When Meningioma Travels: Rare Extracranial Metastasis—Case and Review

Meningiomas are the most common primary intracranial tumors; extracranial metastases occur in < 1% of cases, most often to the lungs or bone. Hepatic spread is exceptionally rare and is more common in atypical or recurrent disease. A 73‐year‐old man with a recurrent left frontal atypical meningioma (Grade II, 2016 WHO CNS classification) developed a 4 × 3 cm hepatic lesion 12 years after initial diagnosis. Liver biopsy revealed spindle‐cell proliferation positive for EMA and negative for S100 protein, consistent with metastatic meningioma. Subsequent intracranial resection showed focal anaplastic transformation (Grade 3, 2021 WHO CNS classification) with Ki‐67 up to 20%. Treatment with Sandostatin and Everolimus stabilized the hepatic lesion, although intracranial recurrences persisted and the patient died during a surgical brain resection of a recurrence from a massive intraoperative hemorrhage. This exceptionally rare hepatic metastasis from an atypical meningioma emphasizes the possible need for long‐term systemic surveillance. Repeated recurrences, high mitotic activity, and histologic transformation may predict metastatic potential. Our review of the last decade identified only a few similar extracranial cases, supporting targeted imaging and individualized therapy in high‐risk meningiomas.