We report the case of a 59-year-old man who consulted for an intellectual deficit, seizures, syncope, disorientation and stupor in the previous days.
The non-contrast-enhanced CT scan showed a peripheral left frontal lesion of 3'5 cm in diameter, with a broad base and mass effect, accompanied by trans-subcisive hernia, collapse of the third ventricle and dilatation of the lateral ventricles
These findings were interpreted as the presence of a menigioma of the left frontal lobe and resection was performed in December 2000.
Histopathology was reported as a partially calcified meningeal osteosarcoma (Macr: Masa 5'2x4'5 cms).
Mycrosis: Well-defined osteogenic tumor, without parenquima.
Irregular trabeculae containing areas of bone voids, well differentiated areas with osteoclastic cells, necrosis and hemorrhage.
99mTechnetium scintigraphy was positive in the surgical field, normal laboratory tests and body CT showed paralysis of the left hemidiaphragm and hydrothorax.
Since the lesion had collapsed and ruled out metastatic involvement, the patient started an adjuvant chemotherapy program, but after a first cycle of cisplatin and adriamycin, magnetic resonance imaging showed the persistence of a meningeal mass.
A second resection was performed with wide margins and the pathologist informed in the specimen the persistence of an osteosarcoma of the dural meninge, with brain tissue and bone tissue infiltration.
An adjuvant chemotherapy regimen was programmed with cyclophosphamide 600 mg/m2, bleomycin 15 mg/m2 and actinomycin-D 0'6 mg/m2 (day 1/21 days) and methotrexate weekly.
For this reason, adjuvant RT was administered from March to May 2000, 50 + 14 Gy (5x2 Gy/week) of 60Cobalto.
The patient continued revisions until May 2003, when a local relapse was discovered by MRI, and was sent to the Neurosurgery Service of Carlos Haya Hospital in Malaga.
On May 11, 2003, referring to intellectual deficit and urinary incontinence, a new CMNB was performed showing an expansive frontoparietal process, extended to the right frontal lobe and to the corpus callosum in both lungs.
Surgery, CT and RT were ruled out, and high-dose corticosteroids were administered, resulting in initial improvement.
However, on August 30, 2003, the patient came to the emergency room of our center, presenting a severe deterioration of consciousness, with a Karnoffsky index of 30%, dyspnea and thrombosis of the left femoral system.
After achieving stabilization, active oncological treatment was implemented and the patient was in charge of our Palliative Care Unit.
