Isolated meningeal inflammatory myofibroblastic tumor: an enigmatic tumor

Excerpt

A 41-year-old woman was admitted to our institution with a slowly progressing, severe headache for 2 years. She had no neurological deficits on physical examination, and her laboratory findings were normal. Magnetic resonance imaging (MRI) showed dural thickening, a dural-based mass in the right temporal lobe, and minimal herniation in the occipitoparietal lobe due to the edema surrounding the mass. The dural-based mass had spiculated margins on contrast-enhanced T1-weighted images. Dural thickening, contrast enhancement, and leptomeningeal contrast enhancement were seen. In addition, the contrast-enhanced T1-weighted images showed dural venous sinus thrombosis (Fig. 1). To evaluate venous sinus narrowing or occlusion, digital subtraction angiography (DSA) was performed with carotid artery injection. No contrast filling was observed in the superior sagittal sinus, transverse sinus, or deep venous sinuses due to venous thrombosis. For determination of a definitive diagnosis, an open biopsy of the right temporal lobe was performed (Fig. 1f). The pathological examination indicated intense inflammatory cells (Fig. 2). Considering the pathological, radiological, and clinical findings, a meningeal inflammatory myofibroblastic tumor (IMT) was diagnosed. The patient was treated with corticosteroids, and her symptoms decreased during follow-up.

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