Home Life Sciences A de novo meningioma with rapid growth: A possible malignancy imposter?
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A de novo meningioma with rapid growth: A possible malignancy imposter?

  • Zhenjiang Pan , Jing Bao and Shepeng Wei EMAIL logo
Published/Copyright: June 12, 2025

Abstract

Meningiomas, accounting for approximately 33% of primary central nervous system tumors, are the most prevalent type in this category. Advanced age is frequently viewed as a barrier to surgical intervention, yet recent cases have challenged this perception by demonstrating successful outcomes in elderly patients. This case report aims to illustrate the feasibility and benefits of surgical treatment in older individuals. An 84-year-old patient presented with a newly diagnosed meningioma and underwent surgical tumor removal at age 88. Following a comprehensive preoperative evaluation that excluded significant comorbidities, the procedure utilized advanced surgical techniques and optimized postoperative care to ensure safety and recovery. Pathology revealed a World Health Organization grade 1 fibrous meningioma, confirming its benign nature. The patient tolerated the surgery well and recovered successfully, marking her as the oldest reported individual to undergo such treatment. This case demonstrates that advanced age does not inherently limit tumor growth or preclude surgical intervention. Through meticulous patient assessment and personalized treatment strategies, elderly patients can achieve positive outcomes. It highlights the value of a tailored approach, prioritizing overall health and specific medical needs, and supports proactive surgical management to enhance quality of life and clinical results. This challenges traditional assumptions about age-related restrictions on surgical feasibility.

1 Introduction

Meningiomas are the most common primary tumors of the central nervous system (CNS), accounting for approximately one-third of all primary brain and spinal cord tumors [1]. With a median diagnostic age of 65 years, their incidence rises significantly with advancing age [2]. Notably, these tumors are two to three times more prevalent in women than in men, underscoring a striking gender disparity [3,4].

The World Health Organization (WHO) classifies the majority of meningiomas as grade 1, characterized by benign and slow-growing behavior. However, grades 2 (atypical) and 3 (anaplastic) meningiomas, though less common, exhibit aggressive features and higher recurrence rates, posing substantial clinical challenges [5]. Intriguingly, hospital-based studies, especially from tertiary care centers, reveal a disproportionately higher prevalence of these aggressive grades compared to general population data – likely reflecting referral biases and the complexity of cases treated at such institutions [6,7].

Thanks to advancements in neuroimaging and molecular pathology, our understanding of meningioma etiology has deepened, particularly regarding genetic and environmental factors. These insights are paving the way for targeted therapeutic strategies aimed at higher-grade meningiomas [8].

In this context, we report a compelling case of an 84-year-old patient who developed a new meningioma, which was surgically removed at the age of 88. This patient is likely the oldest individual with a WHO grade 1 fibrous meningioma to have undergone successful surgical treatment to date. Her case underscores the vital role of individualized treatment strategies for elderly patients, demonstrating that advanced age alone should not preclude surgical intervention. The patient’s remarkable outcome aligns with emerging evidence advocating for tailored approaches to maximize benefits, even in the aging population [9,10].

2 Case report

An 88-year-old female (weight: 65 kg, BMI: 23.5) presented with a 2-month history of dizziness, blurred vision, and progressive memory decline. Her medical history included type II diabetes mellitus, hypertension, and a 5-year history of anxiety disorder managed with fluoxetine (20 mg daily), with no known drug allergies. Neurological examination revealed normal speech and intact muscle strength (Grade 5) across all major muscle groups; however, visual acuity and fields could not be assessed due to poor cooperation. Brain MRI disclosed a large, heterogeneously enhancing left parasagittal occipital extra-axial mass anchored to the tentorium cerebelli (Figure 1). Retrospective imaging review showed no tumor on CT scans from 2015 to 2018, with the lesion first detected in December 2019 (16.9 mm), exhibiting slow growth to 34.1 mm by September 2021 and accelerated expansion to 54.0 mm by 2023, spanning ages 84–88 (Figures 2 and 3). Under general anesthesia with three-pin head fixation in the lateral prone position, a horseshoe-shaped incision oriented toward the transverse sinus was made. Microscopic dural opening revealed a grayish-white tumor with well-defined margins, no adhesions to the falx cerebri, and moderate vascularity (Figure 4). Originating from the tentorium cerebelli, the tumor was resected en bloc within 2 h, achieving a Simpson Grade 2 resection with local cauterization of the tentorial base. Intraoperative parameters remained stable, with an estimated blood loss of 200 mL and no transfusion required. Post-anesthesia assessment confirmed the patient was conscious, with slow but accurate responses and purposeful limb movements. The postoperative course was unremarkable, with no fever observed. Sutures were removed on postoperative Day 8, and the incision healed excellently (Grade I/A). Postoperative CT scans showed no hemorrhage on Day 2 and occipital lobe rebound by Day 9. Pathology confirmed a WHO Grade 1 fibrous meningioma (Figure 5). The patient was discharged on postoperative Day 11, alert, with fluent speech and preserved neurological function (Grade 5 strength). A telephone follow-up in November 2023, 6 months post-surgery, confirmed her survival and ability to live independently in a nursing home.

