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Meningioma en plaque

CLINICAL HISTORY:
This 46-year old woman complains of five years of progressive right exophtalmos. She has no visual complaints, but mentions periorbital pain and a feeling of pressure.

NEUROLOGICAL EXAMINATION shows severe exophtalmos, with swelling of the soft tissues in the right frontotemporal lobe. Visual acuity is normal.

CONTRAST-ENHANCED CT:
a) BONE WINDOWS (IMAGE 1): There is increased density and widening of the lateral orbital wall (arrow), starting at the ala major of the right sphenoid and extending to the frontal process of the frontal bone and to the right temporal bone.

b) SOFT TISSUE WINDOWS (IMAGE 2): There is intense enhancement of the soft tissues adjacent to the enlarged bone (arrowheads), with an intraorbital component, a subcutaneous component and an extradural intracerebral component extending into the right temporal fossa.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2200/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): Widening of the right frontotemporal bone is noted in the region of the right lateral orbital wall. The soft tissue component of the lesion (arrowheads) is hyperintense and bulges into the orbit with medial displacement of the lateral rectus muscle. The intracranial component displaces the right temporal lobe.

b) TRANSAXIAL T1-WEIGHTED (520/15/1) SPIN-ECHO SEQUENCE (IMAGE 4): The soft tissue component (arrowheads) seen here is isointense to grey matter.

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is intense and homogeneous contrast enhancement of the soft tissue component. The mass extends along the dural surface of the right hemisphere (arrowheads). The mass reaches and crosses the right insula (arrow).

ANGIOGRAPHY: Selective injection of the right internal maxillary artery (IMAGE 8): Diffuse hypervascularity of the pathological tissue is noted, supplied by hypertrophic middle meningeal and superficial temporal arteries.

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS is meningioma en plaque of the right frontotemporal bone.

SURGICAL FINDINGS: Surgical intervention consisted of resection of the lateral orbital wall, the dura mater and the intracerebral component in the right temporal fossa.

ANATOMOPATHOLOGY was consistent with arachnotheliomatous meningioma.

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Fig. 1

Meningioma en plaque, Fig. 1
Meningioma en plaque, Fig. 2
Meningioma en plaque, Fig. 3
Meningioma en plaque, Fig. 4
Meningioma en plaque, Fig. 5
Meningioma en plaque, Fig. 6
Meningioma en plaque, Fig. 7
Meningioma en plaque, Fig. 8