Presentation
Headache.
Patient Data
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Centered within the trigone of the left lateral ventricle is a large rounded vividly enhancing homogeneous mass surrounded by a some high T2 signal within the white matter of the temporal parietal lobes consistent with vasogenic edema. It is clearly intraventricular, is isointense to grey matter on T1 and T2-weighted sequences and demonstrates moderate diffusion restriction and elevated cerebral blood volume of blood flow on perfusion.
In the floor of the left middle cranial fossa is an extra-axial well-circumscribed vividly enhancing lesion with similar signal intensity, associated with minor hyperostosis, characteristic of a meningioma. The remainder of the brain is unremarkable in appearance.
Conclusion:
Left trigonal intraventricular lesion almost certainly represents an intraventricular meningioma. Second smaller middle cranial fossa meningioma in the middle cranial fossa.
Case Discussion
The patient went on to have a resection.
Histology
MICROSCOPIC DESCRIPTION:
Sections show a well-circumscribed moderately hypercellular meningioma with a mixed meningothelial and fibroblastic architecture. Tumor is partially surrounded by a dense fibrous capsule with focal papillary excrescences resembling choroid plexus. Tumor cells demonstrate uniform nuclear features. Frequent psammoma bodies are present. No mitoses or areas of necrosis are identified. There is no evidence of brain invasion.
DIAGNOSIS: Meningioma (WHO Grade I).