Presentation
Incidental finding when the patient's brain was scanned for hyperglycemia induced altered concious state.
Patient Data
Scan performed in the emergency department demonstrates a large calcified extra-axial mass in the left anterior cranial fossa.
The mass is of heterogeneous signal with a central area of low signal on all sequences and a more iso-intense component on T1 and T2 sequences posterolaterally. Most of the mass enhances and demonstrates signal loss and blooming. A moderate amount of edema is present in the adjacent brain.
Case Discussion
This case highlights how large masses can grow if located in so-called silent areas of the brain (typically temporal and frontal lobes). Also note how difficult it is to predict the degree of enhancement of a mass based on the degree of calcification (which in this case is due to psammoma bodies).
Histology
MICROSCOPIC DESCRIPTION: Paraffin sections show a moderately hypercellular meningioma
containing numerous calcified and hyalinised psammoma bodies. Tumor cells have regular nuclear features. No mitotic figures or areas of necrosis are identified and there is no evidence of brain invasion.
DIAGNOSIS: Psammomatous meningioma (WHO grade I)