PMC9911711_01
Brain MRI in a 73-year-old female patient shows strongly enhancing 3.4-cm parasagittal meningioma (A) with mild peritumoral edema on axial T2-weighted MRI (B).
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F1
She was incidentally diagnosed with a parasagittal meningioma in the right frontal area on MRI, which was performed for a systemic workup (Fig. 1).
Follow-up MRI 16 months later shows increased tumor size (A) and peritumoral edema (B).
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F2
She was followed up in the outpatient clinic, and the size of the tumor and peritumoral edema was found to have increased on MRI 16 months later (Fig. 2).
Intraoperative surgical view showing complete removal of the tumor with the adjacent superior sagittal sinus and falx.
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F3
Subsequently, surgical resection was planned, and frontal craniotomy with complete removal of the parasagittal meningioma was performed (Fig. 3).
Histopathologic findings of the meningioma components show sheets of meningothelial cells (A) and pseudo-psammomatous bodies inside a gland-like space (B) with immunopositivity for somatostatin receptor 2a (C) and carcinoembryonic antigen, cytokeratin (inlet) in the pseudo-psammomatous bodies (D). A and B: H&E stain, original magnification, x200; C and D: Immunohistochemistry, original magnification, x200.
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F4
Histopathological studies confirmed a WHO grade 1 secretory meningioma, which revealed a meningothelial structure with positive staining for somatostatin receptor 2a, carcinoembryonic antigen, and cytokeratin in the pseudo-psammomatous bodies (Fig. 4).
Histopathologic findings of the carcinoma components show nuclear immunoreactivity of GATA binding protein 3 (A) and estrogen receptor (B), membranous positivity of E-cadherin (C), focal cytoplasmic positivity of gross cystic disease fluid protein 15 (D), and negative immunoreactivity of progesterone receptor, which are consistent with breast ductal carcinoma (E). A-E: Immunohistochemistry, original magnification, x200.
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F5
The carcinoma components revealed nuclear immunoreactivity to GATA binding protein 3 and estrogen receptor (ER), membranous positivity to cytokeratin and E-cadherin, focal cytoplasmic positivity to gross cystic disease fluid protein 15, and negative immunoreactivity to progesterone receptor (PR), which was consistent with a diagnosis of epithelial ductal carcinoma (Fig. 5).