Meningioma, totally calcified

CLINICAL HISTORY:
This 82-year old woman suddenly developed episodes of speech disturbances and recurrent drop attacks.

NEUROLOGICAL EXAMINATION shows discrete hyperreflexia of the right arm, with slight paresis.

NON-CONTRAST SCAN WITH SOFT TISSUE (IMAGE 1) AND BONE WINDOW (IMAGE 2): Totally and densely calcified mass is seen (arrowheads) in the left parietal region, with broad contact on the convexity.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): A mass is seen at the left parietal convexity with broad peripheral implantation. The majority of the lesion is strongly hypointense (arrow), due to calcification. A small peripheral crescent- like anterior rim is hyperintense. Edema is noted in the white matter.

b) CORONAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGE 4): The lesion remains hypointense.

c) CORONAL (IMAGE 5) AND SAGITTAL (IMAGE 6) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is no enhancement of the calcified center of the lesion. The periphery of the lesion (arrowheads) is intensely enhancing. Note the irregular infiltration of the cortex and the dural tail (arrow).

RADIOLOGICAL DIAGNOSIS is heavily calcified meningioma based on the extraaxial location and the broad implantation on the convexity.

SURGICAL FINDINGS: At surgery the tumor was firmly attached to the dura of the convexity, but was also diffusely infiltrating the cortex. More than 90% of the mass was calcified and very hard.

ANATOMOPATHOLOGY is psammomatous meningioma.

Search also:
Meningioma

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