Atypical meningioma

Case contributed by RMH Neuropathology

Presentation

Not available.

Patient Data

Age: 45 years
Gender: Female
CT

CT Brain

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. Edema in the left frontal lobe without overt features brain invasion.

Second small meningioma located in the right anterior cranial fossa. 

Conclusion: Large parafalcine meningioma. 

DSA (angiography)

Cerebral Angiogram and tumor embolization

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

MRI

Brain 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 tumor suggests higher vascularity. Edema 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.

 

Pathology

MICROSCOPIC DESCRIPTION:  Paraffin sections show a variably hypercellular meningioma with a dural attachment. The tumor has a well developed syncytial architecture. Calcified Psammoma bodies are also noted. Tumor 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 tumor 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 tumors 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. 

PlayAdd to Share

Case information

rID: 39127
Published: 21st Aug 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.