PMC3579081_01
Preoperative images. A : Chest PA imaging. B : Chest CT imaging reveals a right upper lobe mass (upper). PET imaging shows hypermetabolic lesion in the right upper lobe (lower). CT : computed tomography, PET : positron emission tomography.
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F1
She had undergone a right upper lobectomy for carcinoma of the lung 2 years ago (Fig. 1).
Brain MR imaging (at present). The right frontal mass is iso- or hyperintense on the T2 weighted image and enhanced on the T2 weighted image. A calcification lesion is observed inside the mass on the CT scan image. MR : magnetic resonance.
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F2
Brain magnetic resonance imaging (MRI) showed a few hypointense areas surrounded by a diffuse hyper-intense lesion in T2 weighted images; contrast-enhanced T1 weighted MRI showed "a dural tail sign" attached to homogeneously enhancing mass (Fig. 2).
Brain MR, and PET images show the increased size of the dural based mass (after 10 months). The size of the mass has suddenly increased. There are two round figures inside the mass which were not observed before compared to Fig. 1. The mass is hypointense on T2 weighted image, and heterogenously enhanced on T1 enhancing image. PET : positron emission tomography.
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F3
MRI showed increased size of the mass (Fig. 3).
Incidental finding of left anterior communicating aneurysm.
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F4
In addition, an incidental unruptured aneurysm at the anterior communicating artery was found (Fig. 4).
Microscopic images. A : The fibrous meningioma with overlying dura of no carcinoma-bearing area (H-E, x40). B : Higher magnification shows a streaming arrangement of elongated spindle cells resembling fibroblasts and psammomatous calcifications (H-E, x200). C : In carcinoma-bearing areas, cancer glands are irregularly scattered in fibrous meningioma (H-E, x200). D : Immunohistochemical staining for TTF-1 shows strong nuclear positivity in glandular structures (x100).
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F5
Microscopic examination revealed fibrous meningioma, and irregularly bran-ching gland-like adenocarcinoma cell clusters intermixed with this fibrous meningioma in some areas (Fig. 5).