Meningothelial meningioma

Case contributed by A.Prof Frank Gaillard

Presentation

Headache.

Patient Data

Age: 60 years
Gender: Female
Modality: MRI

Occupying the right anterior cranial fossa/anterior aspect of the middle cranial fossa and extending across the midline into the left anterior cranial fossa, there is a lobulated mass measuring 8.8 x 4.0 x 7.1cm. This is slightly hyperintense to cortex on T1 and isointense to cortex on T2 and FLAIR, and demonstrates avid contrast enhancement. The mass is favoured to be extra-axial. Within the mass, there is a rounded region of increased diffusion restriction (ADC = 650 x 10-6 mm2/s), possibly reflecting a region of higher cellularity. No invasion of the orbital apex. The right frontal lobe is compressed and demonstrates a large amount of edema. The right lateral and third ventricles are compressed and there is 26mm leftward midline shift with subfalcine herniation. No definite osseous invasion appreciated.

Conclusion:

Large right frontal/anterior temporal mass with significant mass effect is favoured to represent a meningioma. Haemangiopericytoma, and even less likely would be lymphoma in the differential disagnosis.

 

 

Case Discussion

This patient went on to have a craniotomy and macroscopically complete resection. 

Histology

MICROSCOPIC DESCRIPTION: Paraffin sections show a moderately hypercellular meningioma. A syncytial architectural pattern is discernible throughout the tumour. Tumour cells show moderate nuclear pleomorphism and there are scattered mitotic figures (2/20 HPF). The tumour is seen to have a pushing interface with underlying brain parenchyma but no evidence of brain invasion is seen. There are no areas of necrosis.

DIAGNOSIS: Meningioma (WHO Grade I). 

 

Discussion

Despite the WHO grade I histology, but inline with the radiological appearance, the tumour recurred rapidly at the resection margins (multiple 1.5-2cm diameter nodules) within a few months. This suggests that it is in fact a WHO II tumour, with perhaps sampling error or brain invasion not being evident. 

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Case Information

rID: 42309
Case created: 15th Jan 2016
Last edited: 23rd Jan 2016
Inclusion in quiz mode: Included

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