PMC5508490_01
A T2-weighted axial MRI: hyperintense signal alteration over a wide area in the diploic region in front of the temporal pole in the context of which is an nodular area heterogeneously hypointense. B. In the same layer, in the diploic region there is presence of an hypointense area in FLAIR sequences. C. T1-weighted MRI axial scan after administering paramagnetic contrast e.v.: slightly non- homogenous increase of signal of the globular formation in the intradiploic area.
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MRI (Fig. 1) showed a large intradiploic lesion involving the lateral wall of the orbit and the greater wing of the sphenoid in T2 weighted sequences.
3D CT reconstruction: osteolytic alteration of the orbital wall in the same location as the MRI showed.
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After contrast was administered the round formation showed increased signal intensity in a slightly non- homogenous way. :  CT scan (Fig. 2) showed an osteolytic lesion involving the lateral wall of the orbit and the greater wing of the sphenoid.
The arrow in the photo shows the membrane of the cyst of the meningioma after removal of a very thing bone layer.
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We opened it and were faced with a large cystic cavity with a thin fibrous wall, it was all contained inside the bone (Fig. 3).
Vision from the operatory microscope of the surgical field: the horizontal arrow shows the cystic cavity, the vertical one the tumoral nodule.
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The cyst was full of yellow liquid; there was also a rather large mural nodule (Fig. 4), which was completely and easily removed.
A Haematoxylin and Eosin stained sections of the mural nodule (A, B) show a benign meningothelial meningioma (WHO Grade I) comprising cells with oval to round nuclei and small nucleoli, arranged in syncytial and lobular patterns. There are no atypical or malignant features. An area (C) showing the interface between the tumor above and the bone matrix below with the intervening fibrous cyst wall. The tumor is attached to, but does not infiltrate the fibrous wall or the underlying bone.
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Histological examination (Fig. 5) showed that the mural nodule was a benign meningothelial meningioma (WHO Grade I) comprising cells with oval to round nuclei and small nucleoli, arranged in syncytial and lobular patterns, without atypical or malignant features.