Brain meningioma with initial manifestation similar to cervical radiculopathy: a case report

Figures & data

Figure 1 X-ray of the cervical spine anterior–posterior (A) and lateral (B) views showed a mild narrowing of intervertebral disk spaces at almost every level of the cervical spine and osteoarthrosis of several apophyseal joints.

Figure 2 Cervical spine magnetic resonance imaging sagittal (A) and axial views showed herniation of the intervertebral disk in C3/4 (B1), C4/5 (B2), and C5/6 (B3) shown by arrows in (A), with a compression of the ventral surface of the spinal cord.

Figure 3 Axial view of brain computed tomography without contrast.

Notes: (A) Two large lobulated masses, with some calcifications in the right frontal region and in the frontal–parietal region, and with severe adjacent frontal bone hyperostosis. The T₁-weighted image obtained before (B) and after (C) the intravenous administration of gadolinium, showing a homogeneous enhancement of the tumors in the high frontal area and frontal–parietal region, in suspected meningioma.

Figure 4 A–D Histologic findings of atypical meningiomas (World Health Organization) grade II.

Notes: (A) Composed of storiform spindle cells and plump meningothelial cells with abundant eosinophilic cytoplasm (10×10); (B) focally increased mitotic activity (arrow) (eight mitoses, ten HPF) (10×40); (C) immunohistochemical stain shows positive immunoreactivity to EMA (patchy mild-to-moderate granular membranous and cytoplasmic staining) (10×40); (D) frequent hyaline degeneration and formation of psammoma bodies (arrow), arranged in fascicles or whorl-growth patterns (10×20).
Abbreviations: HPF, high power fields; EMA, epithelial membrane antigen.

Figure 5 Depending on the location of the patient’s meningioma (arrows), the weakness, numbness, and paresthesia of the upper-left limb were compatible with the cortical homunculus, which compressed to the primary somatosensory area (A) and the primary motor cortex (B).

Notes: Adapted by permission from BMJ Publishing Group Limited. [Schott G. Penfield’s homunculus: a note on cerebral cartography. J Neurol Neurosurg Psychiatry. 1993;56:329–333].¹⁵ Redrawn by YHH.

SchottGPenfield’s homunculus: a note on cerebral cartographyJ Neurol Neurosurg Psychiatry1993563293338482950

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