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Meningioma, intraventricular, possibly anaplastic

CLINICAL HISTORY:
This 27-year old man complains of three months of severe bitemporal headaches. Now the frequency of these headaches increases and tinnitus has developed. Furthermore the patient complains of problems with vision and memory.

NEUROLOGICAL EXAMINATION reveals bilateral papilledema. There is a left homonymous lower quadrantanopsia.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): Midline shift to the right is noted with obliteration of the atrium of the right lateral ventricle. A homogeneously hyperdense multilobulated mass is seen (arrowheads) at this level, with some surrounding edema.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): Homogeneous and intense enhancement of the lesion is apreciated.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): The multilobulated mass is seen, situated within the right lateral ventricle. There is substantial surrounding edema. The mass is somewhat hyperintense to grey matter. Within the lesion several areas of signal drop-out (arrowheads) can be seen, due to vessels.

b) CORONAL T1-WEIGHTED (700/20/1) SPIN-ECHO SEQUENCE (IMAGES 4 AND 5): The mass is isointense to grey matter. Notice again the intraventricular location and the presence of hypertrophic vessels (arrowheads) within and at the surface of the tumor, leading to signal voids.

c) CORONAL (IMAGES 6 AND 7) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Intense contrast enhancement of the lesion is noted, as are the overlapping veins (arrowheads).

RADIOLOGICAL DIAGNOSIS is intraventricular meningioma based on the homogeneous intensity, the homogeneous enhancement and the evidence of hypertrophic venous drainage.

SURGICAL FINDINGS: At surgery, the tumor was situated in the trigone and the temporal horn of the right lateral ventricle. The surface was bumpy and tightly adherent to the ventricular wall. The tumor was composed of solid and soft components. The lesion was highly vascular, supplied by choroidal arteries. Resection was complete.

ANATOMOPATHOLOGY was consistent with arachnotheliomatous meningioma, with focal anaplastic degeneration.

COMMENT: Because of the focal anaplastic degeneration, adjuvant radiotherapy was given. Survival now is 7 years.

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Fig. 1

Meningioma, intraventricular, possibly anaplastic, Fig. 1
Meningioma, intraventricular, possibly anaplastic, Fig. 2
Meningioma, intraventricular, possibly anaplastic, Fig. 3
Meningioma, intraventricular, possibly anaplastic, Fig. 4
Meningioma, intraventricular, possibly anaplastic, Fig. 5
Meningioma, intraventricular, possibly anaplastic, Fig. 6
Meningioma, intraventricular, possibly anaplastic, Fig. 7