Meningioma of the Mandible: Imaging with CT

Abstract

SUMMARY:We present the first description of CT of a meningioma of the mandible in the literature. Extracranial meningiomas are exceedingly rare. There have been 3 cases of meningioma of the mandible described in the literature, but none characterized with cross-sectional imaging. We describe the clinical and CT features used to establish the diagnosis as well as how to differentiate this lesion from other pathology of the mandible. Only 3 cases of a meningioma of the mandible have been described in the literature.1,2 The mandibular meningiomas are classified as primary extracranial meningiomas. Extracranial meningiomas are usually an extension of an intracranial tumor but can arise independently, such as meningioma of the mandible. The independent formation of these tumors is believed to involve meningocytes along the sheaths of cranial nerves as they exit the skull foramina, fibroblastic mesenchymal cell transformation, or displaced arachnoid cap cells. Metastasis from a central nervous system (CNS) meningioma can naturally give rise to an "ectopic" meningioma as well. Extracranial meningiomas are exceptionally rare. To our knowledge, we report the first CT findings of a mandibular meningioma. Case ReportA 62-year-old man presented with fullness on the left mid-body of the mandible. The patient's history dated to 2 years earlier when he sought consultation from his dentist. A swelling was noted on his left lower gum with mild pain, which was clinically thought to represent an abscess. Plain films revealed a large well-delineated radiolucent lesion involving the mandibular body. He was treated with 4 different antibiotic regimens during the following year with no regression of the mass. The patient denied any bleeding from the oral cavity or any problems with speech or mastication. At that point, his primary care physician referred him to an otolaryngologist for further management and work-up of the mass.The work-up included a CT of the mandible without contrast, which showed a well-circumscribed lytic expansile mass involving the mandibular body on the left side, which broke through the cortex at several different sites. The mass measured approximately 7 ϫ 3 cm (anteroposterior ϫ transverse) and spanned from the alveolar ridge to the inferior cortex. Posteriorly, the lesion extended 1 cm from the angle of the mandible and anteriorly 1.8 cm from the mentum (Fig 1). There was no evidence of gross tumor extending into the infratemporal fossa along the course of V3, and the foramen ovale was normal on the CT scan.A fine-needle aspiration of the mass was performed. Cytologic analysis revealed neoplastic spindle cells present with minimal nuclear and cytologic atypia. The sample was reviewed at an intradepartmental pathology conference and was determined to represent an extracranial meningioma. The patient was then recommended for segmental mandibulectomy and mandibular reconstruction with a fibula free flap.Postoperatively, the left submandibular gland and left mandible were submitted to surgical pathology for analy...

Ectopic Meningioma in the Maxillary Alveolar Ridge: Report of a Case with a Review of the Literature

“…For instance, resection of the mandible may be carried out due to malignant nature of the lesion. 13 Our case was a transitional type which has a low risk of recurrence or aggressive growth. Therefore, we do not plan to resection.…”

“…In this case, the histological definite diagnosis was transitional meningioma, which falls into grade I. The oral cavity is an extremely rare location for ectopic meningioma to be encountered; four cases in the maxilla [7][8][9][10] and six in the mandible [11][12][13][14][15] have been reported in the English language literature. Table 1 shows details of all the cases reported previously in the literature.…”

Ectopic Meningioma of the Mandible: A Rare Site of Presentation for a Common Tumour

“…This was the first ever radiological description of a Mandibular meningioma in published literature. (4) One other case has been reported in a 10-year-old boy with basal cell nevus syndrome. (5) The main differential diagnosis at this site is perineurioma.…”

“…To date, only five such cases have been published in the English literature. (2)(3)(4)(5) We present one such case of ectopic meningioma occurring in the mandible of a 40-year-old female patient. We have supported our histopathological observations with immunohistochemical studies, which showed positive staining for vimentin and EMA in the tumour.…”

“…To date only 5 cases of meningioma of mandible have been reported in the English literature, one of those having been reported in a 10-year-old child with basal cell nevus syndrome. (2,3,4,5) We are hereby presenting the case of a 41-year-old female patient with a long-standing swelling in the right submandibular region. On imaging her mandible showed a depressed eroded area and the salivary gland was visualized separately.…”