Presentation
Headache.
Patient Data
Right frontal region extra-axial vividly contrast enhancing lesion with a broad based dural contact and thin "dural tail" extending along the right frontal convexity. The lesion projects 33 mm from the dura, indenting the right frontal lobe, with distortion of the frontal horn of the right lateral ventricle. No significant T2 FLAIR hyperintensity of the subjacent right frontal lobe. Smaller left frontal extra-axial lesion arising in the region of the greater wing of sphenoid measuring 11 x 7 mm is also vividly contrast enhancing with broad dural contact.
Conclusion: Large right frontal convexity meningioma with facilitated diffusion characteristics.
Case Discussion
This turned out to be a chordoid subtype of meningioma which is an uncommon histological variant of meningioma which has a predilection for rapid growth and local recurrence and are designated as WHO grade 2 tumors. The most helpful MRI feature in distinguishing a chordoid meningiomas from other histological variants are their diffusion characteristics; they typically have facilitated diffusion.
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