Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2021.332
Autopsy and Case Reports
Clinical Case Report

Intraosseous meningioma mimicking osteosarcoma

Ruben Delgado; Hisham F. Bahmad; Vinay Bhatia; Allen B. Kantrowitz; Cristina Vincentelli

Downloads: 1
Views: 88

Abstract

Background: Predominantly intraosseous meningiomas are rare entities that include true primary intraosseous meningiomas (PIM), as well as meningiomas that may show extensive bone involvement, such as en plaque meningiomas. Different hypotheses have been proposed to decipher the origin of PIMs, such as ectopic arachnoid cap cell entrapment during birth or after trauma. Surgical resection is the treatment of choice of such lesions.

Case presentation: We present a case of a 65-year-old man with an enlarging mass in the parieto-occipital region that grew slowly and progressively over 13 years, following head trauma during a motor vehicle accident. One year prior to presentation, he started experiencing daily holocranial headaches and blurry vision. CT and MRI studies revealed a permeative midline calvarial lesion measuring 14 cm in greatest dimension with extensive periosteal reaction, extension into the subcutaneous soft tissues, subjacent dural thickening and intracranial extension with invasion of the superior sagittal sinus. The favored pre-operative clinical diagnosis was osteosarcoma. The abnormal calvarium was excised and histopathological examination confirmed the diagnosis of a predominantly intraosseous calvarial meningioma, WHO grade I.

Conclusions: The present case highlights the importance of histopathologic diagnosis in guiding therapeutic decisions and reiterates the necessity of considering PIM or meningiomas with extensive intraosseous component in the differential diagnosis of calvarial masses, even when imaging suggests a neoplasm with aggressive behavior, such as osteosarcoma.

Keywords

Case Reports, Meningioma, Osteosarcoma, Skull

References

1 Preusser M, Brastianos PK, Mawrin C. Advances in meningioma genetics: novel therapeutic opportunities. Nat Rev Neurol. 2018;14(2):106-15. http://dx.doi.org/10.1038/nrneurol.2017.168. PMid:29302064.

2 Samadi N, Ahmadi SA. Meningioma: a clinicopathological evaluation. Malays J Med Sci. 2007;14(1):46-52. PMid:22593651.

3 Kwon SM, Ko Y, Bang SS. Primary intraosseous osteolytic meningioma: a case report and review of the literature. BMC Neurol. 2019;19(1):176. http://dx.doi.org/10.1186/s12883-019-1392-5. PMid:31337352.

4 Agrawal V, Ludwig N, Agrawal A, Bulsara KR. Intraosseous intracranial meningioma. AJNR Am J Neuroradiol. 2007;28(2):314-5. PMid:17297003.

5 Muzumdar DP, Vengsarkar US, Bhatjiwale MG, Goel A. Diffuse calvarial meningioma: a case report. J Postgrad Med. 2001;47(2):116-8. PMid:11832603.

6 Crawford TS, Kleinschmidt-DeMasters BK, Lillehei KO. Primary intraosseous meningioma. Case report. J Neurosurg. 1995;83(5):912-5. http://dx.doi.org/10.3171/jns.1995.83.5.0912. PMid:7472564.

7 Butscheidt S, Ernst M, Rolvien T, et al. Primary intraosseous meningioma: clinical, histological, and differential diagnostic aspects. Journal of Neurosurgery JNS. 2020;133(2):281-90. http://dx.doi.org/10.3171/2019.3.JNS182968.

8 Jang SY, Kim CH, Cheong JH, Kim JM. Extracranial extension of intracranial atypical meningioma en plaque with osteoblastic change of the skull. J Korean Neurosurg Soc. 2014;55(4):205-7. http://dx.doi.org/10.3340/jkns.2014.55.4.205. PMid:25024824.

9 Matschke J, Addo J, Bernreuther C, Zustin J. Osseous changes in meningioma en plaque. Anticancer Res. 2011;31(2):591-6. PMid:21378343.

10 De Jesús O, Toledo MM. Surgical management of meningioma en plaque of the sphenoid ridge. Surg Neurol. 2001;55(5):265-9. http://dx.doi.org/10.1016/S0090-3019(01)00440-2. PMid:11516463.

11 Baek J-U, Cho Y-D, Yoo J-C. An osteolytic meningioma en plaque of the sphenoid ridge. J Korean Neurosurg Soc. 2008;43(1):34-6. http://dx.doi.org/10.3340/jkns.2008.43.1.34. PMid:19096543.

12 Akutsu H, Sugita K, Sonobe M, Matsumura A. Parasagittal meningioma en plaque with extracranial extension presenting diffuse massive hyperostosis of the skull. Surg Neurol. 2004;61(2):165-9. http://dx.doi.org/10.1016/S0090-3019(03)00521-4. PMid:14751632.

13 Commins DL, Atkinson RD, Burnett ME. Review of meningioma histopathology. Neurosurg Focus. 2007;23(4):E3. http://dx.doi.org/10.3171/FOC-07/10/E3. PMid:17961040.

14 Castellano-Sanchez AA, Alexis JB, Poppiti RJ Jr, Nanes M, Villalobos EE. Pathologic quiz case: an unexpected occipital tumor. Arch Pathol Lab Med. 2001;125(2):301-3. http://dx.doi.org/10.5858/2001-125-0301-PQCAUO. PMid:11175659.

15 Lang FF, MacDonald OK, Fuller GN, DeMonte F. Primary extradural meningiomas: a report on nine cases and review of the literature from the era of computerized tomography scanning. J Neurosurg. 2000;93(6):940-50. http://dx.doi.org/10.3171/jns.2000.93.6.0940. PMid:11117866.

16 Azar-Kia B, Sarwar M, Marc JA, Schechter MM. Intraosseous meningioma. Neuroradiology. 1974;6(5):246-53. http://dx.doi.org/10.1007/BF00345784. PMid:4810615.

17 Turner OA, Laird AT. Meningioma with traumatic etiology. Report of a case. J Neurosurg. 1966;24(1):96-8. http://dx.doi.org/10.3171/jns.1966.24.1.0096. PMid:5903303.

18 Lopez DA, Silvers DN, Helwig EB. Cutaneous meningiomas--a clinicopathologic study. Cancer. 1974;34(3):728-44. http://dx.doi.org/10.1002/1097-0142(197409)34:3<728::AID-CNCR2820340332>3.0.CO;2-U. PMid:4851231.

19 Shuangshoti S, Netsky MG, Fitz-Hugh GS. Parapharyngeal meningioma with special reference to cell of origin. Ann Otol Rhinol Laryngol. 1971;80(3):464-73. http://dx.doi.org/10.1177/000348947108000327. PMid:5578792.
 


Submitted date:
07/24/2021

Accepted date:
09/03/2021

Publication date:
10/29/2021

617c505da9539534f74f7fd3 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections