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Washington University Experience | NEOPLASMS (MENINGIOMA) | Mucinous | 2A0 Case 2 (later, same patient, 2nd resection) History Part 2
Case 1 History Part 2 (2013 Resection) ---- The patient is the now 46-year-old woman 13 years after her first right perisylvian region tumor resection in 2000 and diagnosis of meningioma with mucinous features. In 2006, she underwent mastectomy for invasive ductal breast carcinoma (Grade III/III; Stage IIa). MRI of the head in 2009 showed no evidence of mass lesions. In 01/2013, she presented with a generalized seizure. Head CT in 01/2013 showed four new homogeneously enhancing extra-axial masses on the left side including one (~3 cm) in the olfactory groove and along the planum sphenoidale; a second (~2 cm) over the anterolateral left frontal lobe; and a third and fourth (0.5 cm) overlying the left posterior frontal lobe and left parietal lobe. CT of the chest, abdomen and pelvis at that time showed no evidence of extracranial tumor. She received gamma knife radiotherapy in 02/2013, targeting the two larger masses. In 4/2013, she presented after two weeks of intermittent confusion, urinary incontinence, and new right facial droop. CT then showed a large amount of vasogenic edema in the left frontal lobe extending into the right frontal lobe with mass effect and midline shift, as well as a focal cystic area adjacent to the falx cerebri in the medial left frontal lobe, thought to represent post treatment degeneration of the gamma knife treated meningioma. In late 05/2013, she experienced seizures and left hemiparesis; CT showed no interval change from 04/2013. Operative procedure: Left frontal craniotomy, Stealth-guided, for resection of three left frontal meningiomas.
