IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Meningioma

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Headaches and drowsiness.

Patient Data

Age: 55 years
Gender: Female
ct

CT scan demonstrates typical appearances of a meningioma. An isodense extraaxial mass with vivid homogeneous contrast enhancement.

mri

MRI demonstrates markedly high T2 signal, and a CSF cleft sign. The mass enhances vividly and demonstrates prominent surrounding edema. 

Case Discussion

High T2 signal is seen in a variety of histological variants, including microcystic meningiomas, angiomatous meningiomas, secretory meningiomas and to a lesser degree chordoid meningiomas. High T2 signal is more often associated with peritumoral edema. These tumors are usually, therefore, softer and easier to resect but can be highly vascular, and may, therefore, benefit from preoperative embolization. 

This patient went on to have a resection. 

Histology

Sections show multiple fragments of a cellular tumor consisting of spindle cells which have round bland nuclei with prominent intracytoplasmic clearing.  No atypical features are seen.

FINAL DIAGNOSIS: Meningioma WHO grade 1.

Discussion

This is the sort of case that I find personally infuriating. The histology, in this case, does not explicitly state the histological subtype, but mentions 'prominent intracytoplasmic clearing' which makes me think that they are seeing a clear cell meningioma. Unfortunately, clear cell meningiomas are considered WHO grade II tumors. Thus one is left wondering exactly what the answer is. *sigh*

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.