Paediatric primary intraosseous meningioma of the calvarium

A boy in his middle childhood presented with a gradually enlarging, mildly tender swelling in the left frontal region, noticed after minor trauma. Skull radiograph and non-enhanced CT revealed a diffuse sclerotic lesion involving the left frontal bone and overlying subcutaneous soft tissue, suggestive of an intraosseous haemangioma. Contrast-enhanced MRI showed an expansile, hypointense lesion in the frontal bone on the left side with enhancing extraosseous components and a small extra-axial cyst. FNAC findings were consistent with meningioma. A complete resection of the tumour was performed. Histopathology revealed WHO grade I meningo-epithelial meningioma with microscopic dural involvement. Postoperative scans showed complete tumour excision, with a persistent intracranial cyst. Follow-up MRI showed no recurrence. This case emphasises primary intraosseous meningioma as one of the possibilities in osteoblastic slow-growing bony lesions which can be easily misdiagnosed with other common causes of lumps and bumps in the paediatric population.