Dural metastases (mimicking meningioma)

Case contributed by Dr Amr Farouk

Presentation

66-year-old female patient with known breast cancer pathologically proven invasive duct carcinoma grade II metastatic to bone and new developed headache and convulsions.

Patient Data

Age: 66-year-old
Gender: Female
MRI

MRI Brain

An extra-axial dural based ovoid S.O.L is seen at the right frontal parafalcine region. It measures about 2.3 X 3.6 X 3.7 cm along its maximum antero-posterior,transverse and cranio-caudal dimensions respectively.

It elicits intermediate signal on T1 and T2 weighted images.It showed mild increase signal on DWI with isointense signal on ADC (denoting mild diffusion restriction). It shows homogeneous enhancement with enhancing dural tails in post contrast study.

It is seen associated with perifocal brain oedema and  exert mass effect in the form of effacement of the underlying cortical sulci.

Another smaller similar lesion is seen along the left occipital region parafalcine in location also measuring 1.4X1.76 cm along its maximal axial & craniocaudal dimensions.

Multiple calvarial nodular bright foci are seen through the skull.

Case Discussion

A right frontal & left occipital extra-axial enhanced broad based to the dura mimicking meningiomata.

Metastases to the dura constitute one of the least frequent patterns of neoplastic spread to the craniospinal axis.

The neoplasms arise either by direct extension from skull metastases or by hematogeneous spread with Breast cancer, prostate cancer, adenocarcinoma of the lung, and renal cell carcinoma are the most common primaries.

Typically, these tumors produce MR images with increased signals on T2-weighted images, often with an enhancing dural tail mimicking a meningioma.

The diagnosis was made depending on clinical and radiological findings as the patient had comorbidities avoiding an operation.

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Case information

rID: 41127
Case created: 16th Nov 2015
Last edited: 2nd Feb 2016
Inclusion in quiz mode: Included

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