Meningioma with hemorrhagic necrosis

Case contributed by A.Prof Frank Gaillard

Presentation

Patient had a fall from horse, had right subdural haematoma. Headache.

Patient Data

Age: 49-year-old
Gender: Male
CT

CT Brain

3.9 x 2.5 x 3.2 cm right frontal lesion which is extradural and demonstrates small foci of internal high attenuation of the precontrast imaging, which may represent calcification or tiny regions of hemorrhage in this clinical setting. The lesion displays vivid contrast enhancement on the post contrast images. The features suggest a meningioma. There is underlying sulcal effacement but no underlying edema.

Right convexity subdural hematoma measures 5 mm, previously 4 mm.

Associated mass effect causes effacement of underlying sulci, without midline shift.

No new intracranial hemorrhage.

No hydrocephalus.

Conclusion: Right convexity subdural hematoma. Right frontal likely meningioma. MRI is recommended.

Unremarkable CTA COW (not shown).

MRI

MRI Brain

An extra-axial vividly enhancing tumor has a broad base arising from the right frontal bone and anterior cranial fossa floor, indents but does not invade the frontal lobe, is partially calcified and heterogeneous, and measures 41 x 23 x 33 mm. A dural tail of enhancement extends both medial and posterolateral.

In addition, right convexity subdural blood and reactive dural enhancement are shown over the sylvian fissure and posterior frontal and anterior parietal lobes, 4.5 millimeters in maximum thickness, stable from prior CT.

Cerebral parenchymal signal intensity and architecture are otherwise within normal limits.

Normal flow voids are demonstrated in the major arteries at the base of the brain. No hydrocephalus.

Conclusion: Right frontal meningioma with extensive dural tail enhancement merging with enhancement related to the subacute subdural hematoma

Right subdural convexity hematoma

Case Discussion

The tumor was resected: 

MICROSCOPIC DESCRIPTION: 1&2: Paraffin sections show fragments of a moderately hypercellular meningioma. This has a well developed syncytial architecture. Tumor cells show mild nuclear pleomorphism. No mitotic figures are identified. There are several areas of hemorrhagic infarction of tumor and there are numerous hemosiderin-filled macrophages indicating remote hemorrhage. No evidence of brain invasion is seen. Attachment to dura is noted. Dural margins are clear of tumor.

DIAGNOSIS: Right frontal brain tumor: Meningioma (WHO Grade I).

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Case information

rID: 41346
Published: 25th Jan 2016
Last edited: 29th Jun 2017
Tag: rmh
Inclusion in quiz mode: Included

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