Diagnostic and Management Considerations in a Patient With Primary Pulmonary Meningioma With Associated Micro-Solid Nodules

Primary pulmonary meningiomas (PPMs) are rare mesodermal tumors that arise in the lung and are most often incidentally identified as single pulmonary nodules. Most cases of PPM are benign, and surgical resection remains the primary curative treatment. We describe the case of a 65-year-old asymptomatic female who presented with an incidentally identified 2.5 x 1.7-cm lobulated, non-calcified mass in the right lower lobe of the lung, which was diagnosed as PPM that had low fluorodeoxyglucose (FDG)-avidity and associated sub-centimeter nodules present in the same lobe. The patient was closely monitored and the nodules showed essentially no interval enlargement over several months. Given the disparate locations and small sizes of the nodules, no surgical resection was planned. The patient remained clinically stable, and close medical monitoring was determined to be the best course of action. Our case highlights the viability of medical monitoring as an alternative to surgery in asymptomatic patients with benign PPMs that have associated micronodules.