Atypical meningioma

Case contributed by Dr Carlos Felipe Hurtado Arias

Presentation

A 60-year-old woman with a history of cognitive deficit and intermittent global headache of 4 years of evolution, which has gradually increased in intensity in the last year and who was taken to the Emergency Department due to focal seizure with secondary generalization.

Patient Data

Age: 60 years
Gender: Female
MRI

Extraaxial mass in the left frontal lobe, ovoid, circumscribed (a clear difference can be established between the tumor and the adjacent cerebral cortex), based on dural implantation, mass effect (compresses the left lateral ventricle and displaces the structures of the line mean in 4.6 mm), heterogeneous signal intensity per liquid zone in the lower half; the solid segment of the tumor is hypointense in T1 and hyperintense in the sequences with T2 information, also shows restriction in the diffusion.

The signal of the deep and periventricular white matter of the frontal lobe and left parietal in the area of the tumor is frankly elevated in the sequences T2 and FLAIR with respect to the "U-fibers".

The SWI sequence demonstrates large caliber vessels crossing the mass and coming from the base of tumor implantation in the dura mater. No images that suggest bleeding or calcifications are observed in this sequence.

After intravenous administration of the paramagnetic contrast medium, intense enhancement of the solid component of the tumor, the periphery thereof, the base of implantation ("dural tail") and the adjacent meninges are observed.

Case Discussion

This is a woman in the seventh decade of life with no history of neurological disease, presents with nonspecific chronic neurological symptoms that include cognitive deficit, headache and seizures.

An MRI was performed and an additional axial tumor was documented, based on the dural implantation, the cystic component in 50% of the tumor, hypointense in T1, hyperintense in T2 and FLAIR, without calcifications or bleeding, but with extensive vasogenic edema and homogeneous enhancement of the solid component and adjacent meninges. 

Histology

The patient was taken for a guided stereotactic biopsy, and the pathological study documented an atypical meningioma (WHO II).

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Case information

rID: 64536
Published: 30th Nov 2018
Last edited: 30th Nov 2018
Inclusion in quiz mode: Included
Excluded from licensing
Institution: Radiologos Asociados S.A.S - CEDICAF Pereira

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