Presentation
Unwitnessed seizure, severe headache, photophobia and neck stiffness.
Patient Data
There is a 23mm x 21mm x 20mm vividly enhancing, lobulated lesion, left of midline and likely extra-axial in origin within the anterior cranial fossa. No vessels are seen to feed into or drain from this lesion. Surrounding hypoattenuation consistent with edema. It is difficult to appreciate whether there is a dural tail associated with this lesion. No other intra or extra-axial abnormality.
Conclusion: Findings are most consistent with a solid tumor and in this location a meningioma (olfactory groove) is by far the most likely. An aneurysm is considered unlikely. The findings are not consistent with an abscess or infective process. The patient will proceed to MRI for further characterization.
The study is complete as it was terminated due to patient movement.
Findings:
Vividly enhancing 3cm lobulated extra axial mass in the left olfactory groove with no abnormal diffusion restriction. Surrounding edema is again demonstrated. No other intra or extra-axial abnormality, mass, or collection identified. Ventricles and basal cisterns are normal in appearance. The cribriform plate beneath is remodeled but not obviously breached within the limitations of the images and there is no involvement of nasal cavity or ethmoid sinuses to suggest esthesioneuroblastoma.
Conclusion: Incomplete study. The lobulated mass in the left olfactory groove is favored to represent a meningioma.
MICROSCOPIC DESCRIPTION: 1-4. Paraffin sections show a moderately hypercellular tumor. This consists of spindle and epithelioid cells with a loose fascicular and storiform architectural arrangement. A vague whorling architecture is also noted in some areas. Tumor cells show mild nuclear and cellular pleomorphism. Occasional mitotic figures are identified (2/10 HPF). No areas of necrosis are seen. There is no evidence of brain invasion. Immunohistochemistry shows strong staining in tumor cells for CD34 and bcl-2. No staining for epithelial membrane antigen (EMA), progesterone receptor (PgR) or ALK-1 is seen. The features are of solitary fibrous tumor (WHO Grade II). The topoisomerase labeling index is approximately 3%.
DIAGNOSIS: 1-4. Olfactory groove tumor: Solitary fibrous tumor (WHO Grade II).
Case Discussion
Solitary fibrous tumors of the dura are rare dural masses, histologically identical to solitary fibrous tumors found elsewhere, and composed of spindle cells thought to be of mesenchymal origin.
The radiographic appearances are those of a well circumscribed mass arising from the dura (supratentorial convexity, falx and tentorium and posterior fossa). Unlike solitary fibrous tumors of the spinal cord, which most frequently arise from the cord itself and not the theca, parenchymal tumors of the brain are very rare.
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