EXPERIMENTAL AND THERAPEUTIC MEDICINE 7: 1393-1395, 2014

Abstract. Cystic meningioma is an uncommon menin-

gioma variant that is often difficult to distinguish from
other intra-axial tumors, including necrotic gliomas. Cystic
meningiomas located in the ventricle are particularly rare
and may be misdiagnosed with other brain tumors, including
ependymoma, choroid plexus papilloma and neurocytoma,
due to its location. The present study discusses two cases of
lateral ventricular meningiomas, which exhibited intratumoral
or peritumoral cystic changes on magnetic resonance imaging
scans. The two patients underwent surgical treatment and
histological examination confrmed one case of metaplastic
meningioma and the other case of psammomatous menin-
gioma. The two patients were middle-aged females and had
been misdiagnosed prior to surgery. Although this clinical
entity is rare, the diagnosis of meningioma should be consid-
ered, particularly in middle-aged female patients.
Introduction
Intraventricular meningiomas are rare tumors that account
for 0.5-3% of all intracranial meningiomas (1), however, they
remain one of the most challenging problems in neurosurgery.
Among meningiomas of the central nervous system (CNS),
cystic meningiomas are a distinct histological variant of
meningiomas accounting for ~1.6% of all CNS meningiomas.
Thus, cystic meningiomas located in the ventricle are particu-
larly rare and may be misdiagnosed along with other brain
tumors, including ependymoma, choroid plexus papilloma and
neurocytoma. The present study discusses two cases of lateral
ventricular meningiomas that exhibited intratumoral or peritu-
moral cystic changes with magnetic resonance imaging (MRI).
The two cases were misdiagnosed prior to surgery. Written
informed patient consent was obtained from the 2 patients.
The aim of the present study was to provide additional data for
this rare meningioma variant.
Case reports
Case 1
Patient history. A 48-year-old female presented with
a chronic headache and vertigo that had persisted over
a period of 2 months, but had progressively wors-
ened in the last 10 days. Neurological examination,
laboratory tests and other systemic evaluations (i.e., surgical
and medical examination of the whole body) revealed no
abnormalities, with the exception of hypertension.
Examination. MRI scans revealed a 4.5x5.0x4.0 cm
heterogeneously irregular mass located in the trigone of the
right lateral ventricle. An intratumoral cystic change was
also observed. The tumoral parenchyma was hyperintense
on T2-weighted images (WIs) and fluid attenuated inver-
sion-recovery images, while appearing iso- to hypointense
on T1WIs (Fig. 1AE). Patchy calcifcation, which appeared
hypointense in every sequence, was also observed in the
marginal area of the tumor. Contrast enhanced MRI revealed
mild enhancement in the tumoral parenchyma. The inferior and
posterior horn of the right lateral ventricle revealed moderate
obstructive hydrocephalus. Based on previous manifestations,
the tumor was diagnosed as an ependyma or a choroid plexus
papilloma prior to surgery.
Treatment. Surgery via temporal-occipital craniotomy
revealed that the tumor was an ivory-colored hard mass which
was well-circumscribed in the right trigone of the lateral
ventricle. Evident calcifcation was observed without a visible
blood supply. Pathological examination confrmed the mass
to be a metaplastic meningioma [World Health Organization
(WHO) grade I; Fig. 1F].
Case 2
Patient history. A 43-year-old female presented with a persis-
tent headache and blurred vision which has lasted for longer
than one month. Neurological examination revealed papilla
edematous and increased intracranial pressure.
Examination. MRI scans revealed a heterogeneously
cystic-solid mass of 4.8x5.0x5.5 cm in the right lateral ventricle.
The solid area of the tumor exhibited an iso- to hypointense
signal on T2WIs and an isointense signal on T1WIs and diffu-
sion weighted imaging. On an apparent diffusion coeffcient
map, the parenchyma of the tumor exhibited an isointense
Lateral ventricular cystic meningioma: 2 rare case reports
LI-HUA QIU
1,2
, SU LUI
1
, LING ZOU
1
, QIANG YUE
1
and QI-YONG GONG
1
1
Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu,
Sichuan 610041;
2
Department of Radiology, The Second People's Hospital of Yibin, Yibin, Sichuan 644000, P.R. China
Received October 31, 2013; Accepted February 10, 2014
DOI: 10.3892/etm.2014.1550
Correspondence to: Professor Qi-Yong Gong, Huaxi MR Research
Center, Department of Radiology, West China Hospital of Sichuan
University, 37 Guoxue Street, Chengdu, Sichuan 610041, P.R. China
E-mail: qiyonggong@hmrrc.org.cn
Key words: cystic meningioma, intraventricular meningioma,
magnetic resonance imaging, diagnosis
QIU et al: LATERAL VENTRICULAR CYSTIC MENINGIOMA
1394
signal. Overt enhancement was observed on T1-weighted
post-gadolinium contrast images in the solid area instead of
the cystic component (Fig. 2A-E). The tumor was diagnosed as
an ependymoma or a neurocytoma prior to surgery.
Treatment. Surgery via a right temporoparietal craniotomy
revealed that the tumor was a welldefned, yellowish in color,
intact and encapsulated mass that adhered slightly to the
walls of the lateral ventricle and the septum pellucidum. The
Figure 1. MRI scans revealed a 4.5x5.0x4.0 cm heterogeneously irregular mass in the trigone of the right lateral ventricle with slight peritumoral edema.
