PMC7710478_01
Axial (a) and coronal T1-contrast (b) image shows contrast enhancement dural-based tumor with cystic component size 7 x 5 cm resulting in midline shift of approximately 1.6 cm and third ventricular obliteration. Axial T2 image showing hypointense cystic component (c).
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F1
Brain magnetic resonance imaging (MRI) revealed an irregular and heterogeneously enhancing solid lesion at the right temporoparietal region, with intratumoral cystic changes, a broad attachment on the dura, and perifocal brain edema resulting in midline shift to the contralateral side [Figure 1a and b]. T1-weighted sequences and hypointense signal on T2-weighted sequences. There was no destruction of bone structure [Figure 1c].
Microscopic examination revealed the proliferation of neoplastic meningothelial cells with pale eosinophilic cytoplasm forming solid nests, associated with a dense chronic inflammatory infiltrate rich in lymphocytes and some plasma cells (a) (H&E, x20). Both tumor cells and lymphocytes are positive with vimentin (b) (x20). Negative glial fibrillary acidic protein in tumor cells excludes the diagnosis of glioma with xanthomatous changes (c) (x40). CD3 staining in lymphocytes dispersed between tumor cells (d) (x20).
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F2
The inflammatory infiltrates were mostly stained with CD3 [Figure 2].
Immediate postoperative computed tomography scan showing total removal of tumor with some certain extent of midline shift (a). Magnetic resonance imaging axial T1-contrast scan 6 months after operation showing no recurrence (b).
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F3
His postoperative MRI 6 months after surgery showed no residual nor recurrence of the tumor [Figure 3].