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Dural metastasis of neuroblastoma

CLINICAL HISTORY:
This 40-year old woman underwent surgical intervention for esthesioneuroblastoma of the nose, completed with radiotherapy. 3 years ago tumor recurred in the paranasal sinuses with extension into the anterior cranial fossa. At reexploration diffuse dural metastases were found. Now the patient presents with increasing complaints of vertigo, headache and problems with word finding.

NEUROLOGICAL EXAMINATION is normal.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGES 1 AND 2): Bilateral extra-axial masses are seen (arrows), surrounded by some edema. The masses have an irregular outline and are accompanied by more cystic components.

b) CORONAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGES 3 AND 4): Again it is obvious that the lesions are extra-axial with broad implantation on the convexity.

c) TRANSAXIAL (IMAGES 5 AND 6) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is striking contrast enhancement in both lesions. The extra-axial nature of the lesions is confirmed. Dural thickening and enhancement, known as a dural tail (arrows), is seen on both lesions.

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS is dural metastasis of neuroblastoma.

No surgical or pathological confirmation is available. The dural metastases were already noted at the earlier surgery.

Search also:
Leptomeningeal metastases

 

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Fig. 1

Dural metastasis of neuroblastoma, Fig. 1
Dural metastasis of neuroblastoma, Fig. 2
Dural metastasis of neuroblastoma, Fig. 3
Dural metastasis of neuroblastoma, Fig. 4
Dural metastasis of neuroblastoma, Fig. 5
Dural metastasis of neuroblastoma, Fig. 6