PMC3420442_01
T2-weighted axial (a) and coronal (b) MRI performed 1 year prior to surgery show right posterior frontal flow void with adjacent cortical foci of susceptibility artifact suggesting vascular malformation.
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A magnetic resonance imaging (MRI) scan performed one year prior to surgery showed a suspected single right posterior frontal flow void with adjacent cortical foci of susceptibility artifact compatible with calcification or hemosiderin from remote, small hemorrhages suggesting an atypical vascular lesion (Figures 1(a) and 1(b)).
Axial CT without contrast demonstrates right posterosuperior temporal lobe ill-defined clumped calcification.
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Imaging was repeated and showed the same lesion again felt to likely represent an atypical vascular malformation (Figures 2 and 3). 
Relatively T1-weighted gradient echo axial MRI with gadolinium contrast shows serpentine enhancement in depths of right sylvian fissure compatible with presumed vascular malformation.
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Imaging was repeated and showed the same lesion again felt to likely represent an atypical vascular malformation (Figures 2 and 3). 
T1-weighted axial (a) and coronal (b) MRI at the 1-year postoperative visit show encephalomalacia, no increase in size of residual lesion, and persistent enhancement in sylvian cistern.
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A surveillance MRI performed at this visit showed encephalomalacia and no change in the size of the residual lesion (Figures 4(a) and 4(b)).
Histologic sections (200x) stained with hematoxylin and eosin (H&E) demonstrate greatly thickened vascular walls (a, arrow) within the cerebral cortex that are concentrically surrounded by meningioma cells, typical of meningioangiomatosis. Pyramidal cells (a, arrowhead) of the architecturally distorted cortex are noted between thickened vascular structures. In other regions (b, arrow), vessels showed fewer surrounding meningioma cells, but greater degrees of collagen, indicating substantial chronicity. Psammoma bodies (b, arrowhead) were scattered throughout.
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On pathological examination, there were numerous thickened blood vessels surrounded by sheaths of well-differentiated meningothelial tumor cells, generally ranging from one to five cell layers thick, noted throughout the distorted cerebral cortex (Figures 5(a) and 5(b)).