Meningioma with haemorrhagic 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 haemorrhage 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 oedema.

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

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

No new intracranial haemorrhage.

No hydrocephalus.

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

Unremarkable CTA COW (not shown).

MRI

MRI Brain

An extra-axial vividly enhancing tumour 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 millimetres 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 haematoma

Right subdural convexity haematoma

Case Discussion

The tumour was resected: 

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

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

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Case information

rID: 41346
Case created: 27th Nov 2015
Last edited: 25th Jan 2016
Tag: rmh
Inclusion in quiz mode: Included

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