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Meningioma with peripheral tumoral cysts

Case contributed by Assoc Prof Frank Gaillard


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 edema. 

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

DSA (angiography)

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

Note the enhancement of the tumor 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. Tumor embolized using Contour 15-250 micron PVA particles. Reduction in vascularity of tumor (persisting MCA supply), with no embolic complication. 

Case Discussion

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


MICROSCOPIC DESCRIPTION: The sections show a moderately cellular meningioma with infiltration into the attached dura. The tumor forms whorls. No sheeting arrangement is seen. The tumor cells have ovoid nuclei with no nuclear pleomorphism. Foreign body material is present within a few blood vessels, consistent with preoperative embolization. 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
Published: 30th Sep 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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