Presentation
Headache.
Patient Data
A large left parieto-occipital extra-axial cystic space occupying lesion is seen; it elicits heterogeneous bright T2/FLAIR signals and low T1 signal (with areas iso-intense to the grey matter) and shows internal areas of diffusion restriction. The lesion exerts mass effect in the form of compression of the underlying cortical sulci, compression of the body of the left lateral ventricle, and midline shift. The lesion shows intense post-contrast enhancement after contrast administration, with a dural tail.
Pathology confirmed chordoid meningioma.
Case Discussion
Chordoid meningiomas are a rare WHO grade 2 meningioma. Chordoid meningiomas are associated with a higher risk of recurrences than WHO-grade 2 meningiomas.
Pre-operative diagnosis of chordoid meningioma may help in pre-operative surgical planning. Large size and irregular shape may be associated with higher tumor grade.
Several studies showed that the utility of ADC can be used to differentiate between meningioma subtypes. ADC was found to be significantly higher in chordoid meningiomas.
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