Jain Aakash, Hoeprich Mark, Mittal Monika, Kupsky William J, Mittal Sandeep
Clin Neuropathol. 2014 Nov-Dec;33(6):412-7. doi: 10.5414/NP300777.
We report the incidence of spontaneous infarction of a falcine meningioma without preceding hemorrhage and shed light on the relation between intratumoral necrosis and hemorrhage.
A 50 year-old woman presented with recurrent headaches and was found to harbor a falcine meningioma. The patient elected to observe the mass and 13 months later she developed new neurological deficits. Prior to scheduled resection, she presented with abdominal pain and underwent emergent laparoscopic cholecystectomy. Two days after the procedure, she developed sudden right hemiparesis associated with severe headache. MRI of the brain showed an intratumoral wedge-shaped hypointense area with significant peritumoral edema. The patient was started on high-dose corticosteroids with considerable improvement in strength.
The patient underwent a complete resection of the tumor with no new neurological deficits post-operatively. Histopathological analysis confirmed a WHO grade II atypical meningioma with extensive necrosis without hemorrhage.
This case highlights that tumor infarction, although rare, should be in the differential diagnosis of patients with meningiomas presenting with new neurological deficits. When this condition is recognized and treated in timely manner with high-dose corticosteroids and surgical resection, patients can have favorable long-term outcomes.
我们报告一例无先前出血的大脑镰脑膜瘤自发性梗死的发生率，并阐明肿瘤内坏死与出血之间的关系。
一名50岁女性因反复头痛就诊，被发现患有大脑镰脑膜瘤。患者选择观察该肿块，13个月后出现新的神经功能缺损。在计划切除术前，她出现腹痛并接受了急诊腹腔镜胆囊切除术。术后两天，她突然出现右侧偏瘫并伴有严重头痛。脑部MRI显示肿瘤内有楔形低信号区，周围有明显的肿瘤水肿。患者开始使用大剂量皮质类固醇治疗，肌力有明显改善。
患者接受了肿瘤全切术，术后无新的神经功能缺损。组织病理学分析证实为WHO二级非典型脑膜瘤，有广泛坏死但无出血。
该病例突出表明，肿瘤梗死虽然罕见，但在出现新的神经功能缺损的脑膜瘤患者的鉴别诊断中应予以考虑。当这种情况被及时识别并用大剂量皮质类固醇和手术切除进行治疗时，患者可获得良好的长期预后。
