PMC4508744_01
Presurgical three-dimensional (A) and axial (B) computed tomography scans showing bony erosions (A, asterisk) and homogeneous sclerotic change (B, arrow) in the left parietal bone. Coronal suture (A, arrow); squamosal suture (A, arrowhead). Pre-contrast sagittal T1-weighted (E), and post-contrast axial (C) and coronal (D) T1-weighted magnetic resonance images demonstrating an intensely enhancing subcutaneous mass, 1.5 x 1.5 cm in diameter (asterisk), and irregular thickening of the dura mater underneath (E, arrowhead and C, D, arrow).
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F1
Cranial computed tomography scans showed focal bony erosions and homogeneous sclerotic change at the affected site (Fig. 1A, B). The diploic tissue of the affected skull was abnormally thinned (Fig. 1C, D).
Intraoperative photographs demonstrating the subcutaneous mass firmly adhered to the temporalis muscle (A, arrow), eroded outer table (A, asterisk), and the affected dura mater with irregular-shaped, yellowish convolutions both on the outer (C, arrow) and inner (D, arrow) sides, whereas macroscopically intact surface of the inner table (B, arrow).
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F2
The dura mater contained irregular-shaped, yellowish convolutions both on the outer and inner surfaces, and was resected circumferentially with adequate margins (Fig. 2).
Photomicrographs of the resected specimens showing A: tumor infiltration amongst into the temporalis muscle fibers (arrows) (H-E stain, x10; inset, x50), B: tumor extension passing through the diploe (arrowheads) (H-E stain, x10; inset, x50), C: sheet-like proliferation of the tumor on the inner surface of the dura mater with finger-like outward extensions (arrows) (H-E stain, x10), and D: histological appearance of the tumor consistent with WHO grade I meningothelial meningioma (H-E stain, x50). WHO: World Health Organization, H-E: hematoxylin-eosin.
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F3
The histological diagnosis was consistent with benign meningothelial meningioma [World Health Organization (WHO) grade I], with finger-like outward extensions passing through the dura mater and overlying skull, and infiltration amongst into the temporalis muscle fibers (Fig. 3).