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Incidental pediatric intraparenchymal meningioma: illustrative case
Adriano M Lino-Filho1, Bárbara A Morais1,2, Mateus Neves Faria Fernandes3
1Division of Neurosurgery, Department of Surgery, Clinics Hospital, Federal University of Goiás, Goiânia, Goiás, Brazil.
Background:
Meningiomas are the most common benign tumors among CNS neoplasms. In the pediatric population, however, they account for only 0.4%-4.6% of all intracranial neoplasms; they are rare inside the brain parenchyma and are frequently confused with other entities, such as glioneuronal tumors and cavernomas, among others.
Observations:
The authors describe the case of a 4-year-old male who presented to the emergency department for evaluation of periorbital cellulitis and was incidentally diagnosed with a brain tumor. MRI demonstrated an expansive heterogeneous lesion, 2.2 × 1.9 × 1.8 cm, in the left lingual gyrus. Spectroscopy and perfusion imaging suggested a low-grade glioneuronal tumor. After thorough discussion, the family and medical team elected to pursue surgical treatment. The patient had an uneventful postoperative recovery, and subsequent pathological and immunohistochemical analysis confirmed the diagnosis of a fibrous meningioma (WHO grade 1).
Lessons:
Intraparenchymal meningiomas are a rare and misdiagnosed tumor, especially in the pediatric age group, and therefore are not usually considered in the differential diagnosis of intra-axial neoplasms in children. When suspected, surgery may be encouraged due to the tendency of these tumors to exhibit more aggressive behavior compared with adult meningiomas. https://thejns.org/doi/10.3171/CASE24611.
Insights
Pediatric intraparenchymal meningiomas are rare and often misdiagnosed brain tumors. Early surgical intervention may be beneficial due to their potential for aggressive behavior in children.
Area of Science:
- Neuro-oncology
- Pediatric Neurosurgery
Background:
- Meningiomas are common CNS tumors, but rare in children (0.4%-4.6% of pediatric intracranial neoplasms).
- Intraparenchymal meningiomas are particularly rare and often misdiagnosed as glioneuronal tumors or cavernomas in pediatric patients.
Purpose of the Study:
- To highlight the diagnostic challenges and management of a rare pediatric intraparenchymal meningioma.
- To emphasize the importance of considering meningiomas in the differential diagnosis of pediatric intra-axial lesions.
Main Methods:
- Case report of a 4-year-old male with incidental diagnosis of a brain tumor.
- Utilized MRI, spectroscopy, and perfusion imaging for initial assessment.
- Confirmed diagnosis via pathological and immunohistochemical analysis post-surgery.
Main Results:
- An expansive, heterogeneous lesion in the left lingual gyrus was identified.
- Initial imaging suggested a low-grade glioneuronal tumor.
- Post-operative analysis confirmed a fibrous meningioma (WHO grade 1).
Conclusions:
- Intraparenchymal meningiomas are rare and frequently misdiagnosed in children.
- These tumors may exhibit more aggressive behavior in pediatric patients compared to adults.
- Surgical intervention is often recommended for suspected pediatric intraparenchymal meningiomas.
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