PMC4077786_01
X-ray of the cervical spine anterior-posterior (A) and lateral (B) views showed a mild narrowing of intervertebral disk spaces at almost every level of the cervical spine and osteoarthrosis of several apophyseal joints.
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Based on an assumption of cervical radiculopathy, an X-ray of the cervical spine was performed, which showed evidence of reduced normal lordosis with a mild narrowing of the intervertebral disk spaces at almost all levels of the cervical spine, with osteoarthrosis of several apophyseal joints (Figure 1).
Cervical spine magnetic resonance imaging sagittal (A) and axial views showed herniation of the intervertebral disk in C3/4 (B1), C4/5 (B2), and C5/6 (B3) shown by arrows in (A), with a compression of the ventral surface of the spinal cord.
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Magnetic resonance imaging (MRI) of the cervical spine revealed a minor disk bulge at C3-C4, C4-C5, and C5-C6, with posterocentral and right paramedian compression of the ventral surface of the spinal cord (Figure 2).
Axial view of brain computed tomography without contrast.. Notes: (A) Two large lobulated masses, with some calcifications in the right frontal region and in the frontal-parietal region, and with severe adjacent frontal bone hyperostosis. The T1-weighted image obtained before (B) and after (C) the intravenous administration of gadolinium, showing a homogeneous enhancement of the tumors in the high frontal area and frontal-parietal region, in suspected meningioma.
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Brain computed tomography was performed, revealing two large lobulated masses, with some calcifications in the right high-frontal region and another in the right frontal-parietal region and with severe adjacent frontal bone hyperostosis (Figure 3A). Brain MRI (Figure 3, B and C) with gadolinium showed two lobulated and well-defined brain tumors, one of which was in the right high-frontal area and the other in the right frontal-parietal area.
A-D Histologic findings of atypical meningiomas (World Health Organization) grade II.. Notes: (A) Composed of storiform spindle cells and plump meningothelial cells with abundant eosinophilic cytoplasm (10x10); (B) focally increased mitotic activity (arrow) (eight mitoses, ten HPF) (10x40); (C) immunohistochemical stain shows positive immunoreactivity to EMA (patchy mild-to-moderate granular membranous and cytoplasmic staining) (10x40); (D) frequent hyaline degeneration and formation of psammoma bodies (arrow), arranged in fascicles or whorl-growth patterns (10x20).. Abbreviations: HPF, high power fields; EMA, epithelial membrane antigen.
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The immunohistochemical stain and the pathology report were consistent with atypical meningioma, World Health Organization (WHO) grade II (Figure 4).