Cystic Meningioma: Unusual Imaging Appearance of a Common Intracranial Tumor

Mittal, Amit; Layton, Kennith F.; Finn, S. Sam; Snipes, George J.; Opatowsky, Michael J.

doi:10.1080/08998280.2010.11928664

Cited by 18 publications

(14 citation statements)

References 4 publications

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“…Proposed mechanisms include reactive gliosis, peritumoral edema, or trapping of CSF within the cleft between the expanding tumor and adjacent brain. 2,9,12,15,20,21 The latter mechanism is the most likely etiology of the cysts in our study.…”

Section: Discussionmentioning

confidence: 65%

Peritumoral cysts associated with pituitary macroadenoma

Herde¹,

Hoang

Tran

et al. 2015

JNS

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OBJECT Peritumoral cysts are benign nonneoplastic cysts that are found adjacent to extraaxial brain tumors such as meningiomas, schwannomas, craniopharyngiomas, and esthesioneuroblastomas. Peritumoral cysts associated with pituitary macroadenomas have not been previously described in the literature. The authors report 6 cases of giant macroadenoma-associated peritumoral cysts and delineate their imaging spectrum. METHODS The authors retrospectively reviewed the records of 179 patients diagnosed with pituitary macroadenomas who underwent tumor resection at their institution and had preoperative MRI scans available for review. The patients were evaluated for the presence of associated peritumoral cysts. Clinical presentation, histopathology, follow-up time, tumor and peritumoral cyst dimensions were recorded. Signal intensity on T1-weighted, T2-weighted, diffusion-weighted, and FLAIR sequences, as well as pre- and postcontrast appearance, were determined. RESULTS Six patients (3.4%) with associated peritumoral cysts were identified in our cohort of 179 patients with pituitary macroadenoma. Twelve patients in the cohort had giant macroadenomas (≥ 4.0 cm), and 50% of these tumors had associated peritumoral cysts with significant extrasellar extension of the macroadenoma. Only tumors with craniocaudal, transverse, and anteroposterior diameters of 3.6 × 3.4 × 4.2 cm to 7.0 × 7.4 × 6.8 cm (mean 5.3 × 5.1 × 5.6 cm), respectively, had associated peritumoral cysts. The growth pattern in all tumors was suprasellar, with predominant anterior and lateral extension. Cysts showed T1-weighted, T2-weighted, and FLAIR hyperintensity in 67%, 67%, and 60% of patients, respectively. There was no contrast enhancement of the cyst wall or fluid contents in any patient. Postoperatively, cysts had completely resolved (4 of 5) or significantly decreased in size (1 of 5). One patient was lost to follow-up. CONCLUSIONS Macroadenoma-associated peritumoral cysts are rare, benign, and likely nonneoplastic fluid collections that do not represent neoplasm. These cysts display a predictable pattern of hyperintensity on T1-weighted, T2-weighted, and FLAIR sequences and do not enhance. They most likely represent proteinaceous CSF in a sulcus or cistern that becomes trapped (encysted) by anterolateral extension of unusually large macroadenomas. Peritumoral cysts may facilitate resection of the associated macroadenoma by providing a cleavage plane.

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Section: Discussionmentioning

confidence: 65%

Peritumoral cysts associated with pituitary macroadenoma

Herde¹,

Hoang

Tran

et al. 2015

JNS

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“…9 The greatest diagnostic dilemma includes differentiating a cystic meningioma from a microcystic meningioma. 9 The greatest diagnostic dilemma includes differentiating a cystic meningioma from a microcystic meningioma.…”

