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Malignant Neoplasm of the Cerebral Meninges B050

Last amended 
Tuesday, January 9, 2018
Current RMA Instruments:
Reasonable Hypothesis SOP [1]
3 of 2018
Balance of Probabilities SOP [2]
4 of 2018
Changes from previous Instruments

SOP Bulletin 200 [3]

ICD Coding
  • ICD-9-CM Codes: 192.1
  • ICD-10-AM Codes: C70.0, C70.9
Brief description

This SOP covers malignant meningiomas arising in the lining of the brain. It does not cover benign cerebral meningiomas, which are much more common and which are covered by a separate SOP.

Confirming the diagnosis

The diagnosis may be suspected based on imaging findings (CT or MRI of the brain), but definitive diagnosis requires histology.

The relevant medical specialist is a neurosurgeon or oncologist.

Additional diagnoses covered by SOP
  • Anaplastic meningioma
  • Malignant meningioma
  • Papillary meningioma
  • Rhabdoid meningioma
  • Any WHO grade III meningioma
Conditions excluded from SOP
  • Atypical meningioma (WHO grade II)* - meningioma SOP
  • Benign meningioma*
  • Intermediate grade meningioma (WHO grade II)* - meningioma SOP
  • Malignant meningioma arising in the spinal cord meninges#
  • Carcinoid tumour of the meninges#
  • Hodgkin’s lymphoma of the meninges*
  • Non-Hodgkin’s lymphoma of the meninges*
  • Soft tissue sarcoma of the meninges*
  • Primary malignant melanoma of the cerebral meninges#

* another SOP applies

# non-SOP condition 

Clinical onset

The condition tends to be asymptomatic or minimally symptomatic and be found incidentally on imaging (or at autopsy).  Clinical features may include seizures and focal defects related to the tumour location. 

Clinical worsening

The condition rarely metastasises to other sites but local recurrence occurs in the majority of cases and overall 5 year survival is less than 50%.  Evidence of clinical worsening beyond the normal course of the disease is required for a clinical worsening factor to apply.

World Health Organisation 2016 Classification of Meningiomas

WHO Grade 1 (covered by meningioma SOP)

  • Meningiothelial meningioma
  • Fibrous (fibroblastic) meningioma
  • Transitional (mixed) meningioma
  • Psammomatous meningioma
  • Angiomatous meningioma
  • Microcystic meningioma
  • Secretory meningioma
  • Lymphoplasmacyte-rich meningioma
  • Metaplastic meningioma

WHO Grade 2 (covered by meningioma SOP)

  • Chordoid meningioma
  • Clear cell meningioma
  • Atypical meningioma

WHO Grade 3 (covered by MN cerebral meninges SOP)

  • Papillary meningioma
  • Rhabdoid meningioma
  • Anaplastic meningioma

Diagnostic commentary for malignant neoplasm of the cerebral meninges

Confirmation of a diagnosis of malignant neoplasm of the cerebral meninges

To investigate this condition you will need to know whether the malignant neoplasm of the cerebral meninges is a particular type of neoplasm known as a sarcoma of the cerebral meninges. If you do not know this then you should indicate that the diagnosis is not confirmed. A Diagnostic report (? [4]) will then be generated which will allow you to request this information from the appropriate source.

Diagnostic criteria for malignant neoplasm of the cerebral meninges [5]

13981

The veteran has sarcoma of the cerebral meninges.

Rulebase for malignant neoplasm of the cerebral meninges

Place holder node for Rulebase for malignant neoplasm of the cerebral meninges

No clinical management for malignant neoplasm of the cerebral meninges

Malignant neoplasm of the cerebral meninges - No clinical management for malignant neoplasm of the cerebral meninges Factor

Last reviewed for CCPS 19 February 1996.

Investigative Documents

Medical Report - Inability to Obtain Appropriate Clinical Management - [GQACM]

Preliminary questions [13980]

[7]13988

there is some evidence that an inability to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges may be a factor in the worsening of the condition under consideration.

13989 [8] the clinical onset of malignant neoplasm of the cerebral meninges occurred after the end of the veteran's last period of VEA service.

[9]13990

the veteran's malignant neoplasm of the cerebral meninges permanently worsened.

[10]13991

the veteran was unable to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges at some time.

13992 [11] the inability to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges contributed to the clinical worsening of the veteran's malignant neoplasm of the cerebral meninges.

13994 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges and VEA service for the clinical worsening of malignant neoplasm of the cerebral meninges.

13995 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges and operational service for the clinical worsening of malignant neoplasm of the cerebral meninges.

or

13996 — the veteran has established the causal connection between the inability to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges and eligible service for the clinical worsening of malignant neoplasm of the cerebral meninges.

Clinical worsening and operational service [13995]

[12]13997

the veteran was unable to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges during operational service.

[13]16632

the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service duties.

