J Korean Neurosurg Soc.  2014 Dec;56(6):509-512. 10.3340/jkns.2014.56.6.509.

Primary Osteolytic Intraosseous Atypical Meningioma with Soft Tissue and Dural Invasion: Report of a Case and Review of Literatures

• Yun JH
• Lee SK

• KMID: 2191146
• DOI: http://doi.org/10.3340/jkns.2014.56.6.509

Abstract

Primary intraosseous meningioma is a rare tumor, and atypical pathologic components both osteolytic lesion and dura and soft tissue invasion is extremely rare. A 65-year-old woman presented with a 5-month history of a soft mass on the right frontal area. MR imaging revealed a 4 cm sized, multilobulated, strongly-enhancing lesion on the right frontal bone, and CT showed a destructive skull lesion. The mass was adhered tightly to the scalp and dura mater, and it extended to some part of the outer and inner dural layers without brain invasion. The extradural mass and soft tissue mass were totally removed simultaneously and we reconstructed the calvarial defect with artificial bone material. The pathological study revealed an atypical meningioma as World Health Organization grade II. Six months after the operation, brain MR imaging showed that not found recurrence in both cranial and spinal lesion. Here, we report a case of primary osteolytic intraosseous atypical meningioma with soft tissue and dural invasion.

Keyword

Atypical; Intraosseous; Meningioma; Osteolysis

MeSH Terms

Aged
Brain
Dura Mater
Female
Frontal Bone
Humans
Magnetic Resonance Imaging
Meningioma*
Osteolysis
Recurrence
Scalp
Skull
World Health Organization

Figure

• 

  Fig. 1 Initial CT and MR scans. CT scan with bone window (A) demonstrates a right-sided frontal mass expanding the calvaria with cortical destruction. Axial T2-weighted (B) MR images show the frontal intracalvarial mass lesion that was hypointense on T2-weighted images with the surrounding edema. The lesion shows intense and homogeneous enhancement on the postcontrast T1-weighted (C) image. Sagittal postcontrast T1-weighted MR images (D) reveal the intracranial extension and extradural location of the lesion.

• 

  Fig. 2 Pathologic findings of the tumor specimens. Histological specimen showing atypical meningioma with freguent mitosis (A) and geographic necrosis (B) (H&E, original magnification ×100).

• 

  Fig. 3 Follow-up images 6 months after the operation. Postoperative MR image axial postcontrast T1-weighted (A) and sagittal postcontrast T1-weighted (B) MR images show no recurrence of the mass lesion except for postoperative changes.

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  Fig. 4 Comparative illustrations of the tumor of bone origin including intraosseous meningioma (A) and the tumor of meningeal origin including intracranial meningioma (B). Prior illustration (A), which demonstrates a broad calvarial tumor base, shows more expansion of the soft tissue and dural lesion while tumor base of the next illustration (B) located in the meaninges including the dura or arachnoid and it shows more expansion of the brain, bone and a few soft tissue lesions.

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