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Meningioma wiht bone invasion

CLINICAL HISTORY:
This 55-year old woman suffered her first grand mal seizure.

NEUROLOGICAL EXAMINATION is normal.

CT:
a) NON-CONTRAST CT (IMAGE 1): A spontaneously hyperdense mass is seen (arrowheads) at the right frontal convexity with thickening of the adjacent bone (arrow).

b) CONTRAST-ENHANCED CT (IMAGE 2): Intense and homogeneous enhancement is noted (arrowheads).

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): The right lateral ventricle is compressed by an extra-axial mass (arrowheads), protruding into the right hemisphere. The mass is slightly hyperintense and is broadly implanted on the convexity. Some edema (arrow) of the cortex and the subcortical white matter is noted.

b) TRANSAXIAL T1-WEIGHTED (680/20/1) SPIN-ECHO SEQUENCE (IMAGE 4): The mass (arrowheads) is isointense with grey matter.

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGES 6 AND 7) AND SAGITTAL (IMAGE 8) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Intense and homogeneous enhancement of the tumor is seen. There is a dural tail (arrows). Focal thickening of the frontal bone is noted with some enhancing strands (arrowheads) within the bone.

ANGIOGRAPHY: Selective injection of the right internal maxillary artery in anteroposterior (IMAGE 9) and lateral (IMAGE 10) projection. Hypervascularity is appreciated (arrowheads) supplied by the middle meningeal artery.

RADIOLOGICAL DIAGNOSIS is meningioma based on the extraaxial location with broad implantation on the convexity, the intense enhancement, the dural tail and the hyperostosis of the overlying bone.

SURGICAL FINDINGS: At surgery, the tumor had grown into the overlying temporal bone and the dura was diffusely infiltrated with tumor. The tumor was resected together with the dura. Part of the bone flap was removed.

ANATOMOPATHOLOGY ( IMAGE 11) shows psammomatous meningioma.

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Meningioma

 

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Fig. 1

Meningioma wiht bone invasion, Fig. 1
Meningioma wiht bone invasion, Fig. 2
Meningioma wiht bone invasion, Fig. 3
Meningioma wiht bone invasion, Fig. 4
Meningioma wiht bone invasion, Fig. 5
Meningioma wiht bone invasion, Fig. 6
Meningioma wiht bone invasion, Fig. 7
Meningioma wiht bone invasion, Fig. 8
Meningioma wiht bone invasion, Fig. 9
Meningioma wiht bone invasion, Fig. 10
Meningioma wiht bone invasion, Fig. 11