J Korean Soc Radiol.  2019 Jul;80(4):756-760. 10.3348/jksr.2019.80.4.756.

Imaging Features and Pathologic Correlation of Papillary Meningioma: A Case Report

Affiliations
  • 1Department of Radiology, Eulji University Hospital, Daejeon, Korea. midosyu@eulji.ac.kr
  • 2Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea.

Abstract

Papillary meningioma is rare meningeal tumors and is associated with aggressive clinical behavior as compared with other meningiomas. We report a case of papillary meningioma in a 50-year-old woman presented with complaints of headache, nausea and vomiting. MRI revealed a very macrolobulated heterogeneously enhancing solid mass at the right frontal convexity with focal prominent inward infiltrating portion and surrounding moderate brain edema. The localization of the lesion as intra-axial or extra-axial in origin was difficult. Demonstrated diffusion restriction and high relative cerebral blood volume value were similar to conventional meningioma, but hypervascular inward infiltrating portion could be seen in papillary meningioma. The histopathology examination of the resected tissues revealed papillary meningioma with an increased cellularity and high nuclear/cytoplasm ratio. She underwent radical excision of the tumor, followed radiotherapy and tumor recurrence occurred at 12 months later.


MeSH Terms

Blood Volume
Brain Edema
Diffusion
Diffusion Magnetic Resonance Imaging
Female
Headache
Humans
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Meningeal Neoplasms
Meningioma*
Middle Aged
Nausea
Radiotherapy
Recurrence
Vomiting

Figure

  • Fig. 1 A 50-year-old female with papillary meningioma in the right frontal region. A. MR images show a macrolobulated mass in right frontal lobe with a focal prominent inward infiltrating portion. The axial T2-weighted image shows an irregular mass with intermediate signal intensity at the right perisylvian inferior frontal convexity, measuring 5.1 × 4.7 × 5.2 cm. The lesion extends to deep white matter with mass effect, compressing the right lateral ventricle. It is predominantly solid with several intratumoral microcystic components with moderate surrounding brain edema, and peripheral engorged veins. Post-contrast T1-weighted axial, coronal, and sagittal images show heterogeneous enhancement of the tumor. B. The pre-contrast axial CT scan shows a large, irregular heterogeneous increased attenuated mass at the right perisylvian inferior frontal convexity. Note the mass shows moderate surrounding brain edema. Post-contrast axial CT of the lesion shows an inhomogeneously enhancing soft tissue mass. C. DWI and the ADC show diffusion restriction of the tumor. D.Perfusion MRI shows an increased relative cerebral blood volume value within the mass, especially in inward infiltrating portion. E.On histopathological examination, the tumor shows increased cellularity, a perivascular pseudopapillary pattern with rhabdoid features, and pleomorphism (haematoxylin and eosin stain, × 400). F. After 21 months, an axial gadolinium-enhanced follow-up MR image shows a recurrence of the tumor along the surgical bed of the right perisylvian frontotemporal area. ADC = apparent diffusion coeffcient, DWI = diffusion-weighted imaging


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