Figure 1 
               Brain MRI images demonstrating a large left-sided parasagittal occipital extra-axial mass with heterogeneous enhancement, with the base of the tumor located on the tentorium cerebelli (yellow dashed circle). The mass is isointense to grey matter on T1-weighted images and hyperintense on T2-weighted images (a)–(c); the calcified components are hypointense on T2-weighted images. There is marked contrast enhancement on T1-weighted images with gadolinium (d)–(f).
Figure 1

Brain MRI images demonstrating a large left-sided parasagittal occipital extra-axial mass with heterogeneous enhancement, with the base of the tumor located on the tentorium cerebelli (yellow dashed circle). The mass is isointense to grey matter on T1-weighted images and hyperintense on T2-weighted images (a)–(c); the calcified components are hypointense on T2-weighted images. There is marked contrast enhancement on T1-weighted images with gadolinium (d)–(f).

Figure 2 
               A series of axial CT scans from 2015 to 2023 shows no tumor within the red dashed circle. Within the yellow dashed circle, a tumor is observed growing progressively larger over the years. The mass, located in the occipital region close to the tentorium cerebelli, appears isodense with scattered areas of calcification in its center. The scans correspond to the years 2015 (a), 2018 (b), 2019 (c), 2020 (d), 2021 (e), and 2023 (f).
Figure 2

A series of axial CT scans from 2015 to 2023 shows no tumor within the red dashed circle. Within the yellow dashed circle, a tumor is observed growing progressively larger over the years. The mass, located in the occipital region close to the tentorium cerebelli, appears isodense with scattered areas of calcification in its center. The scans correspond to the years 2015 (a), 2018 (b), 2019 (c), 2020 (d), 2021 (e), and 2023 (f).

Figure 3 
               The tumor growth curve illustrates an increase in diameter from 16.9 mm in 2019 to 54.1 mm in 2023. The annual growth rate of the tumor diameter was approximately 9 mm/year before surgery.
Figure 3

The tumor growth curve illustrates an increase in diameter from 16.9 mm in 2019 to 54.1 mm in 2023. The annual growth rate of the tumor diameter was approximately 9 mm/year before surgery.

Figure 4 
               Photographs were obtained through an operating microscope from the surgeon’s perspective. The areas within the yellow dashed lines and circles represent the tumor. In panel (a), immediately after the dura mater (Me) was opened, the dividing line (yellow dashed line) between the tumor (Tu) and brain tissue is visible. Following the opening of the arachnoid membrane, panel (b) displays the tumor (Tu). Panel (c), taken after partial resection, reveals that the tumor’s texture was slightly soft and its blood supply was moderate. Panel (d) shows that the tentorium cerebelli (Tc) is fully visible after the tumor was completely resected.
Figure 4

Photographs were obtained through an operating microscope from the surgeon’s perspective. The areas within the yellow dashed lines and circles represent the tumor. In panel (a), immediately after the dura mater (Me) was opened, the dividing line (yellow dashed line) between the tumor (Tu) and brain tissue is visible. Following the opening of the arachnoid membrane, panel (b) displays the tumor (Tu). Panel (c), taken after partial resection, reveals that the tumor’s texture was slightly soft and its blood supply was moderate. Panel (d) shows that the tentorium cerebelli (Tc) is fully visible after the tumor was completely resected.

Figure 5 
               Postoperative pathology and imaging. No residual tumor was observed within the yellow dashed circle. Panel (a) displays the head CT on the second day postoperatively, while panel (b) displays it on the eighth day. The operation field is clean, and there is no intracranial bleeding. Panel (c) presents the pathology of a Grade 1 fibrous meningioma, with a Ki-67 index of 1%.
Figure 5

Postoperative pathology and imaging. No residual tumor was observed within the yellow dashed circle. Panel (a) displays the head CT on the second day postoperatively, while panel (b) displays it on the eighth day. The operation field is clean, and there is no intracranial bleeding. Panel (c) presents the pathology of a Grade 1 fibrous meningioma, with a Ki-67 index of 1%.

