Presentation
Altered conscious state.
Patient Data
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Large left frontal mass with positive mass effect resulting in midline shift to the right. The mass is isodense to grey matter with a small amount of adjacent edema.
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There is vivid yet mildly homogeneous enhancement of the mass. Further small enhancing lesions of the anterior cranial fossa floor.
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There is a large vividly enhancing extra-axial left frontal mass, which hyperintense T2 signal and hypointense T1 signal. CSF cleft, buckling of the adjacent white matter, pial vessels around the lesion in keeping with an extra-axial location. The lesion demonstrates prominent intralesional flow voids in keeping with a highly vascular lesion.
No restricted diffusion. Resultant severe mass effect on the adjacent brain with distortion of the left frontal lobe. Associated FLAIR signal intensity in the left frontal lobe on the vasogenic edema. Left to right midline shift.
Several other much smaller extra-axial subfrontal mass lesions with similar imaging characteristics bilaterally, approximately six in number. The largest of these lesions is in the right olfactory groove.
Case Discussion
The patient proceeded to craniotomy and resection of the left frontal mass.
Histopathology
MACROSCOPIC DESCRIPTION: "Brain tissue": A piece of tan brown and white soft tissue 50x45x50mm with a piece of fibrous dura attached at one aspect 75x55mm. Also received in the pot are several loose fragments of tissue 30x20x15mm in aggregate.
MICROSCOPIC DESCRIPTION: The sections show a moderately cellular tumor with attached dura. The tumor forms sheets with occasional whorls and fascicles. The tumor cells have ovoid nuclei with no nuclear pleomorphism. Mitoses are inconspicuous. There is no necrosis. The background stroma is focally myxomatous. No brain parenchyma is seen. No evidence of atypical or malignant change is identified. The tumor cells are EMA and progesterone receptor positive. The Ki-67 index is 2%. CD34 is negative. The features are those of meningioma.
DIAGNOSIS: Brain tissue: Meningioma (WHO Grade I).
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