Intraosseous meningioma

Case contributed by Dr Sophie Parker

Presentation

Large bony lump over right frontal bone, slowly growing over 6 years.

Patient Data

Age: 60 years
Gender: Female
x_ray

Asymmetric thickening and increased density of the right calvarium.

ct

Non-contrast CT of the head demonstrates a large osseous density lesion involving most of the right frontal bone, extending from the inner table, replacing the diploic space and with a subgaleal component beyond the outer table of the skull. No intracranial component. Appearances are suggestive of an intraosseous or en plaque meningioma.

Note the incidental hypoplastic right mastoid air cells. 

Bone scan

Nuclear medicine

Solitary right frontal bone lesion with increased tracer uptake.

mri

MRI demonstrates a large intraosseous lesion involving most of the right frontal bone. The lesion is markedly hypointense on T1 and T2 and has a small amount of patchy internal enhancement. Mild irregularity of the inner table of the skull but no intracranial component. Large extracranial component beyond the outer table of the frontal bone. Appearances are most suggestive of a primary intraosseous meningioma or en plaque meningioma.

Case Discussion

This slow-growing skull lesion was intially considered likely to represent Paget disease or fibrous dysplasia, however the MRI subsequently performed is more in keeping with a primary intraosseous meningioma or en plaque meningioma.

The decision was made for conservative management rather than resection and calvarial reconstruction in this case.

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