Intraventricular meningioma

Case contributed by Bruno Di Muzio



Patient Data

Age: 35 years
Gender: Female



Solid and homogeneously enhancing mass within the left lateral ventricle trigone involving the choroid plexus but also with a broad ependymal contact surface. Angiogram circle of Willis is normal. 



There is a well-defined intraventricular lesion centered in the left trigone/occipital horn, which is hypointense on T1 and hyperintense on T2 and demonstrates slight diffusion restriction.  There is moderately extensive surrounding edema in the left periventricular parieto-occipital deep white matter. Intense but heterogeneous enhancement and the lesion shows contiguous enhancement with the choroid plexus best appreciated on the anterior and inferior aspect of the lesions however this may represent a "dural tail" phenomenon.
No evidence of hemorrhage within the lesion.
Mild dilatation of the ipsilateral temporal and occipital horns of the lateral ventricle. No other intra or extra-axial enhancing lesion is present.  There is minimal midline shift to the right.  The basal cisterns are symmetric.

Macroscopy:  Labeled "Left intraventricular tumor". Multiple pieces of roughened grey tissue, 50 x 46 x 16 mm in aggregate. Sectioning shows homogenous firm white-grey tissue. No normal brain identified.

Microscopy: Formalin-fixed, paraffin-embedded sections show a neoplasm comprised of spindled cells arranged in haphazard fascicles and whorls. The cells have plump ovoid nuclei with delicate vacuolated chromatin, conspicuous round nucleoli and tapered eosinophilic cytoplasm.  Scattered intranuclear pseudo inclusions are present.  There is an accompanying light lymphocytic infiltrate.  There is no necrosis.  There is no small cell change. Mitoses are rare, numbering fewer than 4 within 10 high power fields.

Conclusion: Left intraventricular tumor:  Meningioma, WHO Grade I.

Case Discussion

Vividly enhancing left lateral ventricle trigone mass involving the choroid plexus in a young female adult patient. The imaging appearances and epidemiology are very typical for an intraventricular meningioma, further confirmed on resection. 

Differentials to consider on imaging are: 

  • ependymomas are typically heterogeneous masses with areas of necrosis, calcification, cystic change and hemorrhage frequently seen. They tend to have a more "plastic" conformational shape within the ventricle
  • choroid plexus metastasis is usually more heterogeneous
  • choroid plexus papillomas tend to show a much more vivid contrast enhancement and, in adults, are most often (70%) seen in the fourth ventricle 

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