Presentation
First episode of generalized tonic-clonic seizure.
Patient Data
Large extra-axial lesion centered at the right frontal lobe with dense calcification and contrast enhancement. Mild surrounding vasogenic edema. No hemorrhage or necrosis.
Significant mass effect and generalized sulcal effacement with compression of the right lateral ventricle. There is near complete effacement of the suprasellar, prepontine and premedullary cisterns. Cisterna magna is effaced as well with both cerebellar tonsils protruding below the level of the foramen magnum.
Conclusion: Large extra-axial lesion of the right frontal lobe resulting in significant mass effect with transtentorial and cerebellar tonsillar herniation.
Large extra-axial lesion at the right frontal lobe is isotense on T1-weighted sequence, isointense on T2-weighted sequence and demonstrates homogenous contrast enhancement. Central region of T2 hypointensity is consistent with calcification. Mild degree of diffusion restriction.
Mass effect with 10mm midline shift towards the left side. Narrowing and possible invasion of the anterior aspect of the superior sagittal sinus. Downward displacement of the right lateral ventricle and midbrain.
Conclusion: Appearance of the extra-axial lesion of the right parafalcine lesion is suggestive of meningioma.
Case Discussion
The patient underwent stereotactic craniotomy and excision of the right parafalcine lesion.
HISTOLOGY:
Sections show pieces of a highly cellular tumor. The tumor forms vague intersecting fascicles and vague whorls of cells, with sclerotic eosinophilic fibrous bands in the stroma. The tumor cells have oval-to-elongated nuclei, fine chromatin and a small nucleolus. Scattered psammoma bodies are present. Areas of brain invasion are seen. An occasional mitotic figure is identified. There is no sheeted growth, nucleoli or necrosis. Fibrous dura is seen attached to the specimen.
FINAL DIAGNOSIS: Atypical meningioma (WHO grade II).