Meningioma, atypical: case 2

CLINICAL HISTORY:
This 56-year old person suffers from several months of progressive memory disturbances, both short term and long term. She mentions dyscalculia and problems with naming things.

NEUROLOGICAL EXAMINATION only shows discrete finger agnosia bilaterally.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2200/80/1) SPIN-ECHO SEQUENCE (IMAGE 1): A huge left frontal mass is seen with intensity comparable to grey matter. Some intratumoral hyperintensities are noted as is accompanying edema. The lesion demonstrates broad insertion on the convexity (arrowheads).

b) TRANSAXIAL T1-WEIGHTED (512/14/1) SPIN-ECHO SEQUENCE (IMAGE 2): The lesion now is more hypointense. Again seen is the broad insertion on the periphery of the convexity (arrowheads) and the mass effect on the midline.

c) TRANSAXIAL (IMAGES 3 AND 4), CORONAL (IMAGE 5) AND SAGITTAL (IMAGE 6) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The periphery of the tumor enhances intensely. The center is not enhancing with an irregular central shape. Again seen is broad implantation on the convexity with evidence of dural tail (arrowhead).

RADIOLOGICAL DIAGNOSIS is atypical meningioma. The diagnosis of meningioma is based on the extraaxial location, the broad insertion on the dura of the convexity and the intense enhancement.

SURGICAL FINDINGS: At surgery, a 6 cm diameter meningioma was found, tightly adherent to the dura of the frontal convexity. The center of the tumor appears to be necrotic, but without cystic component.

ANATOMOPATHOLOGY was consistent with fibrous meningioma Grade I.

Search also:
Meningioma