IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Meningothelial meningioma

Case contributed by Frank Gaillard

Presentation

Headache.

Patient Data

Age: 60 years
Gender: Female
mri

Occupying the right anterior cranial fossa/anterior aspect of the middle cranial fossa and extending across the midline into the left anterior cranial fossa, there is a lobulated mass measuring 8.8 x 4.0 x 7.1cm. This is slightly hyperintense to cortex on T1 and isointense to cortex on T2 and FLAIR, and demonstrates avid contrast enhancement. The mass is favored to be extra-axial. Within the mass, there is a rounded region of increased diffusion restriction (ADC = 650 x 10-6 mm2/s), possibly reflecting a region of higher cellularity. No invasion of the orbital apex. The right frontal lobe is compressed and demonstrates a large amount of edema. The right lateral and third ventricles are compressed and there is 26mm leftward midline shift with subfalcine herniation. No definite osseous invasion appreciated.

Conclusion:

Large right frontal/anterior temporal mass with significant mass effect is favored to represent a meningioma. Hemangiopericytoma, and even less likely would be lymphoma in the differential disagnosis.

 

 

Case Discussion

This patient went on to have a craniotomy and macroscopically complete resection. 

Histology

MICROSCOPIC DESCRIPTION: Paraffin sections show a moderately hypercellular meningioma. A syncytial architectural pattern is discernible throughout the tumor. Tumor cells show moderate nuclear pleomorphism and there are scattered mitotic figures (2/20 HPF). The tumor is seen to have a pushing interface with underlying brain parenchyma but no evidence of brain invasion is seen. There are no areas of necrosis.

DIAGNOSIS: Meningioma (WHO Grade I). 

 

Discussion

Despite the WHO grade I histology, but inline with the radiological appearance, the tumor recurred rapidly at the resection margins (multiple 1.5-2cm diameter nodules) within a few months. This suggests that it is in fact a WHO II tumor, with perhaps sampling error or brain invasion not being evident. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.