new_n_lost
Politically InCorrect
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A 50-year-old woman presents with a 5-year history of headaches, generalized tonic-clonic seizures, and bilateral leg weakness. Skull films reveal hyperostosis of the calvarium. Biopsy of the responsible lesion shows a whorling pattern of the cells.
Which of the following is the most likely diagnosis?
A. Arachnoid cyst
B. Glioblastoma multiforme
C. Meningioma
D. Metastatic breast cancer
E. Oligodendroglioma
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| paheli
It'sAllAboutGoodKarma
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C, meningioma
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| SURVIVOR
Forum Junior
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C. A whorl anywhere (in the skull) is a meningioma, except the uterus maybe!  (leiomyoma)
P.S: Though meningioma comes from the meninges. The bone involvement is a rare feauture of the tumor!
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| PGI2alpha
Forum Elite
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C. meningioma for sure
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| new_n_lost
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paheli wrote:
C, meningioma
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| new_n_lost
Politically InCorrect
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The correct answer is C.
The most likely diagnosis is an intracranial meningioma. Meningiomas are slow-growing, benign tumors comprising 15% of intracranial tumors; they are most common in the elderly. They originate from either dura mater or arachnoid and are sharply demarcated from brain tissue. Meningiomas often incite an osteoblastic reaction in the overlying cranial bones. Microscopically, the meningioma cells have a tendency to encircle one another, forming whorls and psammoma bodies. Clinically, they present as mass lesions; seizures may occur. The superior parasagittal surface of the frontal lobes is a favorite site of origin. This can often produce leg weakness, since the leg motor fibers that pass down through the internal capsule originate in parasagittal cortical regions. Treatment of meningiomas is usually surgical.
Arachnoid cysts (choice A) are formed by splitting of the arachnoid membrane; most arachnoid cysts arise near the Sylvian fissure. They may present with mass effect, but would be unlikely to produce seizures, prominent focal signs, or reactive hyperostosis.
Glioblastoma multiforme (choice B) is an aggressive malignant astrocytoma that would likely have killed the patient long before 5 years had elapsed.
Metastatic breast cancer (choice D) would generally look different microscopically (the whorling cell pattern is characteristic of meningioma). It would be unlikely for metastatic cancer to cause a reaction in the overlying bone, or to be present long enough to cause symptoms for 5 years.
Oligodendrogliomas (choice E) are glial tumors that could produce the described clinical picture, but usually do not cause hyperostosis of the calvarium or exhibit the characteristic whorling cell pattern microscopically.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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