IS Case 423: Cystic meningioma

Daniel Ginat, MD, MS

University of Rochester


Imaging Sciences URMC 2010
Publication Date: 2010-08-27

History

Patient is a 64-year-old female with left-sided weakness.

Findings

On CT there is a large mixed cystic and solid lesion within the right frontal lobe. On MRI the lesion is mostly cystic and contains an enhancing solid component.

Diagnosis

Cystic meningioma

Discussion

Cystic meningiomas represent an unusual form of a relatively common brain tumor. These are further differentiated into "true" intratumoral cystic meningiomas and meningiomas with peritumoral cysts. "True" cystic meningiomas are exceedingly rare and are characterized by the presence of neoplastic meningeal cells lining a fluid-filled cavity. Such cysts are believed to form either as a result of degenerative changes, secondary to ischemia and necrosis, or due to copious fluid secretion. Peritumoral cysts are perhaps more frequent and contain high protein content, but are of uncertain etiology. In either case, these entities are of significance because of the increased mass effect and represent a potential imaging diagnostic dilemma. Indeed, the differential diagnosis includes cystic metastases, glioblastoma, and hemangioblastoma. However, features that might suggest the diagnosis include a dural tail with meningeal blood supply, and tumor location. MRI is more accurate in characterizing these lesions and is more helpful for surgical planning than CT.

References

  1. Buetow MP, Buetow PC, Smirniotopoulos JG. Typical, atypical, and misleading features in meningioma. Radiographics. 1991 Nov;11(6):1087-106. PMID: 1749851
  2. Sheporaitis LA, Osborn AG, Smirniotopoulos JG, et al. Intracranial meningioma. AJNR Am J Neuroradiol. 1992 Jan-Feb;13(1):29-37. PMID: 1595462
  3. Chen TY, Lai PH, Ho JT, et al. Magnetic resonance imaging and diffusion-weighted images of cystic meningioma: correlating with histopathology. Clin Imaging. 2004 Jan-Feb;28(1):10-9. PMID: 14996441
  4. Demir MK, Müslüman M, Kilicoglu G, Hakan T, Aker FV. Imaging features of unusual intracranial cystic meningiomas. Can Assoc Radiol J. 2007 Apr;58(2):109-15. PMID: 17521055

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