Meningioma (cystic, mixed lipomatous and syncitial)

Case contributed by Frank Gaillard



Patient Data

Age: 55 years
Gender: Female

Large right sided low density mass is present with significant mass effect. It is not certain if this is intra or extra-axial although there is white matter buckling suggesting it is extra-axial. 

Large lesion is noted overlying the right parietal lobe, the majority is similar to CSF signal (but not identical) and there is a peripheral more solid component adjacent to the dura. The lesion is likely extra-axial as it is broad based to the overlying dura and there is displacement of the vessels overlying the cortex on this side. No underlying vasogenic edema. There is mass effect with 10 mm of midline shift. There is also slight dilation of the lateral ventricles. A small amount of diffusion restriction is noted in the solid component, and there is modest enhancement of the solid component. A small amount of dural enhancement is also noted. A non specific high T2 signal focus is noted in the right temporal lobe.

CONCLUSION: Large lesion overlying the right parietal lobe, likely extra-axial and hence it likely represents the suspected diagnosis of a cystic meningioma.

Case Discussion

The patient went on to have surgery. 



The sections show a moderately hypercellular meningioma with a well-developed syncytial architecture. Variably sized cystic spaces are noted as well as areas of lipomatous metaplasia. Collections of hemosiderin-filled macrophages are also seen. Tumor cells have uniform nuclear features. No mitotic figures or areas of necrosis are identified and there is no evidence of brain invasion. Broad attachment to dura is noted.

DIAGNOSIS: Meningioma

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