A 69-year-old male patient presented with multiple episodes of fall for 6 months. Magnetic resonance imaging of the brain showed T1 isointensity, T2 hyperintensity, and homogenous enhancement on contrast [Figure 1a – f ]. Intraoperatively, the tumor was completely intraventricular without any attachment to the surrounding thalamus or tela choroidea. This unique case was managed as (according to history and imaging) meningioma, but biopsy came out as metastatic deposit of squamous cell carcinoma from the lung [Figure 2a – d ].

Figure 1

(a-c) Contrast-enhanced brain MRI (axial, coronal and sagittal sequences, respectively) showing homogenously enhancing lesion at the posterior third ventricular region. (d) Axial T2 brain MRI sequence showing hyperintense mass attached to tela choroidea. (e) FLAIR sequence of brain MRI showing hyperintense lesion. (f) DWI sequence of brain MRI showing diffusion restriction in the lesion

Figure 2

(a) Microphotograph showing tumor cell population (H and E, ×100). (b-d) High-power view (H and E, ×400) of the carcinoma cells with focal keratinization

Intraventricular metastasis presents with various aspects of enhancement (uniform, punctate, ring) which can often lead to misdiagnosis of meningioma.[ 1 2 ] This case is educational for both neurosurgeons and radiologist as missing proper diagnosis can affect both the management and outcome of patients.

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References

1. Tagle P, Villanueva P, Torrealba G, Huete I. Intracranial metastasis or meningioma?. An uncommon clinical diagnostic dilemma. Surg Neurol. 2002. 58: 241-5

2. Brant WE, Helms CA.editors. Fundamentals of diagnostic radiology. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 143-