Brain Tumor Res Treat.  2015 Oct;3(2):151-155. 10.14791/btrt.2015.3.2.151.

Primary Intraosseous Osteolytic Meningioma of the Skull Mimicking Scalp Mass: A Case Report and Review of Literature

• Kwon SY
• Shin HS
• Kim TH
• Kim HJ

• KMID: 2114665
• DOI: http://doi.org/10.14791/btrt.2015.3.2.151

Abstract

Primary extradural meningioma is about 1-2% of all meningiomas. Primary intraosseous meningioma is a rare form of intra-bone tumors that account for approximately 67% of extradural meningiomas. We report a primary intraosseous meningioma of a 69-year-old man who had headaches and a mass on right parietal scalp for the past few months. Remarkably, the brain tissue within the osteolytic cavity of the skull was normal in computed tomography and magnetic resonance images. Resection, duraplasty, and cranioplasty were performed. The patient's symptoms disappeared after surgery, and the histological diagnosis was an osseous meningothelial meningioma (World Health Organization grade I).

Keyword

Benign meningioma; Calvarium; Osteolyses; Multiple Myelomas

MeSH Terms

Aged
Brain
Diagnosis
Headache
Humans
Meningioma*
Multiple Myeloma
Osteolysis
Rabeprazole
Scalp*
Skull*

Figure

• 

  Fig. 1 Initial brain CT. CT scan (A) shows a right-sided superior parietal mass expanding the calvaria. Bone window CT (B) demonstrates a bony destruction. C and D reveal a well-defined, enhancing soft tissue mass in right parietal bone.

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  Fig. 2 Preoperative magnetic resonance images. T1 saggital weighted (A) MR shows a round shape, scalp bulging, iso-signal intensity. No parenchymal invasion on T2 axial weighted (B) image. Postcontrast T1-weighted MR (C and D) reveal a well-defined, lobulated, enhanced round mass in the right parietal bone (2.06×2.8 cm), with bone destruction and an intracranial extension compressing the brain.

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  Fig. 3 Pathologic findings. A: The tumor cells are growing in a whorling pattern type (H&E, ×100). B: The tumor cells display typical subnuclear inclusions (H&E, ×200) (green arrows). C: The tumor cells express epithelial membrane antigen (EMA), which strongly suggests meningothelial differentiation. H&E, hematoxylin and eosin.

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  Fig. 4 Postoperative images show that was no evidence of residual mass at operative site.

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  Fig. 5 Comparative CT scans. Both A and B have osteolytic skull lesions at right parietal area. A: The tumor has a broad calvarial base, more expansion of the soft tissue. B: The tumor has a broad dural base, brain edema and more expansion of the brain parenchyme.

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