Meningioma with peripheral tumoural cysts

Case contributed by A.Prof Frank Gaillard

Presentation

Generalized tonic clonic seizure.

Patient Data

Age: 40 years

A large, peripherally located (probably extra-axial) mass is present which demonstrates vivid contrast enhancement and adjacent oedema. 

A large vividly enhancing extra-axial mass with peritumoural cysts (with enhancing cysts suggesting they are part of the tumour) is demonstrated with extensive associated oedema. 

DSA (angiography)

Vascular tumour with morphology consistent with meningioma supplied predominantly by the right middle meningeal artery. Additional supply from distal MCA branches.

Note the enhancement of the tumour is early compared to other vessels and stays late. This has been referred to, perhaps unkindly, as a mother-in-law sign; naturally this depends on the particular mother in law. 

Envoy 6Fr MPA exchanged into the proximal ECA. Middle meningeal artery selected using an Asahi Chikai/Headway 17 microcatheter. Tumour embolised using Contour 15-250 micron PVA particles. Reduction in vascularity of tumour (persisting MCA supply), with no embolic complication. 

Case Discussion

The patient went on to have surgery, confirming a cystic meningioma

Histology

MICROSCOPIC DESCRIPTION: The sections show a moderately cellular meningioma with infiltration into the attached dura. The tumour forms whorls. No sheeting arrangement is seen. The tumour cells have ovoid nuclei with no nuclear pleomorphism. Foreign body material is present within a few blood vessels, consistent with preoperative embolisation. Mitoses are inconspicuous. There is no necrosis. No brain parenchyma is seen. No evidence of atypical or malignant change is identified. The dural edges appear clear.

FINAL DIAGNOSIS: Meningioma (WHO Grade I).

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Case information

rID: 48218
Case created: 26th Sep 2016
Last edited: 1st Oct 2016
Inclusion in quiz mode: Included

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