Abstract
RATIONALE: Primary ectopic meningiomas (PEMs) are extremely rare, with limited literature available on the subject. Understanding their clinical and radiological characteristics is crucial for accurate diagnosis and treatment. PATIENT CONCERNS: This study presents a case of a multicentric PEM involving the lungs and cranial bone barrier, aiming to provide new insights into its clinical and diagnostic features. DIAGNOSES: A 46-year-old woman with no prior history of intracranial meningiomas or other tumors was found to have multiple lobulated nodules in the lungs during a routine physical examination. Computed tomography scans revealed well-defined lesions with mild to moderate heterogeneous enhancement. Magnetic resonance imaging showed a lesion at the cranial bone barrier, which presented as a high-signal area on T2-weighted FLAIR images and mild to moderate enhancement on T1-weighted images. The magnetic resonance spectroscopy displayed a broad Lip peak but lacked N-acetylaspartate or creatine peaks. Histopathological and immunohistochemical analyses confirmed the diagnosis of multicentric PEMs. INTERVENTIONS: We performed surgical resection of the lesion on the cranial bone plate and conducted follow-up examinations for the multiple lesions in the lungs. OUTCOMES: This case highlights the diagnostic challenges of multicentric PEMs involving the lungs and cranial bone barrier. Due to their extremely low incidence and nonspecific clinical manifestations, a comprehensive evaluation combining radiological, pathological, and immunophenotypic data is essential for accurate diagnosis. LESSONS: This case underscores the importance of a thorough, multidisciplinary approach to diagnosis and treatment and provides valuable insights for managing similar rare cases.