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

3 Discussion

3.1 A remarkable case of rapidly growing meningioma in an 88-year-old woman

This case tells the compelling story of an 88-year-old woman diagnosed with a newly developed meningioma. Over just 3 years, the tumor grew dramatically from 16 to 54.1 mm in diameter, defying expectations typically associated with advanced age. Initially discovered at age 84, the meningioma measured a mere 16.9 mm, with no signs of brain damage – a finding that justified adopting a conservative “watch and wait” approach, often recommended for small tumors in older patients with limited life expectancy or comorbidities [11].

By the time the patient reached 86, the tumor had grown to 34.5 mm. Despite the significant increase in size, there were no clinical signs of increased intracranial pressure or peritumoral edema (Figure 1e), and the patient remained asymptomatic. Regular follow-up was maintained, aligning with findings from a meta-analysis of 2,130 patients showing that 51% of those with incidental, asymptomatic meningiomas underwent active monitoring, and only 25% required intervention over an average follow-up period of 4 years [12].

However, the story took an unexpected turn. Over the next 2 years, the tumor’s growth accelerated, averaging 11 mm annually, and reached 55.5 mm by the time the patient was 88. Alarmingly, the presence of surrounding edema suggested the possibility of a higher-grade meningioma, raising concerns about the patient’s prognosis [1315]. Surprisingly, the pathological analysis post-surgery revealed a WHO grade 1 fibrous meningioma (Figure 3c), reaffirming its benign nature. This finding stands in contrast to recent reviews suggesting a higher prevalence of grade 2 meningiomas in patients aged 80 and older [16].

Despite the tumor’s rapid progression, the patient’s lack of significant comorbidities allowed for a craniotomy, which successfully removed the mass. The operation proceeded without complications, and the patient made a smooth recovery, returning home shortly thereafter. This case demonstrates that even in the context of rapid tumor growth and advanced age, surgical intervention remains a viable and effective option.

4 Challenging preconceptions: Surgery in the elderly

This case serves as a powerful reminder that advanced age neither slows tumor growth nor inherently contraindicates surgical treatment. While the patient’s tumor exhibited rapid progression, timely intervention, guided by careful monitoring, led to a successful outcome. Emerging evidence suggests that neurosurgical procedures in appropriately selected elderly patients can yield outcomes comparable to those of younger cohorts, provided there are no significant comorbidities [15,16].

Maiuri et al. investigated intracranial meningiomas in patients aged ≥80 years, highlighting their pathological features and surgical challenges. Their study underscores that surgery remains feasible even in very elderly patients, with a notable case involving a 96-year-old individual – surpassing the age of my 88-year-old patient. Key findings emphasize that tumor characteristics, rather than age alone, should guide treatment decisions. Surgical risks, though present, can be mitigated with careful patient selection and tailored approaches. This evidence challenges age-related contraindications, supporting individualized management [16]. My patient’s case aligns with this, though their age is not the upper limit observed.

The findings from this case underscore the importance of personalized treatment plans that consider the patient’s overall health, tumor characteristics, and the potential for improved quality of life. They challenge the long-held notion that advanced age precludes surgery, advocating instead for proactive decision-making tailored to individual circumstances. By embracing this approach, clinicians can help elderly patients achieve outcomes that enhance both their quality of life and clinical prognosis, even when managing benign CNS tumors.

5 Conclusion

Meningiomas, among the most common primary brain tumors, have a striking prevalence in the elderly population. According to the WHO, approximately 80–85% of these tumors are classified as grade 1, underscoring their typically benign nature. Yet, their impact on patients’ quality of life, particularly in advanced age, poses critical challenges.

Thanks to remarkable advancements in science and technology, the landscape of meningioma management has undergone a transformative shift. Our findings illuminate a key paradigm: advanced age should no longer be viewed as a contraindication for surgical intervention. On the contrary, for elderly patients without significant comorbidities, surgical removal of meningiomas is not only feasible but also often life-enhancing.

By prioritizing tailored, patient-specific approaches, modern neurosurgical techniques empower clinicians to achieve successful outcomes, even in older adults. These results challenge outdated assumptions and affirm that age alone is not a barrier to effective treatment. With proper evaluation and intervention, elderly patients can enjoy a restored quality of life, exemplifying the power of precision medicine and innovative care.

