Case contributed by Fabio Macori


Follow-up in breast cancer. First exam after surgery

Patient Data

Age: 70 years
Gender: Female

The CT examination shows the presence of a roundish formation in the right frontal lobe, with contrast impregnation. Even though the characteristics are not typical of metastases, the clinical history of breast cancer needs to be further investigated.


Axial and sagittal T1-weighted sequence demonstrates in the right frontal lobe, anteriorly the middle cerebral artery, the mass to be isointense to grey matter; axial T2-weighted sequence demonstrates the mass to be mildly, homogeneously hyperintense to grey matter and to extend anteriorly along the posterior aspect of the anterior cranial fossa floor.

Post-contrast coronal T1-weighted sequence demonstrates a well-circumscribed, homogeneously enhancing mass with a broad dural tail that inferomedially.


Case Discussion

Meningiomas are the most common non-glial tumor of the central nervous system (CNS).

Even though meningioma has a reasonably typical behavior, it is necessary to consider atypical forms; at the same time, some pathologies can mimic meningioma.

In this case, the CT aspect, while suggesting a meningioma, required an in-depth investigation to exclude the presence of metastases in the patient's clinical history, operated for breast cancer.

The MR appearance, as well as the presence of a dura tail, confirmed the diagnostic hypothesis of meningioma making the diagnosis essentially certain. 

Editorial note: a dural tail is not pathognomonic of a meningioma. 

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