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Pseudomeningioma, metastasis

CLINICAL HISTORY:
This 61-year old patient underwent mastectomy for breast carcinoma three years ago. Now she complains of progressive headache and disorientation.

NEUROLOGICAL EXAMINATION reveals left hemiparesis and bilateral papilledema.

CONTRAST-ENHANCED CT (IMAGES 1 AND 2): Substantial midline shift to the left is seen with total obliteration of the right lateral ventricle. A contrast enhancing lesion is identified (arrow) with broad implantation on the right parietal convexity and marked associated edema.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2800/95/1) SPIN-ECHO SEQUENCE (IMAGE 3): A low intensity lesion is confirmed (arrowheads) in the right parieto-occipital region, with broad implantation on the dura. Marked white matter edema is seen.

b) TRANSAXIAL T1-WEIGHTED (580/14/1) SPIN-ECHO SEQUENCE (IMAGE 4): The tumor (arrowheads) is now more isointense with grey matter. Note the broad implantation on the dura and the thickening of the adjacent dura.

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Intense and homogeneous enhancement of the lesion is appreciated. Note the presence of a dural tail (arrowhead) in the transaxial direction.

RADIOLOGICAL DIAGNOSIS includes meningioma and metastasis.

SURGICAL FINDINGS: At surgery the tumor was located within the cerebral cortex and was very hard. The overlying dura mater was firmly infiltrated. The tumor was moderately vascular and had a blue-grey colour. Total resection of the tumor together with the overlying dura mater was performed.

ANATOMOPATHOLOGY was consistent with metastatic adenocarcinoma.
IMAGE 8 illustrates a similar finding of metastasic breast carcinoma, attached to the dura in another patient.

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Meningioma

 

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Fig. 1

Pseudomeningioma, metastasis, Fig. 1
Pseudomeningioma, metastasis, Fig. 2
Pseudomeningioma, metastasis, Fig. 3
Pseudomeningioma, metastasis, Fig. 4
Pseudomeningioma, metastasis, Fig. 5
Pseudomeningioma, metastasis, Fig. 6
Pseudomeningioma, metastasis, Fig. 7
Pseudomeningioma, metastasis, Fig. 8