Purely Epidural Thoracic Meningioma With Elevated Ki-67 in a Postmenopausal Female With Prior Gynecologic Malignancies: A Case Report

Meningiomas are common central nervous system (CNS) tumors; however, purely epidural spinal meningiomas are an exceedingly rare subtype. Their differentiation from other extradural lesions, particularly in patients with a history of malignancy, remains a diagnostic challenge. Additionally, the potential influence of hormonal factors on meningioma development is not fully understood. Here, we present the case of a 60-year-old female with a purely epidural thoracic meningioma, notable for its occurrence after a history of stage IA endometrial and ovarian cancer. Despite its classification as a World Health Organization (WHO) Grade 1 meningioma, the tumor exhibited an elevated Ki-67 index of 4.5%, a finding rarely documented in purely extradural spinal meningiomas. This case contributes to the limited literature on extradural meningiomas and raises questions about the biological behavior of such tumors, particularly in patients with prior gynecologic malignancies and hormone replacement therapy exposure. This case underscores the importance of considering oncologic history and hormonal influences in the evaluation of spinal tumors. It also highlights the diagnostic and management challenges associated with purely epidural meningiomas and emphasizes the potential role of Ki-67 as a prognostic marker in extradural lesions. Further research is warranted to explore the interplay between hormonal factors and meningioma pathogenesis.