CASE 141 Published on 26.11.2000

Atypical meningioma

Section

Neuroradiology

Case Type

Clinical Cases

Authors

R Sigal, A Lusinchi, P Wibault, F Eschwège

Patient

65 years, male

Categories

No Area of Interest ; Imaging Technique CT, CT, MR

No Procedure ; No Special Focus ;

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Clinical History

Routine imaging follow up after treatment of sinonasal cancer

Imaging Findings

Middle age patient treated for a cancer of the facial area by surgery and external irradiation. No neurological symptoms. Systematic follow up CT and MR are presented.

Discussion

Post irradiation meningioma are a late and rare manifestation of irradiation (1). They can be either associated with low-dose x-ray therapy such as individuals treated in childhood for tinea capitis (2), or with high-dose cranial irradiation (3). The average time from radiation therapy to diagnosis is around 25 years (range 5 to 40 years (3) for high dose irradiation; the with interval is longer in meningiomas induced by lower doses of irradiation (2). These tumors have distinct characteristics: their location at the site of maximal irradiation, and features suggesting rapid growth and aggressive biological behavior (2). There is a significantly higher number of calvarial tumors, a high proportion of multiple meningiomas, a higher recurrence rate following apparent complete , and an increased number of histologically malignant meningiomas (2). MR is the imaging modality of choice (4): the aggressive behavior of radiation induced meningiomas helps to differentiate them from spontaneous meningiomas which usually present as well marginated lesions. Rapid growth and multiple location can also help to anticipate the correct diagnosis.

Differential Diagnosis List

Radiation-induced meningioma

Final Diagnosis

Radiation-induced meningioma

References

[1] Rubinstein AB, Shalit MN, Cohen ML, Zandbank U, Reichenthal E (1984)
Radiation-induced cerebral meningioma: a recognizable entity.
J Neurosurg Nov;61(5):966-71. (PMID: 6593438)

[2] Soffer D, Pittaluga S, Feiner M, Beller AJ
Intracranial meningiomas following low-dose irradiation to the head.
J Neurosurg 1983 Dec;59(6):1048-53. (PMID: 6631499)

[3] Mack EE, Wilson CB
Meningiomas induced by high-dose cranial irradiation.
J Neurosurg 1993 Jul;79(1):28-31. (PMID: 8315464)

[4] Becker M, Schroth G, Zbaren P, Delavelle J, Greiner R, Vock P, Allal A,
Rufenacht DA, Terrier F (1997)
Long-term changes induced by high-dose irradiation of the head and neck
region: imaging findings.
Radiographics Jan-Feb;17(1):5-26. (PMID: 9017796)

Case information

URL:	https://eurorad.org/case/141
DOI:	10.1594/EURORAD/CASE.141
ISSN:	1563-4086

Figure 1

CT study, 2 years after the end of the treatment

The post contrast coronal CT shows normal post therapeutic changes at the level of the ethmoid, nasal cavity and anterior skull base. There is no intracranial lesion.

Figure 2

CT study, 4 years after the end of the treatment