Presentation
Headache. History of mastectomy for DCIS.
Patient Data
There is a hyperdense extradural mass centered over the falx to the left of midline with central coarse calcification and associated vasogenic edema and mass effect in the left frontal lobe and overlying hyperostosis.
Solitary large solid dural base mass is identified overlying the anterior left frontal lobe with extensive vasogenic edema. Features are almost certainly those of a meningioma.
Case Discussion
The patient went on to have a resection.
Histology
Paraffin sections show a moderately hypercellular meningioma. This has a well developed syncytial architecture. Moderate numbers of calcified psammoma bodies are also noted. Tumor cells have uniform nuclear features. No mitotic figures or areas of necrosis are identified. Invasion into a small amount of attached brain tissue is identified.
FINAL DIAGNOSIS: atypical meningioma due to brain invasion (WHO Grade II)
Discussion
Unfortunately, imaging struggles to accurately predict the grade of meningiomas or whether or not there is brain invasion, and the presence of vasogenic edema is not a good indicator that invasion is present.
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