Olfactory groove meningioma (huge)

Case contributed by Assoc Prof Frank Gaillard


Headache and personality change.

Patient Data

Age: 70 years
Gender: Male

Large olfactory groove hyperdense mass with hyperostosis. 

A large lesion, isointense to grey matter on T1 and slightly hyperintense on T2, centered in the anterior cranial fossa, measures 71 x 62 x 49 mm (trans x AP x CC). The lesion shows vivid homogeneous enhancement, with a central spoke-wheel of vessels seen arising from the floor of the anterior cranial fossa. The tumor effaces the frontal lobes, frontal horns of the lateral ventricles and the genu of the corpus callosum. There is extensive white matter T2/FLAIR high signal in the frontal lobes, consistent with edema. The lesion wraps around the anterior falx, but is larger on the left than the right.

Enhancement in the roof of the left ethmoid sinuses, with loss of definition of the overlying cortex, is concerning of tumor invasion. Review of the CT shows possible permeative change in this region. The posteroinferior aspect of the tumor extends into pituitary fossa, abutting the medial aspects of both supraclinoid internal carotid arteries (ICA). The anterior carotid arteries (ACA) extend over the posterosuperior surface of the tumor for much of its extent, and are deviated to the right.

A 18 x 11 mm T2 hyperintense lesion at the left posterolateral aspect of the tumor suppresses on FLAIR, consistent with a cyst (such as a peritumoural arachnoid cyst).

Case Discussion


The sections show a moderately cellular meningioma with attached dura. The tumor forms whorls. No sheeting arrangement is seen. The tumor cells have ovoid nuclei with no nuclear pleomorphism. Mitoses are inconspicuous. There is no necrosis. No brain parenchyma is seen. No evidence of atypical  or malignant change is identified.


Meningioma (WHO Grade I).


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Case information

rID: 32939
Published: 23rd Dec 2014
Last edited: 19th May 2020
Inclusion in quiz mode: Included

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