A known case of Left frontal lesion referred for further management.
MRI BRAIN WITH CONTRAST REPORT
Left frontal well defined mixed signal intensity lesion, major portion of lesion is cystic measures ~ 75x45mm with thin enhancing wall, an ~ 23x25mm eccentric avidly enhancing mural nodule within the lesion, marked perilesional vasogenic odema. Mass effect, mid line shift of ~ 15 mm to right, sub falcine herniation, mild mid brain compression.
Imaging wise diagnosis given was Neoplastic Primary Glioma, Metastasis.
Any other guess ?
Ok.. here is ...
REPORT OF HISTOPATHOLOGICAL EXAMINATION
Specimen : Excisional biopsy – Left frontal lobe SOL.
Gross Appearance : The specimen consists of multiple, irregular, soft to friable pieces of dull grey – tan tissue; together measuring 4.0X3.3X2.0 cm. The cut section shows dull grey tan appearance. Representative sections are submitted for processing. Codes : A and B.
Microscopy : Sections A and B both show cellular meningothelial neoplasm. It comprise lobules and sheets of intermediate sized, round to oval cells having modestly hyperchromatic nuclei with round to oval configuration and having delicate - peripherally condensed chromatin and many cells having small nucleoli. Overall scattered cells show nucleoli - cytoplasmic invaginations. The cells have faint eosinophilic cytoplasm with indistinct margins. The interstitium shows prominent congested vasculature with scattered few lymphocytes. Overall the entire tumour shows 0 – 2 mitosis per 10 HPF. There is no evidence of frank cytological anaplasia nor of brain invasion.
Diagnosis : Meningioma; grade I of III.
Even surgeon was also surprised with histopathology report.
Retrospectively review of case shows enhancing dural thickening in left frontal region. Meningioma is known to be associated with meningeal cysts which varies in size and can be large enough as in this case giving appearance of a predominantly cystic lesion with mural nodule.