Fibroblastic meningioma mimicking an intracerebral hemorrhage: case report

ABSTRACT A 50-year-old woman presented to the emergency room complaining of severe headache. A non-contrasted head CT was obtained, which demonstrated a hyperdense image compatible with an intracerebral hemorrhage in the posterior region of the left temporal lobe. The patient displayed no neurological deficit during the consultation and a subsequent MRI showed a temporoinsular bleeding lesion that was suggestive of an atypic meningioma or a metastatic lesion. Afterwards, neck, chest and abdomen CT scans were performed, and the imaging ruled out a secondary neoplasm. The patient underwent surgical resection of the lesion, and a solid tumor was found with no bleeding associated. The pathology reported a WHO I fibroblastic meningioma.

Cystic Lesions in Giant Intraventricular Meningioma: Cases Report

Background: Giant meningioma stemming from intraventricular zone has been reported to be extremely few. Two cases of supersize (>8 cm) intraventricular meningiomas presenting with cystic lesions and their clinical characteristics were collected in our study.Case description: One patient was a 56-year-old man who hospitalized for blunt headache and weakness of right lower limb along with defect of right visual field for 12 months. The other patient is a 22-year-old lady presented with slight headache accompanied with right facial numbness for one week. Computed tomography and magnetic resonance imaging of both patients revealed a giant heterogeneous, enhancing tumor mainly in the left trigonum with a low-density or hypointense cystic lesions located within or around the tumor. Total resection was performed via a transcortical approach in both cases. The pathological and immunohistochemical staining indicated fibroblastic meningioma (case one) and atypical meningioma (case two) respectively. Postoperatively, both of patients recovered free from episodes of symptoms and imaging examinations confirmed no evidence of regrowth of the meningioma during an average 24 months follow-up. Conclusions: Cystic lesions may indicate the histopathologic malignancy of intraventricular meningioma. Transcortical approach through the posterior temporal lobe or the parieto-occipital lobe is an effective technology for giant intraventricular meningiomas.

Reasons for Diagnostic Delay of Foot Drop Caused by Parasagittal Meningioma: Two Case Reports

Foot drop is defined as an impaired ability or inability of dorsiflexion. Peripheral nervous system injuries are commonly considered as the cause of this condition. The central causes including parasagittal meningioma are also described in the literature but very rarely and commonly not recognized early. In this article, we report 2 patients with isolated unilateral foot drop as the first symptom of a parasagittal meningioma and discuss several reasons for delayed diagnosis. Two patients were treated with decompressive craniotomy. The histopathological findings demonstrated a fibroblastic meningioma and a meningothelial meningioma. During postoperative follow-up, the woman patient showed nearly complete recovery and the second case regained total muscle power over a period of 12 months. The rarity of the disease, the absence of upper motor neuron signs, the occurrence of peripheral pathologies and misinterpretation of F wave on nerve conduction study, and motor unit recruitment on electromyography lead to delay in diagnosis and treatment of the central foot drop due to parasagittal meningioma.

Extra-Axial spinal Lumbar Neoplastic Lesions. A Rare Meningotelial entity: Fibroblastic Meningioma. Case Report and Revision of Litterature

