Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA.
J Neurooncol. 2010 Aug;99(1):135-9. doi: 10.1007/s11060-009-0104-1. Epub 2009 Dec 24.
The authors present two cases that illustrate the difficulty in radiographically distinguishing between meningioma and metastatic lesions in patients with known cancer, especially with a parafalcine tumor location. The first patient with known metastatic prostate cancer had imaging studies suggestive of a parafalcine meningioma, but after surgical resection the lesion was found to be histologically consistent with metastatic disease. Conversely, the second patient was thought to have a metastatic breast cancer lesion in the parafalcine region. This presumptive diagnosis based on imaging findings led the patient to undergo radiosurgery treatment; however, the lesion grew over a several-month course and was eventually resected. The pathological analysis revealed that the tumor was, in fact, a meningioma. Using these cases, as well as an extensive review of the literature, the authors highlight the difficulty in making accurate radiographic diagnosis of dural-based lesions, especially in the parafalcine location, where meningiomas are commonly found but can have multiple entities mimicking their presentation. Caution must be used in managing patients with presumed parafalcine meningiomas or metastatic disease that have no histological diagnosis.
作者报告了两例病例，这些病例说明了在已知患有癌症的患者中，特别是在矢状窦旁肿瘤位置，通过影像学来区分脑膜瘤和转移性病变的困难。第一例已知患有转移性前列腺癌的患者的影像学研究提示为矢状窦旁脑膜瘤，但手术切除后的病变组织学表现符合转移性疾病。相反，第二例患者被认为在矢状窦旁区域有转移性乳腺癌病变。基于影像学发现的这种推测性诊断导致患者接受了放射外科治疗；然而，病变在几个月的过程中逐渐增大，最终被切除。病理分析显示肿瘤实际上是脑膜瘤。作者使用这些病例以及广泛的文献复习，强调了在对硬脑膜病变进行准确的影像学诊断方面的困难，特别是在脑膜瘤常见但可能有多种表现形式的矢状窦旁位置。对于没有组织学诊断的假定矢状窦旁脑膜瘤或转移性疾病的患者，必须谨慎处理。
