Mixed microcystic and angiomatous meningioma

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Headache and left sided weakness.

Patient Data

Age: Adult
Gender: Male

MRI Brain

mri

MRI demonstrates a large extraaxial right sided parafalcine mass which is isointense on T1, hyperintense on T2 with areas of attenuation on FLAIR consistent with cystic regions. Bright enhancement of the solid components is noted. No convincing flow voids. The compressed adjacent brain demonstrates extensive edema. 

Case Discussion

This patient went on to have a craniotomy and resection of the mass. 

Histology

Microscopic Description: Sections show a moderately cellular neoplasm, attached to dura matter. There are microcystic changes and prominent vascularity, including both thick and thin-walled blood vessels. In some areas, tumor cells with regular oval nuclei and abundant eosinophilic cytoplasm form solid sheets. There are foci of xanthomatous change and occasional cells associated with round eosinophilic globules. Whorl formation is not evident. There are no atypical features and no brain tissue is present to assess invasion.

FINAL DIAGNOSIS: Meningioma (WHO grade I) with microcystic and angiomatous features

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