Journal List > J Korean Ophthalmol Soc > v.57(11) > 1010458

Joo, Kim, Park, and Shin: A Case of Extra-axial Anaplastic Meningioma with Direct Orbital Extension

Abstract

Purpose

We report the first case of extra-axial anaplastic meningioma with direct orbital extension for differential diagnosis of orbital tumors.

Case summary

An 83-year-old woman presented with a protruding left eye and a palpable mass on the forehead. A brain computed tomography scan revealed a huge sarcomatous mass that had directly invaded the surrounding tissues. We removed the tumor by craniotomy and found that it involved the extradural and intradural spaces, brain parenchyma, subcutaneous tissue, left temporalis, orbital roof, and the other frontal lobe across the midline. A cranioplasty was performed, and the orbital roof was reconstructed with artificial bone and bone cement. The final histological diagnosis was anaplastic meningioma. The left eyeball was restored to its normal position 1 month after the surgery. Also, visual acuity and eye movement of the left eye were preserved.

Conclusions

Direct orbital extension of originated extra-axial cerebral convexity anaplastic meningioma is rare but should be considered in the differential diagnosis of a rapidly growing orbital mass.

References

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Figure 1.
Anterior photographs. 9-cardinal segment photographs. (A) The protruding mass in the left forehead with orbital dystopia. The left globe was displaced inferiorly. Up gaze eye movement disorder is also shown. (B) Proptosis of the left eye.
jkos-57-1781f1.tif
Figure 2.
Initial coronal brain images recorded 1 year ago. (A) Computed tomography. (B) Magnetic resonance imaging. These are showing a heterogeneously enhanced extra-axial mass in the left frontoparietal bone. Bony destruction and intracranial extension are also shown.
jkos-57-1781f2.tif
Figure 3.
Pre-operative brain computed tomography. (A, B) 10.9 × 9.9 × 7.0 cm heterogeneously enhanced extra-axial scalp mass with central necrosis on the left forehead. The left eyeball is deviated inferiorly and the left frontoparietal bone, left supero-lateral/medial bony orbit, left frontal bone, and left temporalis muscle were directly invaded. (C, D) Post-operative brain computed tomography. The inferior deviation of left eyeball was recovered.
jkos-57-1781f3.tif
Figure 4.
Histological findings. Anaplastic meningioma with hypercellularity and a prominent mitotic activity (A: HE stain ×40, B: HE stain ×200).
jkos-57-1781f4.tif
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