case_images: PMC11250670_01
case_images: a Axial FLAIR MRI showing a heterogeneous mass involving the right frontal and parietal lobes. b Axial T1-weighted MRI with contrast showing mild enhancement along the more anterior portion of the mass. c Axial T1-weighted MRI with contrast showing dural enhancement along the superior portion of the mass. Axial (d) and coronal (e) head CT at presentation demonstrating a large right frontal and parietal mass with gyriform calcification (yellow arrow) and new mass effect with midline shift and early hydrocephalus (white arrow). FLAIR, fluid-attenuated inversion recovery.
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case_images: PMC11250670_01_cro-2024-0017-0001-539850_F01.jpg
case_images: F1
case_images: She had a known intracranial mass and had previously declined surgery in favor of serial imaging, with a presumed diagnosis of meningioangiomatosis based on radiographic findings alone (Fig. 1a-c). A head computed tomography scan demonstrated a calcified right frontoparietal mass with 13 mm of midline shift, effacement of the third ventricle and basal cisterns, and concern for right uncal herniation (Fig. 1d, e).
case_images: a Axial head CT postoperative day 1 after craniectomy. b Axial T1-weighted stereotactic postcontrast MRI showing the heterogeneous mass with gyriform calcification (white arrow) and mild enhancement. c Axial diffusion tensor imaging demonstrating the right corticospinal tract is medially deviated by the mass (arrow). Postoperative axial (d) and sagittal (e) MRI with contrast.
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case_images: PMC11250670_01_cro-2024-0017-0001-539850_F02.jpg
case_images: F2
case_images: Postoperative imaging at 24 h showed decreased mass effect and midline shift (Fig. 2a). The lesion caused a significant mass effect, closely approximating and medially displacing the posterior limb of the internal capsule (Fig. 2b, c). Postoperative imaging demonstrated a near-total resection of the lesion with no evidence of acute postsurgical complications (Fig. 2d, e).
case_images: Immunohistochemical evaluation and ancillary testing of meningioma (a, c, e) and oligodendroglioma (b, d, f). a Hematoxylin and eosin (H&E) stain of the dural-based right frontal mass. Scale bar: 100 mum. b H&E stain of right frontal mass. Scale bar: 50 mum. c Somatostatin receptor 2 stain showing strong, diffuse positivity in the meningothelial tumor cells. Scale bar: 200 mum. d Glial fibrillary acidic protein (GFAP) stain highlighting diffuse positive cytoplasmic staining in all of the oligodendroglioma tumor cells. Scale bar: 100 mum. e Epithelial membrane antigen stain highlighting weak, patchy positivity in the meningothelial tumor cells. Scale bar: 200 mum. f Isocitrate dehydrogenase IDH1(R132H) stain showing intense cytoplasmic reactivity in all of the oligodendroglioma tumor cells. Scale bar: 100 mum.
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case_images: PMC11250670_01_cro-2024-0017-0001-539850_F03.jpg
case_images: F3
case_images: Histopathological and ancillary tests were done on both samples (Fig. 3). Histopathological examination of the first resected dural-based right frontal lobe mass revealed a meningothelial meningioma with frequent, scattered psammoma bodies (Fig. 3a). Immunohistochemistry staining with somatostatin receptor 2 (Fig. 3c) and epithelial membrane antigen (Fig. 3e) demonstrated strong diffuse positivity and weak, patchy positivity in the meningothelial tumor cells, respectively. Histopathological examination of the second resected right frontal mass showed an infiltrating glioma with tumor cells displaying rounded, hyperchromatic nuclei, and perinuclear halos (Fig. 3b). Immunohistochemistry demonstrated the following tumor immunoprofile: positive glial-fibrillary acidic protein (Fig. 3d), positive isocitrate dehydrogenase (IDH)1-R132H (Fig. 3f), ATRX expression retained, p53 positive in 5% of tumor cell nuclei, and an MIB-1 proliferation index of approximately 5%.