Atypical meningioma

Case contributed by RMH Neuropathology

Presentation

Headache

Patient Data

Age: 60 years
Gender: Male
MRI

There is an avidly, heterogeneously enhancing extra-axial lesion measuring 33 x 36 x 32 mm ( transverse by AP by cc ) centered in the left parafalcine parietal lobe. The lesion returns intermediate T1 and T2 signal and demonstrates minor restricted diffusion. FLAIR signal hyperintensity extends inferiorly into the left posterior centrum semiovale towards the left periventricular trigone. FLAIR signal abnormality also extends along the parafalcine vertex towards the foot and leg locus of the motor strip. Minimal mass effect is exerted on the adjacent superior sagittal sinus and normal flow in the sinuses is demonstrated on MRV.

There are no remote intra or extra-axial enhancing lesions.

Scattered deep white matter T2 hyperintensity changes are consistent with small vessel ischemic disease.

The ventricular configuration is unremarkable. Incidental cavum septum pellucidum.

Conclusion:

Isolated, left parietal parafalcine enhancing lesion consistent with a meningioma with no mass-effect nor occlusion exerted on the adjacent superior sagittal sinus.

Pathology

Histology

MACROSCOPIC DESCRIPTION (not shown): 

An irregular piece of moderately firm dull yellow tissue 38x20x10mm. A variably lobulated piece of dull yellow to pale grey firm tissue 50x31x29mm with a slightly adherent sheet of dura attached 40x22x3mm. The dura separated from the tumor upon handling and the aspect adherent to tumor as well as the apposing face on the tumor has been inked blue, and the opposite aspect of the dura inked black. The cut surface is uniform dull yellow with some central congestion.

MICROSCOPIC DESCRIPTION: 

The sections show a densley hypercellular meningioma with a predominant syncytial architecture. A diffuse sheeted arrangement of tumor cells is also seen and scattered calcified Psammoma bodies are noted. Tumor cells show moderate nuclear pleomorphism with conspicuous nucleoli. Moderate numbers of mitotic figures are identified (6/10HPF) and there are scattered foci of tumor necrosis. There is widespread invasion of underlying brain parenchyma with edema and reactive gliosis. The features are of atypical meningioma (WHO Grade II). The dural margins are clear of tumor

FINAL DIAGNOSIS: Atypical meningioma with brain invasion (WHO Grade II)

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Case information

rID: 28126
Published: 12th Mar 2014
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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