Presentation
Headache.
Patient Data
There is a large enhancing left parafalcine mass. The mass abuts the anterior falx and the superior sagittal sinus, with possible small extensions of the tumor into the superior sagittal sinus but no compelling evidence of occlusion.
There are small cysts at the interface of the mass with the adjacent brain and multiple parasitized vessels inferior to the mass. There is moderate adjacent mass effect and mild midline shift.
Case Discussion
The appearances were felt to most likely represent a meningioma, although the very high T2 signal is not typical and suggests a histological variant. The variants that usually are T2 hyperintense are microcystic, secretory, cartilaginous (metaplastic) chordoid and angiomatous.
The patient went on to have surgery.
Histology
MICROSCOPIC DESCRIPTION: Paraffin sections show an intensely vascular tumor in which thin-walled vascular spaces of varying caliber are interspersed between small aggregates of cells with round and oval hyperchromatic nuclei and a variable amount of pale cytoplasm. No mitotic figures or areas of necrosis are seen. Attachment to meninges is noted. No evidence of brain invasion is seen. Immunohistochemistry shows strong immunostaining for epithelial membrane antigen (EMA) and vimentin in tumor cells as well as strong nuclear staining for progesterone receptor (PgR) in a moderate number of tumor cells.
FINAL DIAGNOSIS: Angiomatous meningioma.
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