Meningioma with extenstion through skull
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Right frontotemporoparietal abnormal marrow signal with extensive periosteal reaction of the outer table (hair-on end appearance), and an overlying subgaleal soft tissue component that enhances peripherally, surrounding by an edematous scalp. The permeative process extends to the inner table of the skull, deep to which there is an extraaxial mass. The extraaxial lesion is heterogenously enhancing, with enhancement of the overlying meninges extending anteriorly and posteriorly. The extraaxial component demonstrates restricted diffusion. No blood products on EPI images. Mild mass effect of the extraaxial lesion compressing the underlying brain, partially effacing the sulci with minimal midline shift. No other abnormalities was identified.
Right skull mass lesion as described centered on the skull bone with subgaleal and extraaxial components. Appearance is that of a neoplastic processes, including sarcoma of bone, and less likely metastatic deposits. Because of the heterogenous enhancement, meningioma including en plaque or atypical is considered less likely but remains a possibility.
The patient went on to have the mass and affected skull resected.
Paraffin sections show a moderately hypercellular meningioma with a broad dural attachment. Tumour cells have uniform nuclear features and are arranged in syncytia and loose fasciculi. No mitotic figures or areas of necrosis are identified and there is no evidence of brain invasion. Tumour is seen to infiltrate between bone trabeculae in specimen.
Sections of decalcified bone tisue show diffuse infiltration of intertrabecular spaces by meningioma.
The differential in this case would, in addition to meningioma, include a hemangiopericytoma and a metastasis and potentially a primary skull (bone) mass.