This case raised some discussion among the radiology team whether the lesion was intra or extra-axial. By the general radiographic features and in a straightforward approach it looks to be an extra-axial tumor, most likely a meningioma. However, when approaching it with more caution and using reformatted plans, the lesion shows the involvement of the adjacent cerebellar folia, some of them seeming to be thinned and invaded/involved by the tumor; these features raised the concern about the possibility of an intra-axial lesion, such as metastasis.

The patient has no history of known previous malignancy.

After surgery, the lesion was confirmed as a meningioma.

Histology

MICROSCOPIC DESCRIPTION:

1. Bone: The section shows fragments of unremarkable lamellar bone. No evidence of tumor is seen.
2. Tumor: The section shows fragments of a moderately hypercellular meningioma. This has a vague syncytial architecture. Tumor cells show moderate nuclear pleomorphism. No mitotic figures or areas of necrosis are identified and there is no evidence of brain invasion.

DIAGNOSIS: Meningioma (WHO Grade I).