Presentation
Headaches.
Patient Data
A very large extra axial tumor is located on the left side, appearing to arise from the tentorium with the largest component extending above and a smaller component and below, into the posterior fossa. Overall it measures 65 x 60x 70mm, is homogeneous in signal intensity and demonstrates vivid contrast enhancement. There is no evidence of necrosis or hemorrhage. A number of prominent vessels are seen coursing over its surface and extending into the tumor itself. It elevates and distorts the temporal lobe, and isolates the temporal horn of the left lateral ventricle. Medially it markedly distorts the mid brain, pushing it towards the right and resulting in 9mm of midline shift. The right lateral ventricle is dilated consistent with obstructive hydrocephalus, and there is prominence of the optic nerve dural sheathes. The mass does not involve the transverse or sigmoid sinuses on the left, and the main outflow of the superior sagittal sinus is towards the right.
Conclusion: Very large extra axial mass almost certainly represents a meningioma.
MACROSCOPIC DESCRIPTION:
1. "Brain tissue": An irregularly shaped piece of soft gelatinous tissue 10mm. All on for frozen section. FS DIAGNOSIS: Meningioma.
2. "Meningioma": Three rubbery cream nodules, 6x7x3mm, 7x5x2mm, 21x11x8mm and 30x23x16mm. There are also two sheets of ragged and rubbery brown-tan tissue, 42x16x3mm and 52x44x6mm. The larger sheet of ragged tissue has some solid cream tumor attached to it.
MICROSCOPIC DESCRIPTION:
1&2. Paraffin sections show a moderately hypercellular meningioma with a mixed syncytial and fibroblastic architecture. Broad dural attachment is noted. Tumor cells show moderate nuclear and cellular pleomorphism. Occasional mitotic figures are identified (3/20 HPF). There are no areas of necrosis and no evidence of brain invasion is seen.
DIAGNOSIS: 1&2. Brain tumor: Meningioma (WHO Grade I)
Case Discussion
This case illustrates a large well-defined solid extra-axial mass likely arising from the tentorium and with imaging features of a meningioma.
Angiogram was performed to assess vascular supply and possible tumor embolization (not shown), but the meningioma was predominantly supplied via left posterior cerebral artery branches.
Tumor was treated then with surgical resection.
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