Synchronous occurrence of meningioma, pituitary adenoma, and glioma in a single patient: A rare case report

Background High-resolution imaging has increased detection of multiple intracranial neoplastic lesions. Co-existing tumours of different aetiologies are mainly described in case reports and single-surgeon series. When a second asymptomatic lesion is found, the radiographic features of the primary lesion can create new clinical challenges. The ethics and management of such cases remain debated. Case description A 56-year-old female with progressive visual decline, recurrent seizures, and confusion. The imaging showed three neoplastic lesions: a pituitary mass with suprasellar extension, a low-grade left insular glioma, and a right parasagittal extra-axial mass consistent with meningioma. She underwent transnasal transsphenoidal resection of the pituitary mass, confirmed as pituitary adenoma on histopathology. Postoperatively, she recovered well, received Gamma Knife treatment for meningioma, and was followed for 1 year for all lesions. Conclusion A single patient with more than two intracranial neoplasms of different histopathological origins is rare and presents major diagnostic, ethical, and therapeutic challenges. Asymptomatic lesions detected by high-resolution neuroimaging further complicate management. Treatment focused on the symptomatic, surgically accessible lesion, with less invasive options for the others. Close follow-up is essential to monitor tumour control. This case highlights the need for personalised management and an algorithm for patients with multiple intracranial neoplasms.