Presentation
Headache
Patient Data
An infiltrative sclerotic osseous lesion with internal vascular channels centered on the right frontal bone with loss of corticomedullary differentiation and overlying periosteal new bone. Soft tissue component extends into the adjacent right frontal sinus with small volume of soft tissue extending into the extraconal fat along the roof of the right orbit and overlying the periosteal reaction of the outer table of the right frontal bone. No significant intracranial soft tissue component.
Normal aeration of the ethmoid air cells, sphenoid and maxillary sinuses. No other osseous abnormality. No other soft tissue abnormality.
Conclusion: Features are most in keeping with an intraosseous meningioma.
Expansile right frontal bone lesion is noted, with low T1 signal and moderate enhancement. Underlying this is a region of dural thickening and enhancement, with effacement of the underlying sulci. Similarly, enhancement and thickening is seen deep to the scalp which extends into the orbit without proptosis. No T2/FLAIR hyperintensity of the underlying brain. No abnormal diffusion restriction. No intra-axial mass.
Conclusion: Features are almost certainly those of an intraosseous meningioma.
Case Discussion
The patient went on to have an excision confirming the diagnosis.
Histology
MICROSCOPIC DESCRIPTION: Sections show a moderately cellular meningothelial meningioma composed of whorled nests of tumor cells containing abundant cytoplasm, bland oval nuclei and inconspicuous nucleoli. No mitoses or necrosis are seen. No brain tissue is included. No atypical or malignant features are identified. Sections of decalcified bone show tumor infiltrating marrow space between bony trabuculae which focally extend to involve an inked radial excision margin.
FINAL DIAGNOSIS: Meningioma, WHO grade 1, with tumor bone invasion focally involving the inked radial excision margin.
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