고형 종괴 없는 파종성 일차성 역형성 뇌수막종

Abstract

Meningiomas arising from the dural coverings of the brain are most common benign intracranial tumor. Mostly, meningiomas are dural based mass lesions and anaplastic meningioma is an uncommon variant of meningioma. We present a case of primary disseminated anaplastic meningioma without solid mass. A 19-year-old man admitted to the department of neurology because of a 6-month history of headache with nausea, vomiting, and back pain. Magnetic resonance images(MRI) of the brain showed lesions at the right mesial temporal lobe and ipsilateral trigeminal nerve, which showed irregular Gadolinium-enhancement. However, the lesions had no definitive mass formation. Fluid-attenuated inversion recovery(FLAIR) MRI demonstrated high signal intensity on bilateral cingulate gyrus. Cerebrospinal fluid examination revealed a high opening pressure of 400 mmH2O. Protein was elevated with 338 mg/dL. White blood cell(WBC) level was high with 29 per high power field(HPF), and glucose decreased with 3 mg/dL. The patient underwent surgical resection for pathologic diagnosis. Pathological diagnosis was anaplastic meningioma showing rhabdoid features with multiple parenchymal and perivascular invasion He underwent radiation therapy includeing whole neuraxis. Even though primary leptomeningeal enhancement without solid mass in MRI and more suggestive to inflammatory disease on CSF examination are showed, it should not be rule out the possibility of malignancy. The pathological diagnosis of suspected lesion with unusual situation and uncertain behavior is extremely important.