Angiomatous meningioma

Case contributed by Dr Ammar Ashraf

Presentation

Intermittent headache for the last 6 months, associated with dizziness, nausea, and apraxia right leg. No seizures or motor neurological deficits.

Patient Data

Age: 25 years
Gender: Female
MRI

FINDINGS: An extra-axial meningeal based complex solid/cystic lesion is seen in the para-falcine left parietal region. Moderate vasogenic edema around the lesion, mass effect over the body of corpus callosum, and right-sided midline shift of ~ 6 mm are noted. Post-contrast study shows enhancement of the solid component of the tumor as well as the adjacent dura (dural tail sign). MR spectroscopy shows elevated choline and creatine with decreased NAA and elevated alanine peak with increased alanine/NAA ratio.

CONCLUSION: Left para-falcine cystic meningioma.

CT

CT brain one day after surgery

FINDINGS: Status post left high frontoparietal craniotomy with near-complete resection of the mass lesion noted along the medial aspect of the left parietal lobe. A small hypodensity is seen adjacent to the splenium of the corpus callosum, which is suspicious for the residual tumor and needs further evaluation with contrast-enhanced MRI brain after the resolution of the hemorrhagic changes. Postsurgical changes in the left cerebral hemisphere.

MRI

MRI brain 7 weeks after surgery

Findings: Status post excision of left parasagittal cystic meningioma. No obvious enhancing lesion is seen in the excised tumoral bed to suggest recurrence. Postsurgical changes (small focal eccentric subacute hematoma, signs of subacute bleed with hemosiderin deposition on leptomeningeal surfaces of the surgical bed & along the medial aspect of the left parietal lobe, and mild gliotic changes along the medial aspect of the left parietal lobe) are noted in the left parietal lobe.

Conclusion: Status post excision of left parasagittal cystic meningioma with no residual/recurrent disease.

Case Discussion

Procedure: Craniotomy with removal of the left parasagittal tumor.

DiagnosisAngiomatous meningioma with brain infiltration and marked cell degeneration (grade 2 according to the WHO grading). The immunostain with the antibody anti-GFAP highlights the brain infiltration of the tumor.  NSE also highlights the brain tissue invaded by the tumor. Ki67 is very low at <5%. The immunostain with the antibody anti-S100 is positive. Estrogen and progesterone receptors are negative. The immunostain with the antibody anti-EMA is negative.

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Case information

rID: 79459
Published: 27th Jun 2020
Last edited: 1st Jul 2020
Inclusion in quiz mode: Included
Institution: King Abdulaziz Hospital Al Ahsa (MNGHA)

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