Freiburg Neuropathology Case Conference: A Partially Calcified, Dura-based Tumour of the Frontal Lobe
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Clinical Case
Freiburg Neuropathology Case Conference: A Partially Calcified, Dura-based Tumour of the Frontal Lobe C. A. Taschner · O. Staszewski · R. Jabbarli · A. Keuler · M. Prinz
Accepted: 2 January 2013 / Published online: 11 January 2013 © Springer-Verlag Berlin Heidelberg 2013
Case Report
Imaging
A 50-year-old female patient was admitted to a county hospital after an accident due to a first-time generalised seizure with anterograde amnesia. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a parasagittal convexity lesion in the right frontal lobe. The patient received antiepileptic medication and was referred to our university hospital for surgery. A right frontal craniotomy for microsurgical tumour resection was performed. The oval-shaped tumour with the diameter of about 25 mm was adherent to convexity dura, possessed a solid consistency with own capsule and well-defined arachnoid border to surrounding frontal cortex. Macroscopically the tumours seemed compatible with the diagnosis of a convexity meningioma. After excision of affected convexity dura, a complete microsurgical resection of lesion could be achieved. Postoperatively, the patient had no neurological deficit and no seizures under continued antiepileptic medication. After proper recovery she was discharged. A routine ambulatory check-up 2 months after surgery revealed no new clinical complaints; in the absence of seizures the antiepileptic medication was reduced.
Initial CT imaging shows a right frontal, cortical–subcortical lesion (Fig. 1a, b, arrow) which appears hyperdense and presents surrounded by a perifocal oedema. The lesion is partially calcified (Fig. 1b, dotted arrow). On MR imaging, the presence of a perifocal oedema is confirmed on axial FLAIR images (Fig. 2a, b, arrow head). The lesion itself appears isointense when compared to the white matter (Fig. 2a, b, arrow). The calcified portion of the lesion exhibits a distinct loss of signal (Fig. 2b, dotted arrow). On T1-weighted images the lesion is isointense when compared to the grey matter (Fig. 3a, arrow). After administration of Gadolinium the lesion displays homogenous enhancement (Fig. 3b, c, arrow). In addition, it seems to be clearly delineated and does not have any features of local invasion. The calcified portion of the lesion again shows a clear loss of signal (3b, dotted line). The lesion is in broad contact to the dura (Fig. 3c, arrow) and seems to cause dural thickening (Fig. 3c, arrow head). Differential Diagnosis Meningioma
C. A. Taschner () · A. Keuler Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany e-mail: [email protected] O. Staszewski · M. Prinz Department of Neuropathology, University Hospital Freiburg, Freiburg, Germany R. Jabbarli Department of Neurosurgery, University Hospital Freiburg, Freiburg, Germany
Meningiomas are very common primary intracranial tumours in adults, typically growing slowly (WHO grade I) in supratentorial location (90 %). Characteristic of meningiomas is a
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