Atypical meningioma

Case contributed by RMH Neuropathology

Presentation

Not available.

Patient Data

Age: 45 years
Gender: Female

CT Brain

Modality: CT

There is a large parafalcine frontal solid mass with vivid contrast enhancement and prominent calcification on the left anteriorly. 

Significant mass effect on the corpus callosum, without hydrocephalus. No osseous involvement. Oedema in the left frontal lobe without overt features brain invasion.

Second small meningioma located in the right anterior cranial fossa. 

Conclusion: Large parafalcine meningioma. 

Cerebral Angiogram and tumour embolisation

Modality: DSA (angiography)

Hypervascular meningioma invading the anterior superior sagittal sinus, with left greater than right middle meningeal artery supply treated with 50-50 \XB5\ PVA embolisation (post-treatment images not shown). No significant pial supply from the left anterior cerebral artery branches.

Brain MRI

Modality: MRI

A 4.8 x 7.4 x 5.3 cm parafalcine meningioma is noted with prominent calcification on the left anteriorly (better seen on CT). Anteriorly the superior sagittal sinus is invaded and appears occluded on both coronal T1 C+ and phase contrast MRV.

Significant mass effect on the corpus callosum, without hydrocephalus. No osseous involvement. Relatively prominent flow voids / MRA signal in the posterior half of the tumour suggests higher vascularity. Oedema in the left frontal lobe without overt features brain invasion.

Second small meningioma located in the right anterior cranial fossa (8 x 13mm). MRA is unremarkable.

Conclusion: Large parafalcine meningioma with invasion of the superior sagittal sinus.

 

Modality: Pathology

MICROSCOPIC DESCRIPTION:  Paraffin sections show a variably hypercellular meningioma with a dural attachment. The tumour has a well developed syncytial architecture. Calcified Psammoma bodies are also noted. Tumour cells show mild nuclear pleomorphism. An occasional mitotic figure is identified (1/20HPF). No areas of necrosis are seen. A single focus of invasion of tumour into white matter is identified.

DIAGNOSIS:  Meningioma with focal brain invasion (WHO Grade II)

Case Discussion

This case illustrate a meningioma with atypical features and venous sinus invasion. Atypical meningioma are WHO grade II tumours with an increased mitotic rate, corresponding to ~ 7% of all meningiomas and with a greater tendency to recur. 

Importantly an entirely benign meningioma (grade I) is now considered to be grade II regardless of all other features if brain invasion is demonstrated. 

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Case Information

rID: 39127
Case created: 21st Aug 2015
Last edited: 29th May 2016
Inclusion in quiz mode: Included

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