Meningioma: very bright T2

Case contributed by A.Prof Frank Gaillard

Presentation

Headaches and drowsiness.

Patient Data

Age: 55 years
Gender: Female
CT

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

MRI

MRI demonstrates markedly high T2 signal, and a CSF cleft sign. The mass enhances vividly and demonstrates prominent surrounding oedema. 

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 peritumoural oedema. These tumours are usually therefore softer and easier to resect but can be highly vascular, and may therefore benefit from preoperative embolisation. 

Histology

MICROSCOPIC DESCRIPTION: Sections show multiple fragments of tumour which has a cellular tumour consisting of spindle cells.  The spindle cells have round bland nuclei with prominent intracytoplasmic clearing.  No atypical features are seen.

DIAGNOSIS: Meningioma WHO grade 1.

Discussion

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 tumours. Thus one is left wondering exactly what the answer is. *sigh*

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Case information

rID: 14109
Case created: 27th Jun 2011
Last edited: 23rd Jan 2016
Inclusion in quiz mode: Included

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