Presentation
Proptosis
Patient Data
Bony expansion of the left sphenoid greater and lesser wings protruding into the anterior left middle cranial fossa, into the left orbit and into the left infratemporal fossa, this leads to narrowing of the left orbital apex. The lateral rectus is displaced medially as is there optic nerve which is probably compressed at the orbital apex.
Dural thickening is demonstrated lining the anterior aspect of the middle cranial fossa, with associated florid hyperostosis, transosseous enhancement, and periosteal thickening over the surface of the lateral wall of the orbit and temporal fossa. The aforementioned hyperostosis results in proptosis and stenosis of the orbital apex with distortion of the extraocular muscles and optic nerve. The hyperostosis also involves the anterior clinoid and surrounds the optic nerve canal and superior orbital fissure. Inferiorly hyperostosis extends to the anterior margin of the foramina ovale. Superiorly there is extension into the orbital roof and into the squamous part of the temporal bone. No significant enhancing soft tissue component can be identified either within the intracranial cavity, or orbit or base of skull. The remainder of the brain is unremarkable in appearance.
Conclusion:
Typical appearances of a en plaque/intraosseous meningioma with florid hyperostosis and proptosis.
Case Discussion
The patient went on to have a resection.
Histology
MICROSCOPIC DESCRIPTION:
Sections show fibrous dura and bony tissue fragments infiltrated by a moderately hypercellular meningioma with a well-developed syncytial architecture. Tumor cells demonstrate uniform nuclear features. No mitoses or areas of necrosis are identified. No brain tissue is present.
Decalcified sections confirm tumor bone invasion.
FINAL DIAGNOSIS: Intraosseous meningioma (WHO Grade I).
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