J Korean Neurosurg Soc.  2014 Apr;55(4):205-207. 10.3340/jkns.2014.55.4.205.

Extracranial Extension of Intracranial Atypical Meningioma En Plaque with Osteoblastic Change of the Skull

• Jang SY
• Kim CH
• Cheong JH
• Kim JM

• KMID: 2191093
• DOI: http://doi.org/10.3340/jkns.2014.55.4.205

Abstract

Meningioma is a common primary tumor of central nervous system. However, extracranial extension of the intracranial meningioma is unusual, and mostly accompanied the osteolytic change of the skull. We herein describe an atypical meningioma having extracranial extension with hyperostotic change of the skull. The patient was a 72-year-old woman who presented a large mass in the right frontal scalp and left hemiparesis. Brain magnetic resonance imaging and computed tomography scans revealed an intracranial mass, diffuse meningeal thickening, hyperostotic change of the skull with focal extension into the right frontal scalp. She underwent total removal of extracranial tumor, bifrontal craniectomy, and partial removal of intracranial tumor followed by cranioplasty. Tumor pathology was confirmed as atypical meningioma, and she received adjuvant radiotherapy. In this report, we present and discuss a meningioma en plaque of atypical histopathology having an extracranial extension with diffuse intracranial growth and hyperostotic change of the skull.

Keyword

Atypical meningioma; Extracranial extension; Hyperostotic change; Meningioma en plaque

MeSH Terms

Aged
Brain
Central Nervous System
Female
Humans
Magnetic Resonance Imaging
Meningioma*
Osteoblasts*
Paresis
Pathology
Radiotherapy, Adjuvant
Scalp
Skull*

Figure

• 

  Fig. 1 Preoperative brain enhanced computed tomography (CT) scans and magnetic resonance (MR) image. A : Axial CT scan displaying the well-enhanced mass in the right frontal area extended through the skull diffusely. B : Coronal CT scan showing the frontal bulging with rough outer table by the hyperostotic change. C and D : Sagittal and coronal T2-weighted MR images revealing the ill-defined tumor compressing the right frontal lobe and the marginal multi-cystic mass in the right hemisphere.

• 

  Fig. 2 Photomicrographs of the tumor specimens. H & E staining shows the findings of atypical meningioma characterized by geographic necrosis, sheet-like pattern (A, ×40), increased cellularity (B, ×100), mild to moderate pleomorphism and mitotic figures (C, ×400).

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