Neoplasms of the Meninges James G. Smirniotopoulos, MD

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Meningioma: Effect on Skull [Figure 15] • Hyperostosis (15-25%) ‣ With or without micro invasion • Pressure Erosion ‣ Periosteal remodeling • Bone Destruction ‣ Microscopic invasion Meningioma: Mostly Intraosseous [Figure 17] Figure 17 A, B & C 57 y.o. woman, long Hx of seizures. Figure 15 Variable patterns of hyperostosis from meningioma: Inner table, inner and outer table, diploic space, combinations. Hyperostosis [Figure 16] Meningioma Hyperostosis • Does NOT mean invasion of bone • Implies CHRONICITY ‣ And benign behavior • Skull Base ‣ Invasion via HAVERSIAN CANALS Meningioma: Atypical Imaging (Yet, typical Histology) Meningioma – WHO 1 [Figure 18] Figure 16 A & B Hyperostosis from meningioma. “En plaque” Meningioma • Meningioma: ‣ Intradural soft-tissue mass ‣ Extradural soft-tissue mass • Fibrous Dysplasia: ‣ Intra-osseous lesion ‣ No extra-osseous mass Figure 18 A & B Meningioma with typical histology – yet aggressive radiologic appearance. Neuroradiology 1293 Neoplasms of the Meninges
Meningioma Atypical Imaging • Focal Lucency Outside (arachnoid cyst) • Focal Lucency Inside (necrosis, cyst) • Hypodensity (“humid”, lipoblastic) • Focal Hyperdensity (metaplasia, hemorrhage) • Heterogeneous • Hyperintensity on T1W • Hyperintensity on T2W Hemangiopericytoma [Figure 20] • Syn: “angioblastic meningioma” • Cell of Origin – perivascular pericyte of Zahn and/or Zimmerman • < 1% of primary CNS • M 1.4:1 F • Age – 40’s • Dural based, bone destruction, lobulated Fatty Metaplasia [Figure 19] Figure 19 A & B WHO Grade 1 Meningioma with Fatty Metaplasia. Meningioma with Cysts • Inside of neoplasm ‣ (rim enhancement) • Between tumor and brain ‣ (”arachnoid cysts”) • Inside Brain ‣ PIA separates tumor from brain ‣ ?? Results of chronic Edema ‣ Vacuolization of White Matter Meningioma: Atypical Histology • Atypical Meningioma ~ 5-7% • Anaplastic Meningioma ~ 1-3% • ~ 0.2% / 100k per year • Higher incidence of Recurrence • Shorter time to Recurrence • “Atypical Histology” ‣ Necrosis ‣ Excessive mitoses ‣ Invasion into brain* “Malignant Meningioma” • < 3% of all Meningioma • Anaplastic (Malignant) Meningioma • Papillary Meningioma • “Benign” Metastasizing Meningioma • Hemangio-Peri-Cytoma (HPC) • Malignant Fibrous Histiocytoma MFH) Neoplasms of the Meninges 1294 Figure 20 A, B, C & D Hemangiopericytoma. WHO 2,3 Top: Lobulated Mass - narrow attachment base. Hemangiopericytoma (HPC) • Narrow dural base (“Mushrooming”) • No Hyperostosis • No Calcification in tumor • Lobulated (not hemispheric) • Internal Signal Voids (on MRI) ‣ Irregular and multiple Meningioma: Radiologic Features - CT • Feature Benign/”Malignant” • Homogeneous Enhance 72% / 36% • Heterogeneous Enhance 23% / 64% • Hyperostosis 18% / 7% • Calcification 27% / 0% • “Mushrooming” 0% / 57% ‣ Narrow attachment and larger “cap” ‣ Invaginating into brain Parkway Delight vs. Rueben • Parkway Delight Rueben • Pastrami Corned Beef • Coleslaw Sauerkraut • Thousand Island Russian • Muenster Swiss cheese • Pumpernickel Rye Bread Neuroradiology
Page 1 and 2: Neoplasms of the Meninges James G.
Page 3 and 4: Meningioma: Vasogenic Edema • VAS
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Neoplasms of the Meninges James G. Smirniotopoulos, MD

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