PMC10159323_01
A contrast-enhanced axial brain computed tomography image (a and b) showing a right parieto-occipital lesion, well-demarcated, and enhanced capsule consisting of solid and cystic parts with perifocal edema and subtle midline shift to the left.
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F1
Contrast-enhanced computed tomography brain showed a parieto-occipital lesion with a well-demarcated enhanced capsule consisting of mixed solid and cystic parts [Figure 1].
(A-H) Brain magnetic resonance imaging was done preoperatively. (a) axial diffusion-weighted image showing diffusion restriction in the solid part of the lesion. Fluid attenuated inversion recovery sequence images in (b) axial and (c) coronal planes, in addition to (d) coronal and (e) axial T2-weighted images showing a large solid and cystic intra-axial mass in the right parieto-occipital region with surrounding vasogenic edema. (f) axial, (g) sagittal, and (h) coronal gadolinium-enhanced T1-weighted image demonstrating an enhanced lesion and multiple loculations in the cystic component with a thick irregular enhancement of the wall.
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F2
The mass exerted a local mass effect with effacement of the cortical sulci and surrounding vasogenic edema, as well as compression on the posterior horn of the right lateral ventricle with a subtle midline shift to the left side [Figure 2].
Microscopic examination of hematoxylin and eosin (H and E) stained sections. (a and b) (H and E-  10) Proliferation of neoplastic meningothelial cells, infiltrating the dura. (c and d) (H and E-  20) Tumor cells are arranged in whorls, fascicles, and microcystic pattern. Psammoma bodies seen. (e) epithelial membrane antigen immunohistochemistry patchy positive staining and (f) Progesterone receptor immunohistochemistry positive nuclear staining.
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F3
Glial fibrillary acidic protein was negative with Ki67 <2% proliferative index [Figure 3].
A brain magnetic resonance imaging was done 2-month postoperatively. Axial (a) Diffusion-weighted image, (b) FLAIR, and (c) contrast-enhanced T1-weighted images showing postoperative changes noted in the right parietal and occipital lobes with areas of gliosis and focal volume loss. Nodular areas of enhancement are seen at the surgical site, consistent with scarring-no evidence of residual disease or tumor recurrence.
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F4
Brain MRI with and without contrast was repeated 2-3 months later and showed no evidence of residual disease or tumor recurrence [Figure 4].