Presentation
Incidental finding of left parietal calcified meningioma on CT following MVA. GCS 15/14. No focal deficits.
Patient Data
Left parietal convexity mass with calcification and reactive parenchymal edema.
Predominantly left parietal convexity extraaxial mass (CSF cleft sign) with a cystic component that appears intra-axial and left frontoparietal vasogenic edema. ADC values are low (745 10-6 mm2/s). There is SWI signal abnormality corresponding to the areas of calcification on CT. The mass is avidly enhancing with evidence of parenchymal enhancement suggestive of brain invasion - this is best appreciated on the coronal and sagittal imaging.
Formalin-fixed paraffin-embedded tissue after a left parietal craniotomy and tumor resection.
Description: The tumor shows meningothelial architecture in areas and fascicular in others infiltrating to the fibrous stroma (transitional type). There are multiple foci of psammomatous calcification. The cells show moderate variation in nuclear size with frequent nuclear pseudoinclusions. There is no sheetlike architecture or necrosis. Mitotic activity is infrequent.
In one fragment, peripherally there is glial tissue which is focally infiltrated by meningioma. Multifocal infiltration is confirmed on synaptophysin immunohistochemistry.
Case Discussion
In this case example the low tumoral ADC values and evidence of brain invasion are consistent with reported imaging findings of atypical meningioma which was confirmed on tumor resection.
Histology courtesy of Dr. S Roberts-Thomson, Royal Melbourne Hospital, Australia.
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