A Case of Recurrent Meningioma with Malignant Change.

Chae, Jin; Kim, Jong Hyun; Cho, Maeng Ki; Moon, Myong Sun; Choi, Kil Soo; Sim, Bo Sung

Original Article

Journal of Korean Neurosurgical Society 1973;2(1): 107-111.

Jin Chae, Jong Hyun Kim, Maeng Ki Cho, Myong Sun Moon, Kil Soo Choi, Bo Sung Sim

Department of Neurosurgery, Seoul National University, College of Medicine, Seoul, Korea.

ABSTRACT

A 34-year-old male patient was first admitted to our Department on October 16, 1965. He complained of frontal headaches especially in the morning and ild right hemiparesis over the previous 6 months, which were progressively more severe as time went by. On examination, he was mentally clear ut slightly dysphasic: there were mild right hemisparesis and marked bilateral papilledema. Angiogram showed a left posterior frontal vascular tumor. At operation on November 3, 1965, total excision of a posterior frontal parasagittal tumor was performed. To the naked eye, this seemed to be a meningioma; the tumor was egg-sized, round but somewhat lobulated, graysish white in color, firm and fibrotic appearance, and it attached to the superior longitudinal sinus, involving without occluding it. Histologically. It was considered a meningioma of firbrolastic type, containing small amount of capillaries and some areas of collegen deposition around the fibroblasitc cell masses with foci of meningoendothelial cluster; though some doubt was expressed over its innocence. He tolerated the resection of frontal tumor well, and remained in relatively good health for 7 years, as to do his usual farmer work with minimal right hemiparesis. There were some episodes of generalized seizure during there periods. The patients was readmitted on December 25, 1972, however, because of frontal headaches and vomiting over recent 6 months and dysphasia, mental confusion developing rapidly over the previous 3 months. Urinary incontinence was also complained of. On examination he was drowsy, apathetic and mentally confused, more so than when first admitted. There was a goose-egg sized tense bulging in the left frontotemporal region, previously operated. Central-typed right facial palsy, right hypoglossal palsy and bilateral marked papilledema were noted. There were spastic hemiparesis, greater in the upper extremity, and long tract signs on the right side. Angiogram revealed a posterior frontal parasagittal vascular tumor, much as before. At operation on January 5, 1973, subtotal resection of tumor was performed, remaining the deep-seated parasagittal posterior frontal mass. The gross appearance of tumor was necrotic partially on the surfaces, potato-shaped with nodularith and pinkish white in color. On sectioning cut surface was slightly myxoid with cystic degeneration in the center. There was also patchy degeneration, showing yellow tinge in the cut surface. Microscopically, there were prominent hypercellularity with many mitoses, atypism, pleomorphism and degenerative process. Vascutar reaction with amyloid-like infiltration in perivascular area was also demonstrated as with focal pseudocartilagenous degeneration and partial hemorrhage; overall findings were highly suggestive of recurrent memingioma with malignant change (sarcomatous change) in left posterior frontal parasagittal region.