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

• Kim HY
• Yu IK
• Kim SM

• KMID: 2457453
• DOI: http://doi.org/10.3348/jksr.2019.80.4.756

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

Reference

1. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007; 14:97–109.

2. Johnson DR, Guerin JB, Giannini C, Morris JM, Eckel LJ, Kaufmann TJ. 2016 updates to the WHO brain tumor classification system: what the radiologist needs to know. Radiographics. 2017; 37:2164–2180.

3. Buccoliero AM, Caldarella A, Taddei A, Di Lorenzo N, Gallina P, Mennonna P, et al. Atypical, aplastic, and unusual meningiomas. Morphology and incidence in 300 consecutive cases. Pathologica. 2003; 95:83–88.

4. Cushing H, Eisenhardt L. Meningiomas: their classification, regional behaviour, life history, and surgical end results. Springfield: Charles C. Thomas;1938. p. 785.

5. Wang DJ, Zheng MZ, Gong Y, Xie Q, Wang Y, Cheng HX, et al. Papillary meningioma: clinical and histopathological observations. Int J Clin Exp Pathol. 2013; 6:878–888.

6. Kros JM, Cella F, Bakker SL, Geuze DP, Egeler RM. Papillary meningioma with pleural metastasis: case report and literature review. Acta Neurol Scand. 2000; 102:200–202.

7. Kawahara Y, Nakada M, Hayashi Y, Kai Y, Hayashi Y, Uchiyama N, et al. Prediction of high-grade meningioma by preoperative MRI assessment. J Neurooncol. 2012; 108:147–152.

8. Vaquero J, Zurita M, Coca S. Cystic papillary meningioma. Neuropathol Appl Neurobiol. 2002; 28:418–421.

9. Yu XR, Zhang J, Zhang BY, Huang WY, Yin B, Tan WL, et al. Magnetic resonance imaging findings of intracranial papillary meningioma: a study on eight cases. Clin Imaging. 2014; 38:611–615.

10. Pasquier B, Gasnier F, Pasquier D, Keddari E, Morens A, Couderc P. Papillary meningioma. Clinicopathologic study of seven cases and review of the literature. Cancer. 1986; 58:299–230.