Case report Multiple meningiomas in a woman irradiated in utero Annie S. Chen a,⇑ , Katharine J. Drummond a,b , Mohamad M. Jallad a , Iddo Paldor a a Department of Neurosurgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia b Department of Surgery, University of Melbourne, Melbourne, VIC, Australia article info Article history: Received 24 March 2016 Accepted 31 March 2016 Available online xxxx Keywords: Fetal radiation In utero radiation Meningioma Pregnancy Radiation abstract Meningiomas are a common central nervous system tumour and radiation is a known risk factor for their development. In utero radiation exposure correlates to developmental abnormalities and carcinogenesis in a dose- and gestational age-related manner. Radiation induced meningioma has been reported in detail in the literature in patients who had been irradiated earlier in life. At the time of publication, there was no data on radiation exposure whilst in utero and meningioma. We report on a 42-year-old woman with multiple intracranial meningiomas and no other risk factors except a history of in utero exposure to low dose X-ray radiation at 12 weeks gestational age. Ó 2016 Published by Elsevier Ltd. 1. Introduction Meningiomas are a common tumour of the central nervous sys- tem. Several risk factors are known for the development of intracranial meningiomas, including ionizing radiation and genetic anomalies [1,2]. Abdominal irradiation in the pregnant woman and the risk of fetal radiation exposure has been investigated thor- oughly in the past few years [3–6]. In utero radiation (IUR) expo- sure has been shown to correlate to small head size, lower IQ, and growth retardation [6]. The risk is proportional to the radiation dose exposure, the direction of the radiation beam and the timing during pregnancy of exposure [7,8]. The evidence of correlation between IUR and brain tumours in the offspring has been inconclu- sive, and has focused mainly on malignant brain tumours including astrocytomas and primitive neuroectodermal tumour (PNET) [9– 16]. There is no data for the prevalence of meningiomas following in utero exposure to radiation and it is unclear whether in utero exposure portends the same risk for development of meningioma as exposure to radiation later in life. We present a case of multiple meningiomas in a patient with no other risk factors, whose mother was exposed to radiation when 12 weeks pregnant. To our knowledge, this is the first case describ- ing an association between in utero radiation and meningioma. A review of the literature follows. 2. Case report A previously healthy 42-year-old woman presented with a one- month history of progressively worsening headache. Neurological examination was normal apart from mild papilloedema. She underwent MRI of the brain, which revealed at least four distinct extra-axial lesions consistent with multiple meningiomas (Fig. 1). The largest lesion was a tentorial meningioma in the pineal region causing obstructive hydrocephalus. Upon further questioning, it was elucidated that the patient’s mother underwent more than one abdominal X-ray (AXR) whilst pregnant with the patient. The timing of these X-rays was calcu- lated to have been during the twelfth week of gestation. The patient underwent a posterior fossa craniotomy in the sit- ting position and resection of the tentorial meningioma via an infratentorial, supracerebellar approach. Histology confirmed a WHO grade 1 meningioma. She had an unremarkable postopera- tive course and was discharged home without neurological deficit. Outpatient examination and testing for phakomatoses was nega- tive. The patient continues outpatient surveillance and, at last follow-up 14 months following the operation, was neurologically intact with no tumour growth. 3. Discussion and review of the literature 3.1. Radiation-induced meningioma (RIM) Radiation has been shown to increase the risk for the develop- ment of meningiomas and other tumours for both children and http://dx.doi.org/10.1016/j.jocn.2016.03.030 0967-5868/Ó 2016 Published by Elsevier Ltd. ⇑ Corresponding author. Tel.: +61 3 9342 7000. E-mail address: annie.chen@mh.org.au (A.S. Chen). Journal of Clinical Neuroscience xxx (2016) xxx–xxx Contents lists available at ScienceDirect Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn Please cite this article in press as: Chen AS et al. Multiple meningiomas in a woman irradiated in utero. J Clin Neurosci (2016), http://dx.doi.org/10.1016/j. jocn.2016.03.030