Presentation
Unable to get out of chair.
Patient Data
Marked vasogenic edema with the impression of a large right frontal mass. Midline shift to the left. Left lateral ventricular dilatation with periventricular hypoattenuation in keeping with obstructive hydrocephalus and transependymal edema. No bone destruction, erosion or hyperostosis.
Large mass centered in the right frontal region, which is predominantly enhancing but with central hypodensity. It has a broad base along the frontal bone and anterior falx cerebri.
Large heterogeneous mass in the region of the right parafalcine frontal lobe.
The lesion has predominantly low T1 signal and high T2 signal, with intense contrast enhancement.
An irregular non-enhancing component is noted internally, which does not demonstrate increased diffusion restriction, and most likely represent degeneration or necrosis.
The mass has a broad dural attachment to the anterior falx cerebral with multiple vessels seen coursing between the posterolateral aspect of the mass in the right frontal lobe. Small CSF cleft is noted between the anterolateral aspect of the mass and the frontal lobe.
There is a large amount of vasogenic edema involving the right frontal and parietal lobes.
Histopathology:
MACROSCOPIC DESCRIPTION: "Brain tumor": Multiple irregular pieces of rubbery tan-dark brown tissue. Several pieces of tissue have strips of dura up to 45mm.
MICROSCOPIC DESCRIPTION: The sections show a moderately cellular meningioma with focal infiltration into the attached dura. The tumor forms whorls and fascicles. No sheeting arrangement is seen. The tumor cells have ovoid nuclei with no nuclear pleomorphism. Mitoses are inconspicuous. There is one area of necrosis. A small amount of brain parenchyma is seen and there is no evidence of brain invasion. No evidence of atypical or malignant change is identified.
DIAGNOSIS: Brain tumor: Meningioma (WHO Grade I).
Case Discussion
This is a case where the differential diagnosis differs greatly depending on whether the mass is intra or extra-axial. There are a number of signs that can help determine the location of intracranial masses:
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