Presentation
Blurry vision.
Patient Data
An extra-axial mass on the left side of the planum sphenoidale vividly enhances and sends a tongue of tumor into the left optic canal compressing the optic nerve which has high T2 signal. The left optic nerve sheath is collapsed around the nerve which appears bright even at its most anterior extent. the left side of the chiasm and left prechiasmatic section of the optic nerve are also high in T2 signal, difficult to separate from the mass on T2 coronal images.
Features are those of a meningioma.
Case Discussion
The patient went on to have a resection.
Histology
Sections show multiple fragments of tissue which consists of a meningothelial type meningioma. No atypical features are seen. No necrosis is present. No evidence of brain invasion is identified in the specimen.
FINAL DIAGNOSIS: meningioma, WHO grade I.
Discussion
Whenever assessing meningiomas in this region it is imperative to assess the optic canal for small amounts of tumor. In some instances, the entire tumor may be confined to the optic canal and the only clue will be asymmetry of the optic nerve sheaths and nerves.