Presentation
Headache
Patient Data
Large left frontal convexity extra-axial heterogeneously enhancing dural based tumor is associated with dural thickening and central 'spoke-wheel' vascularity. There is considerable mass-effect on the underlying brain and in some locations, it is difficult to identify a clear plane between the mass and the brain; this may represent focal brain invasion. The adjacent superior frontal gyrus appears thickened, although this likely due to mass effect rather than a primary gyral abnormality. There is no extension into or through the adjacent bone.
Moderately extensive white matter disease, likely of ischemic nature. Old superior right cerebellar infarct.
Conclusion:
The mass most likely represents a meningioma. Far less likely differential diagnoses to consider are dural metastases or a hemangiopericytoma (although the spoke-wheel vascularity and absence of skull destruction make this unlikely).
Case Discussion
The patient went on to have a craniotomy and excision of the mass.
Histology
MACROSCOPIC DESCRIPTION:
A flattened ovoid soft dull yellow grey and hemorrhagic tumor 53x52x27mm with a sheet of fibrous tissue on one broad aspect 45x42mm and up to 2mm thick.
MICROSCOPIC DESCRIPTION:
The sections show a moderately hypercellular meningioma. This has a well developed syncytial architecture. Occasional calcified psammoma bodies are also noted. Tumor cells show mild nuclear pleomorphism. A very occasional mitotic figure is identified. No areas of necrosis are seen and there is no evidence of brain invasion. Broad attachment to dural is noted. The dural margins are clear of tumor.
DIAGNOSIS: Meningioma (WHO Grade I).
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