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Meningioma, lipoblastic

CLINICAL HISTORY:
A 60-year old woman suffered transient left hemiparesis 7 years ago with total recovery. She recently developed new hemiparesis 4 months before admission with recovery of motor function within one week. Since then she complains of word finding and memory problems, emotional lability and gait difficulties with recurrent falls.

NEUROLOGICAL EXAMINATION revealed only gait instability.

CT:
a) NON-CONTRAST CT (IMAGE 1) shows a right frontal convexity lesion with little mass effect. The lesion has a very low density center (arrow) with negative attenuation values of -80 Hounsfield Units. This center is surrounded by a broad, focally calcified halo (arrowhead) hyperdense to the adjacent brain.

b) CONTRAST-ENHANCED CT (IMAGE 2): Marked enhancement of the halo is seen, while the center is slightly enhancing.

MRI:
a) TRANSAXIAL T2-WEIGHTED SPIN-ECHO (2500/90/1) SEQUENCE (IMAGE 3): The center of the lesion (arrow) is isointense with the subcutaneous fat, i.e. strongly hypointense. The peripheral halo is isointense to brain.

b) TRANSAXIAL (IMAGES 4 AND 5) AND CORONAL (IMAGE 6) T1-WEIGHTED SPIN-ECHO (450/15/1) SEQUENCE: The center of the lesion (arrowhead) again is isointense with the subcutaneous fat, i.e. hyperintense. The peripheral halo is isointense to brain.

c) CORONAL GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCE (IMAGE 7) shows strong enhancement of the periphery of the tumor, which is now indistinguisable from the center. A dural tail sign is appreciated (arrowheads).

RADIOLOGICAL DIAGNOSIS is meningioma based on the extraaxial location and the calcifications. The findings furthermore suggest lipomatous changes in the center of the tumor.

SURGICAL FINDINGS: Via right frontal craniotomy a hard convexity mass was totally removed.

ANATOMOPATHOLOGY revealed a syncitial meningioma in the center of which disseminated clusters of adipocytes were found.

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Fig. 1

Meningioma, lipoblastic, Fig. 1
Meningioma, lipoblastic, Fig. 2
Meningioma, lipoblastic, Fig. 3
Meningioma, lipoblastic, Fig. 4
Meningioma, lipoblastic, Fig. 5
Meningioma, lipoblastic, Fig. 6
Meningioma, lipoblastic, Fig. 7