[14]14000

the veteran's inability to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

[15]14002

the veteran was unable to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges because of an illness or injury which is identifiable.

14003 — the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for malignant neoplasm of the cerebral meninges is causally related to operational service. [16] [17]

[18]14005

the clinical onset of malignant neoplasm of the cerebral meninges occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for malignant neoplasm of the cerebral meninges is causally related.

Clinical worsening and eligible service [13996]

[19]13998

the veteran was unable to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges during eligible service.

[20]13999

the veteran was unable to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges during eligible service, as a causal result of eligible service duties.

[21]14001

the veteran's inability to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.

or

[15]14002

the veteran was unable to obtain appropriate clinical management for malignant neoplasm of the cerebral meninges because of an illness or injury which is identifiable.

14004 — the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for malignant neoplasm of the cerebral meninges is causally related to eligible service. [16] [17]

[22]14006

the clinical onset of malignant neoplasm of the cerebral meninges occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for malignant neoplasm of the cerebral meninges is causally related. [23]

Therapeutic radiation to the head or neck

Malignant neoplasm of the cerebral meninges - Therapeutic radiation to the head or neck Factor

Last reviewed for CCPS 19 February 1996.

Preliminary questions [13979]

13981 [24] the veteran has sarcoma of the cerebral meninges.

[25]11429

the veteran has undergone a course of therapeutic radiation to the head or neck at some time.

11431 [26] the veteran underwent a course of therapeutic radiation to the head or neck for treatment of an illness or injury which is identifiable.

[27]13982

the course of therapeutic radiation to the head or neck was given for treatment of the identified illness or injury before the clinical onset of malignant neoplasm of the cerebral meninges. [28]

13983 — the veteran has established the causal connection between the course of therapeutic radiation to the head or neck and VEA service for the clinical onset of malignant neoplasm of the cerebral meninges.

13986 — the veteran has established the causal connection between the course of therapeutic radiation to the head or neck and operational service for the clinical onset of malignant neoplasm of the cerebral meninges.

or

13987 — the veteran has established the causal connection between the course of therapeutic radiation to the head or neck and eligible service for the clinical onset of malignant neoplasm of the cerebral meninges.

Clinical onset and operational service [13986]

11438 — the identified illness or injury for which the course of therapeutic radiation to the head or neck was undergone is causally related to operational service. [29] [30]

Clinical onset and eligible service [13987]

11439 — the identified illness or injury for which the course of therapeutic radiation to the head or neck was undergone is causally related to eligible service. [31] [30]

Source URL (modified on 15/01/2018 - 11:17am): http://clik.dva.gov.au/ccps-medical-research-library/sops-grouped-icd-body-system/m/malignant-neoplasm-cerebral-meninges-b050-c700c709

Links
[1] http://www.rma.gov.au/assets/SOP/2018/003.pdf
[2] http://www.rma.gov.au/assets/SOP/2018/004.pdf
[3] http://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20200.pdf
[4] http://clik.dva.gov.au/sop-information
[5] http://clik.dva.gov.au/node/73513
[6] http://clik.dva.gov.au/user/login?destination=comment/reply/63754%23comment-form
[7] http://clik.dva.gov.au/ccpsother-31
[8] http://clik.dva.gov.au/node/71755
[9] clikpopup://CCPS/Reject/OnsetAfterService
[10] clikpopup://CCPS/Reject/NoPermanentWorsening
[11] clikpopup://CCPS/Malignant neoplasm of the cerebral meninges/ACM - contributed to worsening
[12] clikpopup://CCPS/ACM/NoContribution
[13] clikpopup://CCPS/ACM/NotOpService
[14] clikpopup://CCPS/ACM/NotOperDuties
[15] clikpopup://CCPS/rejectwilful
[16] clikpopup://CCPS/ACM/NoIllness
[17] clikpopup://CCPS/reject14003,14004No
[18] clikpopup://CCPS/Malignant neoplasm of the cerebral meninges/ACM - onset prior to operational service
[19] clikpopup://CCPS/ACM/OnsetFailOper
[20] clikpopup://CCPS/ACM/NotEligService
[21] clikpopup://CCPS/ACM/NotEligDuties
[22] clikpopup://CCPS/Malignant neoplasm of the cerebral meninges/ACM - onset prior to eligible service
[23] clikpopup://CCPS/ACM/OnsetFailElig
[24] http://clik.dva.gov.au/therapeutic-radiation-head-or-neck-0
[25] clikpopup://CCPS/reject13981No
[26] clikpopup://CCPS/Therapeutic radiation to the head or neck for identifiable illness
[27] clikpopup://CCPS/reject11431No
[28] clikpopup://CCPS/reject13982No
[29] clikpopup://CCPS/reject11438No
[30] clikpopup://CCPS/reject11438,11439No
[31] clikpopup://CCPS/reject11439No