported episodes of rectal bleeding. A 10-minute episode of cutaneous flushing was observed. The results of routine laboratory tests were unremarkable and included normal urinary and plasma catecholamine, urinary 5-hydroxyindoleacetic acid, and urinary metanephrine and vanillylmandelic acid levels. Computed tomography and sonography of the abdomen revealed biliary cysts. Colonoscopy with systematic biopsies was normal. The electroencephalogram was normal.

To detect a possible carcinoid tumor, we performed In111 pentetreotide (OctreoScan; Mallinckrodt, Inc, St. Louis, Mo) scintigraphy and observed uptake in the right cerebral hemisphere (Figure 1A). Magnetic resonance imaging revealed a tumor consistent with a meningioma (Figure 1B). The tumor was surgically removed, and histopathologic examination disclosed a benign meningioma. The postoperative course was uneventful, and the patient's symptoms disappeared. The final diagnosis was a meningioma of the right temporal lobe revealed by partial complex epilepsy with vegetative symptoms mimicking a gastrointestinal carcinoid tumor.

  • View full-size image.
  • Figure 1. 

    A, In111 pentetreotide (OctreoScan) scintigraphy showing intense uptake in the right cerebral hemisphere. B, Magnetic resonance imaging showing a homogeneous, gadolinium-enhancing, extra-axial tumor measuring 7×5×5 cm, located in the right temporal lobe, with a prominent dural-based tail. These findings were consistent with a meningioma.

Back to Article Outline

Discussion 

Carcinoid tumors are the most common endocrine malignancy. The clinical manifestations depend on the active substances that these tumors secrete and, in the case of gastrointestinal carcinoids, on the tumor location. The classic carcinoid syndrome occurs in less than 10% of patients.1

Phaeochromocytoma was a differential diagnosis but was virtually ruled out by normal biochemical values and computed tomography findings.2

We used In111 pentetreotide (OctreoScan) scintigraphy to locate a suspected carcinoid tumor. The sensitivity of this method is approximately 90%,1 but its specificity is undermined by the fact that a broad spectrum of neuroendocrine and non-neuroendocrine tumors also express somatostatin receptors.3 Magnetic resonance imaging suggested a meningioma, but one third of patients with metastatic carcinoid tumors have central nervous system disorders.4 Furthermore, carcinoid tumors can metastasize to the brain without the extracranial primary lesion being detectable5: Smith et al6 reported the case of an extracranial primary carcinoid tumor that metastasized to a preexisting brain meningioma. In our patient, histopathologic examination eliminated a carcinoid tumor and confirmed the presence of a meningioma.

Our patient's symptoms were of a gastrointestinal nature, and this retrospectively raised the possibility of abdominal epilepsy, an uncommon syndrome. The gastrointestinal manifestations of this type of seizures include abdominal pain, nausea, diarrhea, and bloating. Extra-gastrointestinal manifestations can include loss of consciousness, generalized tonic-clonic seizures, dizziness, headache, pallor/sweating, extremity pain, numbness, and blindness.7 The episodes typically last no more than a few minutes. Most cases of abdominal epilepsy are of temporal lobe origin,7 and they may be either idiopathic or tumor related, as in our patient.

Back to Article Outline

References 

  1. Modlin I, Kidd M, Latich I, et al. Current status of gastrointestinal carcinoids. Gastroenterology. 2005;128:1717–1751
  2. Ilias I, Pacak K. Current approaches and recommended algorithm for the diagnosis localization of phaeochromocytoma. J Clin Endocrinol Metab. 2004;89:479–491
  3. Rambaldi P, Cuccurullo V, Briganti V, Mansi L. The present and future role of 111In Pentetreotide in the PET era. Q J Nucl Med Mol Imaging. 2005;49:225–235
  4. Patchell RA, Posner JB. Neurologic complications of carcinoid. Neurology. 1986;36:745–749
  5. Deshaies E, Adamo MA, Qian J, Dirisio DA. A carcinoid tumor mimicking an isolated intracranial meningioma (Case report). J Neurosurg. 2004;101:858–860
  6. Smith TW, Wang SY, Shoene WC. Malignant carcinoid tumor metastatic to a meningioma. Cancer. 1981;47:1872–1877
  7. Zinkin N, Peppercorn M. Abdominal epilepsy. Best Pract Res Clin Gastroenterol. 2005;19:263–274

PII: S0002-9343(08)00071-5

doi:10.1016/j.amjmed.2008.01.027

The American Journal of Medicine
Volume 121, Issue 5 , Pages e1-e2, May 2008

Article Tools

* Image Usage & Resolution