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Meningioma, pseudocystic

CLINICAL HISTORY:
This 45-year old man complains of three months of headache. Over the past few days he has had difficulties in finding words and he notes weakness of the left arm.

NEUROLOGICAL EXAMINATION shows discrete left hemiparesis.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): Midline shift to the left with compression of the right lateral ventricle is seen. An inhomogeneous partially cystic lesion is noted (arrow) in the right hemisphere, adjacent to the bone.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): The center (arrow) of the lesion shows intense contrast enhancement. The cystic components only enhance at the periphery (arrowheads).

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): Confirmation of mass effect and compression of the right lateral ventricle. Evidence of a multilobulated mass in the right frontoparietal region. In the center of the lesion a hypointense solid nodule (arrow) is found. More peripherally multiple cystic components are seen. Some edema is identified.

b) CORONAL T1-WEIGHTED (560/20/1) SPIN-ECHO SEQUENCE (IMAGE 4): On this sequence the lesion is of overall hypointense cystic character. It is obvious that the tumor is broadly implanted on the dura mater of the convexity. The Sylvian fissure (arrowheads) is considerably depressed.

c) CORONAL (IMAGES 5 AND 6) AND SAGITTAL (IMAGES 7 AND 8) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is intense central enhancement in continuity with enhancing intercystic septa and with intensely enhancing dura mater, giving rise to a complex appearance of the tumor.

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS includes a malignant tumor such as glioblastoma, with dural invasion. Another possibility is an angioplastic meningioma with multiple cysts.

SURGICAL FINDINGS: At surgery, a highly vascularized tumor was found abutting the surface of the dura. The tumor was clearly extraaxial. The cysts surrounding the tumor appeared to correspond not to real tumor cysts, but to isolated cerebrospinal fluid spaces confined by thickened arachnoid membranes.

DIAGNOSIS: Meningioma with meningo-endotheliomatous differentiation.

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Meningioma

 

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Fig. 1

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