Planum sphenoidale meningioma

MICROSCOPIC DESCRIPTION:

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

DIAGNOSIS:

Brain tissue: Meningioma (WHO Grade I).

MRI

Brain (suprasellar protocol)

Technique:

Multiplanar, multisequence imaging has been obtained through the brain, targetted to the suprasellar region, including pre and post contrast sequences.

Findings:

Arising from the planum sphenoidale, to the left of the midline is an extra-axial dural based mass which measures 16 x 15 x 16 mm. It vividly enhances following contrast except for a small cystic area superiorly. It projects between the optic nerves, displacing the left optic nerve laterally and pushing the chiasm backwards. There is a tongue of enhancing tissue extending down into the pituitary fossa on the left side, and the supraclinoid ICA on the left is contacted by the mass over approximately 200°. The pituitary is clearly separate to this mass and unremarkable in appearance and the infundibulum remains midline. Flow voids of the anterior cerebral arteries are preserved, displaced on the left by the mass.

The remainder of the brain is unremarkable in appearance, other than patchy regions of high T2 signal in the white matter consistent with chronic small vessel ischemic change. MRI is unremarkable. No evidence of an aneurysm.

Conclusion:

Features are almost certainly those of a planum sphenoidale meningioma, with no other diagnosis being a serious differential. Features are categorically not those of an aneurysm, thrombosed or otherwise.

Dr Frank Gaillard

Consultant Radiologist