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Idiopathic hypertrophic pachymeningitis mimicking lymphoplasmacyte-rich meningioma

Matthew R Hosler1, Roger E Turbin, Eun-Sook Cho

  • 1Department of Ophthalmology and Visual Science, New Jersey Medical School, Newark, New Jersey 07103, USA.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
|June 6, 2007
PubMed

Insights

Idiopathic hypertrophic pachymeningitis (IHP) can mimic lymphoplasmacyte-rich meningioma (LRM) on imaging and pathology. Re-evaluation of surgical specimens led to a revised diagnosis of IHP in a patient with chronic optic neuropathy and hearing loss.

Area of Science:

  • Neurology
  • Pathology
  • Radiology

Background:

  • A patient presented with a history of optic neuropathy and hearing loss.
  • MRI revealed enhancing dural lesions around the brain stem and internal auditory canals.

Observation:

  • Initial histopathology from 1990 and 1993 was interpreted as inflammatory meningioma, now known as lymphoplasmacyte-rich meningioma (LRM).
  • The patient's relapsing clinical course prompted a review of the original surgical specimens.

Findings:

  • Additional immunocytochemical stains led to a revised pathologic diagnosis of idiopathic hypertrophic pachymeningitis (IHP).
  • Idiopathic hypertrophic pachymeningitis (IHP) and lymphoplasmacyte-rich meningioma (LRM) share overlapping imaging and histopathologic features.

Implications:

  • This case highlights the diagnostic challenges in differentiating IHP from LRM.
  • Accurate diagnosis is crucial for appropriate management of patients with dural lesions and neurological deficits.

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