Dural-based metastatic carcinomas mimicking primary CNS neoplasia: Report of 7 cases emphasizing the role of timely surgery and accurate pathologic evaluation

Natasha Marie Savage, Cargill Herley Alleyne, John R Vender, Ramon E Figueroa Ortiz, Hui Zhang, Thomas A. Samuel, Suash Sharma

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Clinical presentation with dural-based metastasis mimicking meningiomas is rare. We aimed to evaluate the role of frozen section in guiding surgery and histopathologic diagnosis in determining primary sites of dural-based metastatic carcinomas. Following the receipt of HAC approval, we retrospectively reviewed 7cases presenting with dural-based masses clinically suspected to be primary brain tumors (6 meningiomas and 1 superficial glioblastoma), but diagnosed to be metastatic carcinomas on subsequent resection. Pertinent clinical records and follow-up data were reviewed. Patient's age ranged from 59 to 80 years. Imaging showed extra-axial dural-based masses with contiguous but not primary brain involvement. On intra-operative frozen section (not performed in case 7), differential diagnoses included metastatic carcinoma in all cases, and surgery modified accordingly. Nesting, cribriform, and "picket-fence" like glands were among useful histologic diagnostic patterns. Immunoprofile supported histologic diagnosis in all cases. Subsequent clinical and radiologic evaluation confirmed coexistent sites of origin in all cases. The metastases were solitary in all cases; except multiple dural-based tumors in case 1, in which interestingly no systemic metastasis were identified. Dural-based metastatic carcinomas mimicking meningiomas may be solitary, of unknown primary, or without concomitant systemic spread on imaging. Frozen section evaluation is helpful in modifying surgery. Although high-grade, these are typically differentiated enough to allow accurate histopathologic diagnosis, and reasonable determination of primary tumor site, especially with a judicious panel of cytokeratins, transcription factors, hormone receptors and relatively organ-specific markers. Clinicians and pathologists need to be aware of the occurrence, spectrum, need for timely intervention, and accurate diagnosis of dural-based metastatic carcinomas.

Original languageEnglish (US)
Pages (from-to)530-540
Number of pages11
JournalInternational Journal of Clinical and Experimental Pathology
Issue number5
StatePublished - Nov 2 2011


  • Dural
  • Frozen section
  • Immunohistochemistry
  • Meningioma
  • Metastatic carcinoma
  • Radiology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology


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