(AC) Noncontrastenhanced MRI scans revealed that the solid portion of the tumor was hyperintense on T2WIs and T2fuid attenuated inversion recovery
images and hypointense on T1WIs. The cystic portion of the central tumor was hypointense on T1WIs and hyperintense on T2WIs. (D and E) Contrast-enhanced
T1WIs revealed mild enhancement of the tumoral parenchyma following the injection of a contrast medium. Patchy calcifcation, which was revealed as
hypointense in every sequence, was exhibited in the lateral marginal section of the tumor and scattered punctate calcifcation was also located within the solid
area. (F) Microscopic examination of the resected tumor revealed that the left side was meningothelial cells and the right side was osseous tissue (hematoxylin
and eosin staining; magnifcation, x200). MRI, magnetic resonance imaging; WIs, weighted images.
Figure 2. MRI scans revealed a heterogeneously cystic-solid mass with a size of 4.8x5.0x5.5 cm in the right lateral ventricle without peritumoral edema.
(A-D) Noncontrast-enhanced MRI scans revealed that the solid area of the tumor was isointense on T1WIs, diffusion WIs and on an apparent diffusion
coeffcient map, and iso to hypointense on T2WIs. (E) The tumoral parenchyma and septum demonstrated evident enhancement following the injection of
gadolinium contrast media. (F) Pathological examination revealed excessive psammoma body formation (hematoxylin and eosin staining; magnifcation,
x400). MRI, magnetic resonance imaging; WIs, weighted images.
A
D
B C
E F
A
D
B C
E F
EXPERIMENTAL AND THERAPEUTIC MEDICINE 7: 1393-1395, 2014
1395
marginal area of the tumor was cystic and the root originated
from the choroid plexus. Pathological examination confrmed
the mass to be a psammomatous meningioma (WHO grade I;
Fig. 2F).
Discussion
Meningiomas are the most common extra-axial neoplasm with
the general characteristic imaging appearance of isointense
or hypointense on T1WIs and isointense or hyperintense on
T2WIs, exhibiting marked homogeneous contrast enhance-
ment. Lateral ventricular and cystic meningiomas are rare
meningioma variants (1). To the best of our knowledge, cystic
changes in intraventricular meningiomas have not previously
been reported in adult patients.
Cystic meningioma, used to describe meningiomas with
intratumoral or peritumoral cysts, are uncommon and account
for 2-4% of all intracranial meningiomas (2). Rengachary et al
classified cystic meningiomas as intratumoral or extratu-
moral (3). Pathophysiological mechanisms of peritumoral
cysts may be caused by loculated widened subarachnoid
space, edema of the surrounding brain, demyelination or
hemorrhaging near the tumor, while intratumoral cysts are the
outcome of cystic degeneration, ischemic necrosis or hemor-
rhaging within the tumor. Cystic meningioma may often be
misdiagnosed as other neoplasms, including gliomas or meta-
static tumors, on preoperative MRI (4). However, due to the
specifc lesion location (the lateral ventricle), the tumors in the
present study were misdiagnosed as ependymomas, choroid
plexus papillomas or neurocytomas, which are the most
common tumor types to appear with cysts and calcifcations in
the ventricular system.
Although differential diagnosis is difficult to separate
cystic meningiomas from common tumors in the ventricular
system, specifc signs may aid differentiation. The majority
of supratentorial ependymomas (70%) arise within the brain
parenchyma of the cerebral hemispheres rather than from the
ependymal cells lining the ventricular surfaces (5). In addi-
tion, neurocytomas tend to occur in younger patients and are
located at the foramen of Monro and the roof of the lateral
ventricle. Intraventricular choroid plexus papillomas are more
common in childhood with occasional calcifcation of punc-
tate foci in lesions. However, meningiomas are most common
in adult females (6).
Notably, the current two cases had histologically different
subtypes, which may be associated with their various MRI
manifestations. Case 1 is a metaplastic meningioma, char-
acterized by mesenchymal elements, including osseous,
cartilaginous and myxoid tissue, which may lead to calcifca-
tion or ossifcation and cystic formation as exhibited in the
MRI scans. A previous case report (7) regarding a metaplastic
meningioma in a child also revealed similar MRI features; for
example, the meningioma was located in the lateral ventricle
and cystic changes were observed within the tumor. By contrast,
case 2 is of a psammomatous meningioma, which is mainly
composed of hyalin and calcifes to form the characteristic
concentric calcifcations known as psammoma bodies, thus,
is shown as a densely calcifed mass on MRI and CT scans.
The cystic-solid feature of psammomatous meningioma has
not been reported previously. Thus, we hypothesized that the
cystic change in this case may be associated with the penetra-
tion of cerebrospinal fuid around the tumor, which leads to
the multiple cystic changes within the tumor. Metaplastic and
psammomatous meningiomas are classifed as WHO grade 1
with a low risk of recurrence and aggressive growth. Total
tumor resectioning is important to reduce the risk of recur-
rence. The two patients were completely recovered without
positive neurological symptoms and signs of recurrence at
one year follow-up.
In conclusion, to the best of our knowledge, this is the
frst case report of cystic meningioma localized in the lateral
ventricle in adult females. Although cystic meningioma
located in the lateral ventricle is rare, this clinical entity should
be included in the differential diagnosis of neoplasms in the
lateral ventricle, particularly in adult female patients.
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