Brain Tumor Res Treat.  2023 Apr;11(2):140-144. 10.14791/btrt.2022.0029.

A Meningioma With Extensive Peritumoral Edema Mimicking Metastatic Brain Tumor: A Case Report

• Demaisip PD
• Juangco DN
• Tambal NJC
• Alvarez N

• KMID: 2542086
• DOI: http://doi.org/10.14791/btrt.2022.0029

Abstract

Meningioma is the most common brain tumor among all histologically reported malignant and non-malignant tumors of the central nervous system. Angiomatous meningioma is one of the subtypes of meningioma that is rarely reported. In this paper, we present a case of a 67-year-old female patient who sought consultation due to seizure, cognitive decline, and parkinsonism. Contrast-enhanced MRI showed a well-defined tumor in the left frontal lobe convexity with extensive perilesional edema. A tumor excision was done and histopathology studies revealed an angiomatous meningioma subtype. This case is reportable because angiomatous meningioma is a recognized rare entity. It is important to share this entity with other medical professionals and start to consider this condition in differential diagnosis when diagnosing a patient with an intracranial mass with an extensive peritumoral edema. Furthermore, the patient’s unusual presentation of parkinsonian features and its occurrence with colorectal cancer history suggest a possible association between these conditions.

Keyword

Angiomatous meningioma; Central nervous system neoplasms; Colorectal neoplasm; Neoplasms; Research

Figure

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  Fig. 1 Neuroimaging MRI with contrast enhancement. A: The tumor lesion is isointense on the T1-weighted (T1W) sequence located at the left frontal lobe, measuring 3×2.8×3.4 cm. B: There are marked intense enhancements of the lesion after contrast as depicted in the T1W sequence. This abuts the dura and compresses the left frontal horn. C: Susceptibility-weighted image sequence does not show magnetic susceptibility. D and E: There are some signal voids of blood vessels seen in the T2-weighted sequences and it demonstrated marked surrounding edema. F: The region does not show abnormally low apparent diffusion coefficient values.

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  Fig. 2 Histopathologic and gross examination. A-D: Hematoxylin and eosin stain. A: Tumor composed of numerous vascular spaces and meningothelial cells (×100 magnification). B: Vascular spaces lined by endothelial cells with intervening areas of round to ovoid meningothelial cells. Some meningothelial cells are wrapped around the blood vessels, displaying degenerative nuclear atypia with intranuclear pseudo-inclusions (×400 magnification). C: Meningothelial cells with eosinophilic cytoplasm and several hyaline globules within spaces (×400 magnification). D: Psammoma bodies demonstrating concentric calcifications (×400 magnification). E: Gross examination shows an encapsulated tumor (0.2-cm thick capsule) with a dark brown, smooth cut surface with punctate hemorrhages.

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  Fig. 3 Immunohistochemical study. A: Tumor cells show negative immunoreactivity for CD34 but positive for endothelial cells lining the blood vessels (CD34, ×400 magnification). B: Tumor cells show focal, strong nuclear expression on progesterone receptors (progesterone, ×400 magnification). C: Tumor cells exhibiting diffuse, strong, cytoplasmic staining on epithelial membrane antigen (EMA, ×400 magnification).

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