J Korean Neurosurg Soc.  2018 Jan;61(1):120-126. 10.3340/jkns.2015.0609.001.

Intraparenchymal Atypical Meningioma in Basal Ganglia Region in a Child: Case Report and Literature Review

• Liu X
• Zhang Y
• Zhang S
• Tao C
• Ju Y

• KMID: 2403532
• DOI: http://doi.org/10.3340/jkns.2015.0609.001

Abstract

Intraparenchymal meningiomas without dural attachment are extremely rare, especially when they occur in basal ganglia region in child. An 8-year-old boy was admitted at our hospital, complaining of recurrent headache and vomiting for 3 months. Neurological examination showed impaired vision and mild paresis of the left extremities. Magnetic resonance imaging demonstrated a lesion located in the right basal ganglia region extending to superasellar cistern with solid, multiple cystic and necrotic components. Computed tomography revealed calcification within the mass. Due to the anterior cerebral artery involvement, a subtotal resection was achieved and postoperative radiotherapy was recommended. Histopathological examination indicated that the lesion was an atypical meningioma. The postoperative rehabilitation was uneventful. Mildly impaired vision and motor weakness of left extremities improved significantly and the patient returned to normal life after surgery. To our knowledge, intraparenchymal atypical meningioma in basal ganglia extending to superasellar cistern was never reported. The significance in differential diagnosis of lesions in basal ganglia should be emphasized.

Keyword

Intraparenchymal meningioma; Basal ganglia; Atypical meningioma

MeSH Terms

Anterior Cerebral Artery
Basal Ganglia*
Child*
Diagnosis, Differential
Extremities
Headache
Humans
Magnetic Resonance Imaging
Male
Meningioma*
Neurologic Examination
Paresis
Radiotherapy
Rehabilitation
Vomiting

Figure

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  Fig. 1 CT revealing calcification, necrosis, cystic formation of the mass lesion (A and B). No hyperostosis or bone absorbtion was observed (C).

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  Fig. 2 MRI showing a mass lesion in the right basal ganglia consisted of solid and cystic parts. The solid part manifesting isointense signal on T1-weighted (A), T2-weighted (B), and FLAIR (C) with heterogeneous enhancement (D and E); the cystic part showing hypointense signal on both T1-weighted (A) and FLAIR (C) and hyperintensity on T2-weighted images (B) without enhancement of the wall (D and E). Although the lower margin of the tumor touched the dorsum sellae dura, ‘dura tail’ sign was not noted (E). Postoperative MRI revealing that most of the tumor has been resected and the residual part detached from the dorsum sellae (F). Subdural fluid accumulation in the surgical region was also detected (F). FLAIR: fluid at tenuation inversion recovery, MRI: magetic resonance imaging.

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  Fig. 3 Hematoxylin-eosin staining exhibiting sheetlike growth, foci of spontaneous, increased cellularity, small cells with a high nucleus-to-cytoplasm ratio and prominent nucleoli (A: original magnification, ×100; B: original magnification, ×400). Immunohistochemical staining showing positive for epitheliod membrane antigen (D: original magnification, ×400), but negative for glial fibrillary acidic protein (E: original magnification, ×400) and S-100 protein (F: original magnification, ×400). Ki-67 labeling index being approximately 10% (C: original magnification, ×400).

Reference

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