Background and Importance In the field of spinal tumors, and in particular among extra-axial spinal and peripheral nerve tumors, the occurrence of dumbbell lumbar meningioma has not been reported in the literature. In the present study we describe a case of a patient suffering from dumbbell-shaped lumbar meningioma. This tumor resulted, after postoperative histological examination, a fibroblastic meningioma, WHO I grade, a very rare entity. Dumbbell meningiomas are extremely uncommon, comprising only 2–3.6 %. Clinical Presentation An 81-year-old man presented with history of gradually increasing lumbar pain, not related with decubitus and axial load, and right sciatica for 6 months. Another clinical feature was sensitive and motor (4/5 BMRCI) deficits at level of right L5 radicular territory. MRI shows a dumbell lesion in right neuroforamen L5-S1. With the patient in a prone position, we exposed and excised the tumor via a one stage posterolateral approach, through a hemi-laminictomy of L5, starting from a midline lumbar right L5-S1 interlaminar approach, extended to far lateral right articular and extra-articular region. We pre-operatively assumed the mass was a schwannoma because of its location and dumbbell shape, and planned the surgical procedure with use of continuous intraoperative neurophysiological neuromonitoring, to minimize the concrete risk of a possible intraoperative neurologic damage and preoperative neurological deficits worsening. Patient did not develop more deficits and the tumor resulted a fibroblastic meningioma. Patient recovered upright posture and walking during the first postoperative day, with the aid of a lumbar corset. The surgical wound was regular and subfascial lumbar drainage was removed on the first postoperative day. During postoperative recovery no additional neurological deficits appare and the low back pain and the right sciatic pain partially improved. On the fifth postoperative day patient was discharged from the hospital with the indications to wait for the histological examination result for any possible subsequent terapie and for the appropriate follow-up. Conclusion This patient-case report suggests that dumbbell shape of a spinal tumor (in particular at level of lumbar spine) has to be underwent to a very careful differential diagnosis, considering the possibility to discover, among the most frequent histology neoplastic lesions, the presence of histologically more rare tumors. This knowledge is very important from the beginning of surgical and therapeutic planning to the diagnostic and possible postoperative adiuvant therapeutic follow-up of patient.

Convexity meningioma associated with depression: A case report

Introduction. Meningiomas are slow growing, extra-axial lesions, and can be neurologically silent for a long time and present only with depression. Case Outline. A 65-year-old woman developed major depression and was treated with antidepressants for two years. Depression failed to respond to drug treatment and there was no improvement. Two months before admission to hospital, due to the onset of epilepsy attack the patient underwent reinvestigation, and a large temporal convexity meningioma, which corresponded in position to the original electroencephalography focus, was diagnosed using the computer topography of the brain. The patient underwent osteoplastic craniotomy, and a left fronto-temporal convexity meningioma of 5 cm in diameter was completely removed with its attachment to the dura. Histological examination confirmed a fibroblastic meningioma. Conclusion. Total resection of convexity meningioma and decompression of the brain tissue in the region of limbic pathways that are involved, may contribute to a complete remission of depression symptoms. This case also illustrates the need for a prompt neuroimaging of the brain when patients present any atypical psychiatric symptoms, with late onset (>50 years old) of the first depressive episode or fast changes of the mental state.

Sex Steroid and Growth Factor Profile of a Meningioma Associated with Pregnancy

Background:Increased growth of meningiomas during pregnancy as well as postpartum clinical regression of symptoms have been reported but remain poorly understood. A better understanding of the factors that contribute to these observations, including potential factors associated with pregnancy, could enable design of more effective adjuvant therapies.Methods:We describe the presentation of a meningioma during the immediate postpartum period. Serial imaging demonstrated subsequent rapid decrease in size of the tumour prior to any intervention. The lesion was resected, and the tissue was subjected to immunostaining for gene products associated with pregnancy, including estrogen receptor (ER), progesterone receptor (PR), platelet-derived growth factor receptor B (PDGFRB), fibroblastic growth factor receptor 2 (FGFR-2), epidermal growth factor receptor (EGFR) and human placental lactogen (hPL).Results:The lesion proved to be an atypical fibroblastic meningioma grade II (WHO). Immunostaining demonstrated significant staining for PR, PDGFRB, and FGFR-2. No specific staining for ER, EGFR, or hPL was identified.Conclusion:Although clinical regression of meningioma following pregnancy is well-recognized, imaging data are much less abundant. This report provides clear clinical and imaging documentation of a meningioma associated with pregnancy. In addition, the growth factor profile of this tumour suggests the importance of PR, PDGFRB, and FGFR-2 as potential therapeutic targets.