Dural metastases (mimicking meningioma)

Case contributed by Dr Amr Farouk

Presentation

Known breast cancer pathologically proven invasive duct carcinoma grade II metastatic to bone and new developed headache and convulsions.

Patient Data

Age: 65-year-old
Gender: Female
MRI

MRI Brain

An extra-axial dural based ovoid mass is seen at the right frontal parafalcine region. 

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 adjacent 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.

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. In this setting (new neurological symptoms and known metastases form breast cancer elsewhere) the diagnosis is presumptive as the patient had comorbidities avoiding an operation. It remains possible that these represent meningiomas. 

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.

 

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Case information

rID: 41127
Published: 18th Nov 2015
Last edited: 30th Jul 2018
Inclusion in quiz mode: Excluded

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