J Korean Ophthalmol Soc.  2016 Nov;57(11):1781-1785. 10.3341/jkos.2016.57.11.1781.

A Case of Extra-axial Anaplastic Meningioma with Direct Orbital Extension

• Joo JH
• Kim HJ
• Park IK
• Shin JH

• KMID: 2357736
• DOI: http://doi.org/10.3341/jkos.2016.57.11.1781

Abstract

PURPOSE
We report the first case of extra-axial anaplastic meningioma with direct orbital extension for differential diagnosis of orbital tumors.
CASE SUMMARY
An 83-year-old woman presented with a protruding left eye and a palpable mass on the forehead. A brain computed tomography scan revealed a huge sarcomatous mass that had directly invaded the surrounding tissues. We removed the tumor by craniotomy and found that it involved the extradural and intradural spaces, brain parenchyma, subcutaneous tissue, left temporalis, orbital roof, and the other frontal lobe across the midline. A cranioplasty was performed, and the orbital roof was reconstructed with artificial bone and bone cement. The final histological diagnosis was anaplastic meningioma. The left eyeball was restored to its normal position 1 month after the surgery. Also, visual acuity and eye movement of the left eye were preserved.
CONCLUSIONS
Direct orbital extension of originated extra-axial cerebral convexity anaplastic meningioma is rare but should be considered in the differential diagnosis of a rapidly growing orbital mass.

Keyword

Anaplastic meningioma; Cerebral convexity meningioma; Direct orbital extension; Fast growing tumor; Orbital mass

MeSH Terms

Aged, 80 and over
Brain
Craniotomy
Diagnosis
Diagnosis, Differential
Eye Movements
Female
Forehead
Frontal Lobe
Humans
Meningioma*
Orbit*
Subcutaneous Tissue
Visual Acuity

Figure

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  Figure 1. Anterior photographs. 9-cardinal segment photographs. (A) The protruding mass in the left forehead with orbital dystopia. The left globe was displaced inferiorly. Up gaze eye movement disorder is also shown. (B) Proptosis of the left eye.

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  Figure 2. Initial coronal brain images recorded 1 year ago. (A) Computed tomography. (B) Magnetic resonance imaging. These are showing a heterogeneously enhanced extra-axial mass in the left frontoparietal bone. Bony destruction and intracranial extension are also shown.

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  Figure 3. Pre-operative brain computed tomography. (A, B) 10.9 × 9.9 × 7.0 cm heterogeneously enhanced extra-axial scalp mass with central necrosis on the left forehead. The left eyeball is deviated inferiorly and the left frontoparietal bone, left supero-lateral/medial bony orbit, left frontal bone, and left temporalis muscle were directly invaded. (C, D) Post-operative brain computed tomography. The inferior deviation of left eyeball was recovered.

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  Figure 4. Histological findings. Anaplastic meningioma with hypercellularity and a prominent mitotic activity (A: HE stain ×40, B: HE stain ×200).

Reference

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