PMC5200959_01
Axial CT post contrast image (a) and sagittal reconstruction (b) shows an irregular extra-axial solid mass with heterogeneous enhancement and deep cystic change (arrow) adjacent to the falx extending into the right frontal lobe. There is significant peritumoral oedema and mass effect involving the right frontal lobe with displacement of the midline. These findings, together with tumour interdigitating with the brain substance, are consistent with an aggressive frontal meningioma
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Fig1
There were fringes of tumour interdigitating with the brain substance indicating probable brain invasion (Fig. 1).
Axial CT post contrast image showing: a nodular enhancing masses and perilesional oedema in the right frontal lobe, indicative of local recurrence of the meningioma. b A sagittal T1-weighted MR image post contrast confirming the presence of three lesions and invasion of the superior sagittal sinus (arrows)
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Fig2
An MRI confirmed the CT findings indicative of tumour and also detected invasion and occlusion of the anterior part of the superior sagittal sinus (Fig. 2).
Histology of the anaplastic (Grade III) meningioma of the frontal lobe showing; a lobules of meningotheliomatous tumour containing cells with round vesicular nuclei, b areas of focal tumour necrosis containing more pleomorphic tumour cells
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Fig3
There was increased mitotic activity and extensive tumour necrosis was noted (Fig. 3).
Axial thorax CT post contrast image showing an ill-defined soft tissue mass (arrow) superficially located in the left trapezius muscle with peripheral enhancement and low signal in the centre
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Fig4
The lesion was lobulated, had a low attenuation centre, showed peripheral enhancement and did not exhibit evidence of matrix calcification (Fig. 4).
Sagittal T2 (a), axial T1 (b) and axial T2 fat saturated (c) MR images demonstrate a solid well defined soft tissue mass in the medial left trapezius muscle which returns isointense T1-W (between arrow heads) and heterogeneous predominantly high T2-W signal relative to skeletal muscle. There is mass effect on the deeper paravertebral muscles and peripheral feeding vessels along the lateral aspect of the lesion (arrow)
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Fig5
Peripheral feeding vessels were present (Fig. 5).
PET-CT confirms the presence of an FDG avid soft tissue mass in the left trapezius muscle
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Fig6
PET-CT scan demonstrated that the intramuscular lesion was extremely FDG avid with an SUVmax of 22.1 (Fig. 6). PET-CT also revealed disseminated, markedly FDG avid metastases in liver, bone and pleura and residual meningioma in the right frontal lobe.   
Histology of the metastatic meningioma in soft tissues showing: a lobules of tumour showing features of meningotheliomatous meningioma similar to the primary brain tumour b areas where tumour cells exhibit marked nuclear pleomorphism and contain prominent nucleoli. c Expression of EMA by tumour cells
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Fig7
There were a few whorled collections of tumour cells with round or oval vesicular nuclei (Fig. 7).