Oesophageal adenocarcinoma metastasis into a microcystic meningioma: a rare occurrence of tumour to tumour metastasis

A 78 year old male was admitted with a history of a fall following seizures. This occurred 2 years post curative treatment (minimally invasive oesophagectomy with neo adjuvant chemotherapy) for an oesophageal adenocarcinoma staged T3N0M0. On examination, patient had left-sided hemiparesis. A Computed Tomography (CT) and Magnetic Resonance Image (MRI) of the head confirmed a right frontotemporal meningioma with features suggestive of internal haemorrhage or calcification and mild local mass effect. A joint decision was made between the local neuro-surgical and neurology departments to manage this conservatively. However, due to progressive neurological deterioration and a concomitant increase in the size of the haemorrhagic lesion, emergent surgical intervention was indicated. The patient underwent a Simpson one complete resection (complete tumour resection including associated dura matter and abnormal underlying bone). Postoperative histology confirmed a rare case of metastatic oesophageal adenocarcinoma to a microcystic meningioma (World Health Organization Grade I). The meningioma was the only known site of distant metastasis for the oesophageal adenocarcinoma. Our case highlights the only documented case of the adenocarcinoma subtype of oesophageal tumour metastasizing to a meningioma. This case demonstrates the rare but well documented occurrence of tumour to tumour metastasis. It highlights the importance played by imaging and clinical correlation when assessing progressively growing meningiomas in patients with a history of or underlying malignancy.