Answer for BIR CoW 25 Jul 2021
Residual chordoid meningioma
Findings
Right retrocerebellar T2 mixed intensity lesion with bilateral cerebellar hemispheres showing vasogenic edema. Mass effect noted over 4th ventricle. Effacement of basal cisterns noted. On contrast administration, homogeneous enhancement of the lesion seen. Perilesional irregular cerebellar foliar enhancement noted. Another ovoid enhancing lesion noted in the region of pineal gland.
Discussion
Patient was a case of chordoid meningioma , taken MRI post subtotal excision and radiation. The retrocerebellar lesion with a broad dural base with homogeneous enhancement is the residual chordoid meningioma. Adjacent cerebellar foliar enhancement is suggestive of post radiation changes. Another ovoid homogeneously enhancing lesion noted in the region of pineal gland is pineocytoma. Chordoid meningiomas are uncommon histological variants of meningiomas . They have a rapid course of growth and are known for recurrence. They are designated as grade 2 tumors under WHO classification. Chordoid meningiomas are treated with surgical excision. In cases of subtotal excision, radiotherapy is attempted as was done in our case.
Findings
Right retrocerebellar T2 mixed intensity lesion with bilateral cerebellar hemispheres showing vasogenic edema. Mass effect noted over 4th ventricle. Effacement of basal cisterns noted. On contrast administration, homogeneous enhancement of the lesion seen. Perilesional irregular cerebellar foliar enhancement noted. Another ovoid enhancing lesion noted in the region of pineal gland.
Discussion
Patient was a case of chordoid meningioma , taken MRI post subtotal excision and radiation. The retrocerebellar lesion with a broad dural base with homogeneous enhancement is the residual chordoid meningioma. Adjacent cerebellar foliar enhancement is suggestive of post radiation changes. Another ovoid homogeneously enhancing lesion noted in the region of pineal gland is pineocytoma. Chordoid meningiomas are uncommon histological variants of meningiomas . They have a rapid course of growth and are known for recurrence. They are designated as grade 2 tumors under WHO classification. Chordoid meningiomas are treated with surgical excision. In cases of subtotal excision, radiotherapy is attempted as was done in our case.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!