Section: Resultsmentioning

confidence: 99%

Meningiomas

2014

Contemporary Diagnostic Radiology

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Meningiomas are a common nonglial neoplasm that can involve many areas of the central nervous system. Various clinical syndromes and symptoms are found to be associated with meningiomas resulting from their anatomic locations. These tumors can present with an array of imaging features seen in both common and uncommon types of meningiomas. Familiarity with their multitude of clinical presentations and imaging fi ndings can greatly enhance a radiologist's interpretation of these common tumors.An extra-axial mass derived from meningothelial cells, meningiomas have a strong predilection for occurrence in women with 65% of them occurring in women aged 40 to 50 years. The converse is true in the rare pediatric occurrence of meningioma, with 1.5% of all meningiomas found predominantly in boys by the age of adolescence. 1 Overall, meningiomas account for approximately 15% of all symptomatic intracranial neoplasms and 33% of all asymptomatic intracranial neoplasms noted at autopsy.The most recognized classifi cation of meningiomas is based on the World Health Organization (WHO) grading system, which recognizes 15 different histologic subtypes ( Table 1). The microscopic differentiation of the subtypes usually is only able to be determined upon pathologic correlation, not by imaging. The macroscopic variations of meningiomas, encountered by radiologists, often can be categorized into 2 forms: en plaque and globose. En plaque meningiomas present as an extensive region of dural thickening, whereas globose meningiomas present as a rounded, extra-axial mass. Radiographically, meningiomas are classifi ed by their locations, each presenting with varying prevalence and associated clinical symptoms based on location.The rare en plaque meningioma underlies the inner table of the skull and is capable of infi ltrating the dura mater and the overlying bone. Its permissive nature to infi ltrate presents a diagnostic dilemma for the radiologists, especially in noncontrast imaging examinations. Secondary clues of invasion, such as hyperostosis, are quite often absent or nonindicative of the extent of tumoral invasion (Figure 1).Falcine and parasagittal meningiomas are the most common by location 1 (Figure 2). These meningiomas can be further divided into anterior, middle, and posterior thirds to better explain the patient's clinical presentation. Meningiomas occurring in the middle one third of the falx commonly present with focal seizures, and sensory and motor loss that usually begins in the lower extremities. 1 By contrast, meningiomas along the anterior third of the falx, sagittal sinus, or anterior skull base have an insidious onset, presenting with headaches. 1 As a result, these latter meningiomas often are V o l u m e 3 7 • N u m b e r 2 4 N o v e m b e r 3 0 , 2 0 1 4Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this endu...

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“…Meningiomas are generally solid tumors, and their classical appearance on CT and MRI usually leads to a correct diagnosis. 8 Mittal et al 5 mentioned that meningiomas generally have the characteristic imaging appearance of a well circumscribed, solid, homogeneously enchancing extra-axial mass on both CT and MRI.…”

Section: Discussionmentioning

confidence: 99%

“…There are few case reports available on cystic meningioma. [1][2][3][4][5][6][7] Cystic meningioma is an uncommon variant of menin¬gioma. This disease is often difficult to distinguish from other intra axial tumors, including necrotic gliomas.…”

Section: Cystic Meningioma In the Inter-hemisferic Space Location Intmentioning

confidence: 99%

Cystic Meningioma in the Inter-Hemisferic Space Location

Arifin

Tjahjono

Sutiono

et al. 2016

IJIHS

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Objective: The presentation of cystic meningioma in the inter-hemispheric near the falx cerebri is uncommon. It is difficult to differentiate it from intraaxial tumors, such as gliomas. Therefore, it is likely that it is misdiagnosed as other types of brain tumors. Methods: In this study, we reported a cystic meningioma case in the interhemispheric location, showing an intramural nodule on magnetic resonance imaging scans. Results: Patient underwent surgical treatment and pathological section confirmation revealing meningioma. The patient was a middle-age woman and had been misdiagnosed as suffering from glioma followed by slight hemipharesis on the right extremities. Conclusions: Although this is a rare case, it will be good if we always consider cystic meningioma in inter-hemispheric space when diagnosing this type of cystic lesion if the magnetic resonance imaging (MRI) shows a cystic lesion mimicking glioma image presentation.

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Cystic Meningioma: Unusual Imaging Appearance of a Common Intracranial Tumor

Cited by 18 publications

References 4 publications

Peritumoral cysts associated with pituitary macroadenoma

Peritumoral cysts associated with pituitary macroadenoma

Meningiomas

Cystic Meningioma in the Inter-Hemisferic Space Location

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