Meningioma - sphenoid wing - typical

Case contributed by Assoc Prof Frank Gaillard

Presentation

Vague headaches.

Patient Data

Age: 45 years
Gender: Male

Left sphenoid wing extra axial dural based enhancing mass

The lesion displays low signal on T1, intermediate signal on T2 with strong enhancement after contrast injection

Case Discussion

CT and MRI demonstrate characteristic appearances of a left sphenoid wing meningioma. The mass is well circumscribed and extraaxial with a broad dural base. It is isodense to brain on CT and enhanced relatively vividly. On MRI it is isointense on both T1 and T2 images to grey matter, and again demonstrates enhancement. 

In this cases there is little differential diagnosis. It is remote from the the pituitary fossa, making a solid craniopharyngioma unlikely. Signal characteristics are not those of a chondroid tumor. 

Histology

The sections show fragments of tumor, which shows variable and up to densely collagenous fibrosis. The  tumor is present as sheets, islands, and nests of  elongate  cells, with  poorly defined  cytoplasmic outlines. Nuclei are oval and fairly regular,  sometimes with cytoplasmic inclusions. No tumor  necrosis  is  identified,  there  are  no areas  of  tumor cell "sheeting",  with no foci  showing  macronucleoli.   No cerebral  tissue is identified.

Final diagnosis: Meningioma, WHO grade 1

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