Presentation
Headaches, degrading visual acuity and generalized weakness.
Patient Data
A large soft tissue mass expands the clivus and sella turcica, causing bony destruction and obliteration of the sphenoid sinuses, with extension into the suprasellar cistern. The clivus is eroded and not well maintained. The mass extends into the pontine cistern.
It is slightly hyperdense on the non-enhanced CT and there are foci of calcifications. Post-contrast images show diffuse enhancement.
The mass is isointense on T1, slightly hyperintense on T2/FLAIR, with internal low SI foci of calcifications. A thin low SI rim encases the lesion, best seen on the sagittal images.
A small branching vessel is coursing through the lesion.
The cavernous ICA's are displaced laterally, but with preserved signal void.
Case Discussion
HISTOPATHOLOGY:
Description: The tumor cell are immunoreactive for vimentin, EMA, S100, and immunonegative for synaptophysin, HMB45, CD34 and GFAP.
Diagnosis: Meningioma (WHO grade I).
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