RECURRENT FUNGATING ANAPLASTIC MENINGIOMA: A CASE REPORT

Dr. Mahmood Al Hatali, Dr. Simin Laiq, Dr. Zahra Al Hajri, Dr. Aziz Haris, Dr Aiman Al Salmi, Dr. Livingston C., Dr. Fahad Al Khadr, Dr. Ahmed Wadee, Dr. Kaurher Al Zakwani, Dr. Yaqoob Al Saidi, Dr. Arshad Kabir Khan, Dr Sadia Durrani, Dr. Neeraj Salhotra*

ABSTRACT

Anaplastic meningioma, CNS WHO grade 3, is a rare and aggressive tumor characterized by a high risk of local recurrence and poor prognosis. Maximal safe surgical resection followed by radiotherapy remains the mainstay of treatment, while effective systemic chemotherapy for recurrent disease remains limited. We report an unusual case of recurrent meningioma presenting as a large fungating scalp mass. A 50-year-old man presented in 2022 with headache, seizures, and right-sided weakness. Imaging revealed a large right parietal extra-axial mass extending across the midline. He underwent craniectomy and tumor excision; complete removal was limited by venous sinus involvement, and residual tumor remained along the sinus. Initial histopathology showed an atypical meningioma, CNS WHO grade 2. Radiotherapy was advised, and subsequent imaging demonstrated progressive residual disease. Further surgery was initially declined. By August 2026, the tumor had progressed to a large fungating scalp mass with a small intracranial component. Palliative resection was subsequently performed, followed by reconstruction with a rotation flap and skin graft. Histopathology now demonstrated an anaplastic meningioma, CNS WHO grade 3. The postoperative course was uneventful, and palliative radiotherapy was advised. This case highlights the potential for aggressive local progression and histopathological transformation of recurrent atypical meningioma and emphasizes the importance of early multidisciplinary management.

Keywords: Anaplastic meningioma; atypical meningioma; CNS WHO grade 3; recurrent meningioma; fungating tumor; scalp.