In light of his malignant history, CT imaging of his chest, abdomen and pelvis was performed, which failed to identify any metastatic disease. He underwent pre-operative embolization of the extra-axial space occupying lesion, followed by a stereotactic right fronto-temporal craniectomy and resection of the tumor.
MACROSCOPIC DESCRIPTION: "Brain tumour": An oval shaped piece of friable fawn tissue 12mm in maximum dimension. Portion for frozen section.
FS DIAGNOSIS: Favour haemangiopericytoma.
The sections show a densely hypercellular tumour with a broad dural base. Tumour cells have moderately pleomorphic round and oval vesicular nuclei and a variable amount of pale cytoplasm and are arranged in diffuse sheets and perivascular pseudorosettes. Poorly formed papillary structures are noted in some areas. There are frequent mitotic figures (7 in 10 high power fields) as well as scattered foci of necrosis. Tumour cells show moderate cytoplasmic immunostaining for epithelial membrane antigen (EMA), E-cadherin and vimentin and patchy moderate staining for cytokeratin AE1/AE3. No staining for GFAP, progesterone receptor (PgR) or CD34 is seen in tumour cells. The features are of anaplastic (malignant) papillary meningioma. The topoisomerase labeling index is approximately 10%.
DIAGNOSIS: Brain tissue: Anaplastic (malignant) papillary meningioma WHO Grade III
The patient was treated with post-operative radiotherapy. His postoperative recovery was complicated by partial complex seizures, which were medically managed. One month following his craniectomy surgery, the patient underwent a stereotactic right fronto-temporal cranioplasty.
He remained under close radiological surveillance, with his one year post-operative scan shown below.
Unfortunately, 1.5 years following his diagnosis, the patient suffered a stroke, leaving him with a residual dense left facial, upper and lower limb hemiparesis. He was commenced on aspirin therapy and underwent rehabilitation therapy.
At his two year post-operative juncture, routine surveillance imaging unfortunately demonstrated recurrence.
He underwent a redo fronto-temporal craniotomy and tumor resection.
MACROSCOPIC DESCRIPTION: "Brain tissue": A wedge shaped piece of fawn tissue 8x8x6 mm. All for frozen section.
FS DIAGNOSIS: Meningioma with atypical feature
DIAGNOSIS: Brain tissue: Recurrent anaplastic (malignant) meningioma (WHO Grade III).
The patient had an uneventful post-operative recovery and underwent further rehabilitation. He elected not to have any further adjuvant therapy nor surgery in the future. He has also declined any further radiological surveillance and follow-up.
features images from this case