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Intraventricular meningioma

Case contributed by: Dr Frank Gaillard

Presentation:

Headaches. Past history of pancreatic carcinoma (5 years ago).

Patient Data:

Age: 80 years
Gender: Female
Race: Caucasian

CT brain

Modality: CT

Within the trigone of the left lateral ventricle, and involving or bulging into the adjacent brain is a lobulated mass which is slightly hypderdense pre-contrast and demonstrates vivid homogeneous contrast enhancement. 

MRI brain - 3 months later

Modality: MRI

Centred in the left lateral ventricle of the trigone is a brightly enhancing mass which measures 33 x 24 x 41 mm and expands the trigone.  It has an intraparenchymal component laterally, with only a very small amount of adjacent vasogenic oedema.  There is no evidence of calcification or haemorrhage.  The mass is isointense on T1 and on T2 weighted images to grey matter, and demonstrates only minor restricted diffusion.  There is no evidence of hydrocephalus and it is an isolated abnormality. 

Scattered throughout white matter of both cerebral hemispheres are patchy regions of T2 hyper intensity, which are non-specific but most consistent with chronic small vessel ischaemia. The remainder of the brain is unremarkable with no intra or extra-axial abnormality. 

The patient went on to have surgical excision of the mass.

Histology

MACROSCOPIC DESCRIPTION: Seven pieces of white and cream tissue collectively measuring 35x30x10mm.

MICROSCOPIC DESCRIPTION: The sections show a moderately cellular meningioma with attached dura.  The tumour comprises whorls and fascicles with psammoma bodies. The tumour cells have ovoid nuclei with no significant nuclear pleomorphism. Up to 2 mitoses per 10 hpf are identified.  There is a single small focus of necrosis.  There is no evidence of tumour invasion into small amount of attached brain parenchyma. 

The tumour cells show focal positivity for PgR. The Ki-67 index is approximately 1%. 

DIAGNOSIS: Meningioma (WHO Grade I).

Case Discussion:

This case illustrates the typical appearances of an intraventricular meningioma. It is important to remember that although in patients with known malignancies, metastases cannot be discounted (and if fact should always be thought of), different pathology can also be present. 

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