Atypical meningioma

Case contributed by Dr Prashant Mudgal

Presentation

Middle aged man presented with growing scalp swelling, seizures and altered sensorium.

Patient Data

Age: 45-year-old
Gender: Male
Modality: MRI

A large, lobulated, solid, heterogeneously enhancing, extra-axial, dura based mass noted growing both sides of the dura with obvious intracranial and extracranial extensions.

The mass is hyperintense on T1WI, isointense to gray matter on T2WI, showing no restriction of diffusion on DWI and there is no blooming artifact seen on GRE sequence. On spectroscopy there is high choline and low myoinositol peak noted.

Intracranial component is growing Inferiorly into the parietal region causing significant compression of parenchyma and lateral ventricle in the parietal lobe and moderate vasogenic edema. However the margins of this part of lesion are regular and it does not appear to invade the parenchyma. 
The outer/extra-axial  component shows an enhancing dural tail and shows no defined margins. This component of the lesion appear to invade the parietal bone and extending further into the subgaleal tissue in the scalp evident by abnormal thickening and enhancement of dura, calvaria and subgaleal soft tissue.

Imaging features signify a cellular non glial aggressive extra-axial mass; most likely aggressive meningioma.

Another diagnostic possibility includes a hemangiopericytoma

Case Discussion

Imaging features and morphology of aggressive/atypical meningioma and hemangiopericytoma, show significant overlap which makes it difficult to distinguish between the two similar tumors on imaging basis.

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Case Information

rID: 45535
Case created: 28th May 2016
Last edited: 29th May 2016
Tag: pm
Inclusion in quiz mode: Included

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