- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan.
- Department of Pathology, Juntendo University Urayasu Hospital, Urayasu, Japan.
Dr. Satoshi Tsutsumi, Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Japan.
DOI:10.25259/SNI_520_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Hiroki Sugiyama1, Satoshi Tsutsumi1, Akane Hashizume2, Kiyotaka Kuroda1, Natsuki Sugiyama1, Hideaki Ueno1, Hisato Ishii1. Calvarial angiomatous meningioma developed in the diploe. 29-Jul-2022;13:326
How to cite this URL: Hiroki Sugiyama1, Satoshi Tsutsumi1, Akane Hashizume2, Kiyotaka Kuroda1, Natsuki Sugiyama1, Hideaki Ueno1, Hisato Ishii1. Calvarial angiomatous meningioma developed in the diploe. 29-Jul-2022;13:326. Available from: https://surgicalneurologyint.com/surgicalint-articles/11752/
Background: Angiomatous meningioma is a rare subtype of meningiomas. To the best of our knowledge, there have been no reports of intradiploic angiomatous meningioma.
Case Description: A 53-year-old previously healthy woman was diagnosed with a calvarial lesion during a brain checkup. Cerebral magnetic resonance imaging showed an intradiploic tumor, 11 × 14 × 12 mm, in the right parietal bone. It was an enhancing, lobular tumor presenting as isointensity on T1- and hyperintensity on T2-weighted sequences, with an intense enhancement of the adjacent dura mater. Computed tomography revealed bone erosion at the tumor site, extending predominantly into the inner side, and sclerotic changes in the surrounding bone. Total resection was performed. Microscopically, the tumor tissue comprised cells with low-grade meningioma and intervening prominent vasculatures, consistent with angiomatous meningioma.
Conclusion: Angiomatous meningioma should be considered as a differential diagnosis when an intradiploic tumor shows a lobular structure, intense enhancement of the adjacent dura mater, and sclerotic changes in the surrounding skull. These findings can support prompt tumor resection.
Keywords: Angiomatous meningioma, Diploe, Lobular structure, Osteosclerosis
Meningiomas are the most common primary brain tumors in adulthood. They commonly grow in subdural sites, whereas approximately 1% of them are estimated to arise in extradural sites involving the calvarium or diploe.[
Here, we present a unique case of intradiploic angiomatous meningioma with distinctive radiological and intraoperative findings.
A 53-year-old previously healthy woman was diagnosed with a calvarial lesion on a brain checkup and was referred to the hospital. She had not undergone cranial radiotherapy in her life. Cerebral magnetic resonance imaging (MRI) revealed an intradiploic tumor in the right parietal bone protruding into the cranial cavity. It was a lobular mass 11 × 14 × 12 mm, presented isointensity on T1- and hyperintensity on T2-weighted sequences, and was inhomogeneously enhanced with intense enhancement of the surrounding dura mater. The inner table and dura underlying the tumor appeared intact. There was no identifiable peritumoral brain edema [
Axial T1- (a), T2- (b), and postcontrast axial (c) and coronal (d) T1-weighted magnetic resonance images show the intradiploic mass in the right parietal bone, protruding into the cranial cavity (arrow). It involves a lobular mass 11 × 14 × 12 mm in diameter, presenting isointensity on T1- and hyperintensity on T2-weighted sequences, respectively, and is inhomogeneously enhanced with an intense enhancement of the surrounding dura mater (c and d, arrowheads). The inner table and dura underlying the tumor appear intact. There is no identifiable peritumoral brain edema (b).
Photomicrographs of the resected specimens showing tumor tissue comprising cells with oval-shaped nuclei and intervening vasculatures with varying sizes (a and its inset, magnified view). There are few mitotic figures. Immunohistochemical examination shows positive staining for epithelial membrane antigen (b) and progesterone receptor (c), while negative for CD34 (d). Tumor invasions into the adjacent bone (e, arrows) and dura mater (f, arrows) are noted. (a) Hematoxylin and eosin stain, ×40; (b) epithelial membrane antigen, ×200; (c) progesterone receptor, ×200; (d) CD34, ×100; and (e and f) hematoxylin and eosin stain, ×100. Tr: trabecula.
Although the diploe can be affected by varying pathologies, intradiploic meningioma has been rarely reported.[
Whereas CT revealed sclerotic changes in the skull surrounding the tumor. Furthermore, the histological appearance of the resected tumor was consistent with that of an angiomatous meningioma. Therefore, we assumed that the findings identified on the MRI and CT might represent the characteristic appearance of intradiploic angiomatous meningioma.
The present case involved a small intradiploic tumor incidentally detected during a brain checkup. However, intraoperative observation revealed a defective inner table due to compression by the intradiploic tumor. Furthermore, histological examination showed overt tumor invasion into the surrounding bone and underlying dura mater. Therefore, prompt tumor resection is recommended if an asymptomatic intradiploic tumor is assumed to be an angiomatous meningioma.
In addition, the present intradiploic tumor showed unevenly inward extension into the cranial cavity, with the outer table intact. This may be because the inner table of the patient was less resistant to compression by the tumor than the outer table. Further case studies would clarify the pros and cons of these speculations.
Angiomatous meningioma should be considered as a differential diagnosis when an intradiploic tumor shows a lobular structure, intense enhancement of the adjacent dura mater, and sclerotic changes in the surrounding skull. These findings can support prompt tumor resection.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
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