  1. Funding information: Auhors state no funding involved.

  2. Author contributions: Zhenjiang Pan and Shepeng Wei conceptualized the study, performed the surgical procedure, collected the clinical data, and drafted the manuscript. Jing Bao conducted the pathological analysis and contributed to the interpretation of the results. Zhenjiang Pan and Jing Bao reviewed the imaging data and assisted in revising the manuscript. All authors critically reviewed and approved the final version of the manuscript for submission.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2024-08-28
Revised: 2025-04-08
Accepted: 2025-04-26
Published Online: 2025-06-12

© 2025 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  126. Phytochemicals of Roman chamomile: Antioxidant, anti-aging, and whitening activities of distillation residues
  127. Circadian gene Cry1 inhibits the tumorigenicity of hepatocellular carcinoma by the BAX/BCL2-mediated apoptosis pathway
  128. The TNFR-RIPK1/RIPK3 signalling pathway mediates the effect of lanthanum on necroptosis of nerve cells
  129. Longitudinal monitoring of autoantibody dynamics in patients with early-stage non-small-cell lung cancer undergoing surgery
  130. The potential role of rutin, a flavonoid, in the management of cancer through modulation of cell signaling pathways
  131. Construction of pectinase gene engineering microbe and its application in tobacco sheets
  132. Construction of a microbial abundance prognostic scoring model based on intratumoral microbial data for predicting the prognosis of lung squamous cell carcinoma
  133. Sepsis complicated by haemophagocytic lymphohistiocytosis triggered by methicillin-resistant Staphylococcus aureus and human herpesvirus 8 in an immunocompromised elderly patient: A case report
  134. Sarcopenia in liver transplantation: A comprehensive bibliometric study of current research trends and future directions
  135. Advances in cancer immunotherapy and future directions in personalized medicine
  136. Can coronavirus disease 2019 affect male fertility or cause spontaneous abortion? A two-sample Mendelian randomization analysis
  137. Heat stroke associated with novel leukaemia inhibitory factor receptor gene variant in a Chinese infant
  138. PSME2 exacerbates ulcerative colitis by disrupting intestinal barrier function and promoting autophagy-dependent inflammation
  139. Hyperosmolar hyperglycemic state with severe hypernatremia coexisting with central diabetes insipidus: A case report and literature review
  140. Efficacy and mechanism of escin in improving the tissue microenvironment of blood vessel walls via anti-inflammatory and anticoagulant effects: Implications for clinical practice
  141. Merkel cell carcinoma: Clinicopathological analysis of three patients and literature review
  142. Genetic variants in VWF exon 26 and their implications for type 1 Von Willebrand disease in a Saudi Arabian population
  143. Lipoxin A4 improves myocardial ischemia/reperfusion injury through the Notch1-Nrf2 signaling pathway
  144. High levels of EPHB2 expression predict a poor prognosis and promote tumor progression in endometrial cancer
  145. Knockdown of SHP-2 delays renal tubular epithelial cell injury in diabetic nephropathy by inhibiting NLRP3 inflammasome-mediated pyroptosis
  146. Exploring the toxicity mechanisms and detoxification methods of Rhizoma Paridis
  147. Concomitant gastric carcinoma and primary hepatic angiosarcoma in a patient: A case report
  148. Ecology and Environmental Science
  149. Optimization and comparative study of Bacillus consortia for cellulolytic potential and cellulase enzyme activity
  150. The complete mitochondrial genome analysis of Haemaphysalis hystricis Supino, 1897 (Ixodida: Ixodidae) and its phylogenetic implications
  151. Epidemiological characteristics and risk factors analysis of multidrug-resistant tuberculosis among tuberculosis population in Huzhou City, Eastern China
  152. Indices of human impacts on landscapes: How do they reflect the proportions of natural habitats?
  153. Genetic analysis of the Siberian flying squirrel population in the northern Changbai Mountains, Northeast China: Insights into population status and conservation
  154. Diversity and environmental drivers of Suillus communities in Pinus sylvestris var. mongolica forests of Inner Mongolia
  155. Global assessment of the fate of nitrogen deposition in forest ecosystems: Insights from 15N tracer studies
  156. Fungal and bacterial pathogenic co-infections mainly lead to the assembly of microbial community in tobacco stems
  157. Influencing of coal industry related airborne particulate matter on ocular surface tear film injury and inflammatory factor expression in Sprague-Dawley rats
