Hemorrhagic meningioma

Case contributed by Ryan Thibodeau
Diagnosis certain

Presentation

Acute onset headache, left arm and leg weakness, and unsteady gait.

Patient Data

Age: 60 years
Gender: Female
ct

There is a heterogeneously enhancing mass with a thick peripheral rim and internal septations in the right posterior frontal lobe near the vertex. There is associated hemorrhage in this region which may represent intratumoral hemorrhage. There is a moderate amount of surrounding vasogenic edema. There is regional mass effect with partial effacement of the right lateral ventricle and a leftward midline shift. There is effacement of the right sylvian fissure with gyral expansion of the insular cortex.

mri

There is a well-defined heterogeneous solid mass with cystic components in the posterior right frontal lobe with associated extensive surrounding edema. A significant portion of the mass exhibits susceptibility artifact on SWI. The mass results in effacement of the right lateral ventricle atria and occipital horn, as well as a rightward midline shift.

Case Discussion

This is a case of a hemorrhagic meningioma. The patient had no known history of a meningioma.

The patient underwent a right craniotomy for resection of the tumor. Intraoperatively, the dural-based tumor was seen to have areas of both acute and chronic hemorrhage. Histopathologic examination revealed fibroblastic and angiomatous meningioma subtypes with no significant atypia or frank anaplasia. There was no brain invasion identified. There were mixed fresh and degenerated blood elements, as well as hyalinized blood vessels. Immunohistochemical stains showed that the tumor was focally positive for EMA only with an epithelioid reticulin pattern, and with a low Ki-67 (<4%).

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