Case contributed by Frank Gaillard
Diagnosis certain


Headaches and drowsiness.

Patient Data

Age: 55 years
Gender: Female

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


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. 


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.


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*

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