Presentation
Chronic progressive headache with progressive left hemiplegia.
Patient Data
A lobulated well-defined space-occupying lesion is noted within in the posterior aspect of the right lateral ventricle. It is isointense on T1 and T2. Intense homogeneous enhancement of the solid component on post-contrast T1.
Well-defined areas of high intensity on T2 and low intensity on T1 may represent cystic components. An area of high intensity on T1 and low intensity on T2 may represent subacute hemorrhage.
Moderate surrounding edema was noted on T2 and flair, with moderate midline shift.
CSF cleft sign is noted, indicating an extra-axial lesion (intraventricular in this case).
The patient went on to have a resection.
Histology
Sections show neoplastic meningothelial cell proliferation within fibrocollagenous background. Tumor cells are arranged in syncytial and whorling patterns. A few psammoma bodies are noted. There is no evidence of significant nuclear atypia or increased mitotic activity.
Diagnosis
Meningioma, WHO grade 1.
Case Discussion
Intraventricular meningiomas usually occur in the trigone in the posterior aspect of the lateral ventricles, the left lateral ventricle is more common, usually lobulated.
The appearance on MRI is similar to meningiomas in other locations.
The diagnosis was confirmed by pathology (meningioma grade 1).
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