  158. Temperature-dependent development, predation, and life table of Sphaerophoria macrogaster (Thomson) (Diptera: Syrphidae) feeding on Myzus persicae (Sulzer) (Homoptera: Aphididae)
  159. Eleonora’s falcon trophic interactions with insects within its breeding range: A systematic review
  160. Agriculture
  161. Integrated analysis of transcriptome, sRNAome, and degradome involved in the drought-response of maize Zhengdan958
  162. Variation in flower frost tolerance among seven apple cultivars and transcriptome response patterns in two contrastingly frost-tolerant selected cultivars
  163. Heritability of durable resistance to stripe rust in bread wheat (Triticum aestivum L.)
  164. Molecular mechanism of follicular development in laying hens based on the regulation of water metabolism
  165. Animal Science
  166. Effect of sex ratio on the life history traits of an important invasive species, Spodoptera frugiperda
  167. Plant Sciences
  168. Hairpin in a haystack: In silico identification and characterization of plant-conserved microRNA in Rafflesiaceae
  169. Widely targeted metabolomics of different tissues in Rubus corchorifolius
  170. The complete chloroplast genome of Gerbera piloselloides (L.) Cass., 1820 (Carduoideae, Asteraceae) and its phylogenetic analysis
  171. Field trial to correlate mineral solubilization activity of Pseudomonas aeruginosa and biochemical content of groundnut plants
  172. Correlation analysis between semen routine parameters and sperm DNA fragmentation index in patients with semen non-liquefaction: A retrospective study
  173. Plasticity of the anatomical traits of Rhododendron L. (Ericaceae) leaves and its implications in adaptation to the plateau environment
  174. Effects of Piriformospora indica and arbuscular mycorrhizal fungus on growth and physiology of Moringa oleifera under low-temperature stress
  175. Effects of different sources of potassium fertiliser on yield, fruit quality and nutrient absorption in “Harward” kiwifruit (Actinidia deliciosa)
  176. Comparative efficiency and residue levels of spraying programs against powdery mildew in grape varieties
  177. The DREB7 transcription factor enhances salt tolerance in soybean plants under salt stress
  178. Using plant electrical signals of water hyacinth (Eichhornia crassipes) for water pollution monitoring
  179. Food Science
  180. Phytochemical analysis of Stachys iva: Discovering the optimal extract conditions and its bioactive compounds
  181. Review on role of honey in disease prevention and treatment through modulation of biological activities
  182. Computational analysis of polymorphic residues in maltose and maltotriose transporters of a wild Saccharomyces cerevisiae strain
  183. Optimization of phenolic compound extraction from Tunisian squash by-products: A sustainable approach for antioxidant and antibacterial applications
  184. Liupao tea aqueous extract alleviates dextran sulfate sodium-induced ulcerative colitis in rats by modulating the gut microbiota
  185. Toxicological qualities and detoxification trends of fruit by-products for valorization: A review
  186. Polyphenolic spectrum of cornelian cherry fruits and their health-promoting effect
  187. Optimizing the encapsulation of the refined extract of squash peels for functional food applications: A sustainable approach to reduce food waste
  188. Advancements in curcuminoid formulations: An update on bioavailability enhancement strategies curcuminoid bioavailability and formulations
  189. Impact of saline sprouting on antioxidant properties and bioactive compounds in chia seeds
  190. The dilemma of food genetics and improvement
  191. Bioengineering and Biotechnology
  192. Impact of hyaluronic acid-modified hafnium metalorganic frameworks containing rhynchophylline on Alzheimer’s disease
  193. Emerging patterns in nanoparticle-based therapeutic approaches for rheumatoid arthritis: A comprehensive bibliometric and visual analysis spanning two decades
  194. Application of CRISPR/Cas gene editing for infectious disease control in poultry
  195. Preparation of hafnium nitride-coated titanium implants by magnetron sputtering technology and evaluation of their antibacterial properties and biocompatibility
  196. Preparation and characterization of lemongrass oil nanoemulsion: Antimicrobial, antibiofilm, antioxidant, and anticancer activities
  197. Corrigendum
  198. Corrigendum to “Utilization of convolutional neural networks to analyze microscopic images for high-throughput screening of mesenchymal stem cells”
  199. Corrigendum to “Effects of Ire1 gene on virulence and pathogenicity of Candida albicans
  200. Retraction
  201. Retraction of “Down-regulation of miR-539 indicates poor prognosis in patients with pancreatic cancer”
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