Presentation
Headache, and facial numbness and visual disturbance.
Patient Data
Right cerebellopontine angle mass, which is iso-intense to grey matter T1 signal, high signal on FLAIR and T2WI, and enhances vividly on postcontrast images. There is mass effect on the adjacent midbrain and pons. The basilar artery is displaced to the left but appears separate free from the mass. The mass appears separate from the seventh and eighth cranial nerves on these thick slices. Anteriorly the mass extends towards the right Meckel's cave, cavernous sinus and internal carotid artery. There is also associated dural thickening of the adjacent tentorium cerebelli.
There is a separate mass, which arises from the left anterior clinoid process. This has similar characteristics to the right CPA mass. This is in close association with the terminal left internal carotid artery bifurcation.
The patient proceeded to have the mass resected.
HISTOPATHOLOGY
MACROSCOPIC DESCRIPTION: 1. "Brain tissue": A piece of soft tan tissue 2-3mm. All -> F/S + smear. FS DIAGNOSIS: Meningioma. 2. "Brain tissue": Six pieces of tan tissue up to 5mm. A1.
MICROSCOPIC DESCRIPTION: 1&2. Sections show a tumor composed of meningothelial cells with a well developed syncytial growth pattern. Focal dural attachment is noted. Occasional psammomatous microcalcifications are present. Tumor cells contain abundant eosinophilic cytoplasm, round monotonous nuclei with fine chromatin and inconspicuous nucleoli. No mitoses, atypia or necrosis are seen. There is no evidence of malignancy.
DIAGNOSIS: 1&2. Brain tissue: Meningioma, WHO grade I.
Case Discussion
Meningiomas are the second most common cause of a cerebellopontine angle mass, after acoustic schwannomas.
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