CT features of primary pleural gritty meningioma: A case report and review of the literature

Our plain-English summary of CT features of primary pleural gritty meningioma: A case report and review of the literature, by X. Qin, C. Zeng, M. Wei, et al (Acta Radiologica Open, 2023).

The study

• Authors: X. Qin, C. Zeng, M. Wei, X. Li, D. Qiu
• Journal: Acta Radiologica Open
• Published: 2023;12(5):20584601231174459
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Primary ectopic meningiomas, although widely reported in multiple sites of the body, are particularly rare in the pleura. Here, we report a 35-year-old asymptomatic woman who was found to have a large mass in the right pleural area on physical examination chest radiography. Chest CT scan showed a large irregular mass from the right second anterior costal pleura to the right supradiaphragm, in which calcified plaques of varying sizes were widely and heterogeneously distributed. The mass was connected to the pleura (anterior rib pleura, mediastinal pleura, diaphragmatic pleura) in a wide base, with oblique "Z" changes in the coronal view. After the contrast agent injection, the mass exhibited mild enhancement on both arterial and venous phase scans. Furthermore, a linear enhancement that was indicative of "pleural tail sign" changes in the pleura adjacent to the mass was observed. The disease was preoperatively misdiagnosed as malignant pleural mesothelioma, and the postoperative pathological diagnosis was right pleural meningioma (gritty type). Therefore, we carefully analyzed its imaging features and differential diagnosis by consulting relevant literature.

© The Author(s) 2023.

In plain English

This article was a case report with a short review of the literature. It described a 35-year-old woman without symptoms whose chest X-ray showed a mass in the right chest. A CT scan showed a large, irregular mass, about 9.8 cm by 5.9 cm at its largest slice. The mass was attached broadly to the pleura (the lining of the chest), contained many calcified areas of different sizes, and was not accompanied by fluid in the chest. Before surgery, the CT was read as malignant mesothelioma of the right pleura. The mass, about 10.0 cm by 6.0 cm, was removed, and tissue tests showed a pleural meningioma of the gritty type, which the authors described as typically benign. The article did not report any asbestos exposure for the patient. In the discussion, the authors cited other literature linking calcified plaques in mesothelioma to asbestos contact. They noted that the calcifications in this case were spread unevenly through the tumor instead. The patient showed no recurrence at the 4-month follow-up. The authors concluded that knowing this tumor's imaging and pathology features helps diagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report with a review of the literature
• Who was studied: One 35-year-old woman without symptoms whose chest X-ray showed a right thoracic mass; the article does not state where or when she was treated (the authors are from radiology departments in Chongqing, China)
• Exposure: No exposure was studied. The article reports no asbestos or other occupational exposure history for the patient and states only that her past history showed no abnormalities.
• Main results:
  • CT showed a large irregular mass in the right pleural area, about 9.8 cm by 5.9 cm at its largest slice, with uneven density and extensive calcifications of different sizes
  • After contrast injection, the mass enhanced slightly, with linear enhancement of the adjacent pleura described as a "pleural tail sign"; no fluid was seen in the chest cavity
  • Before surgery, the CT was diagnosed as malignant mesothelioma of the right pleura
  • At surgery, the tumor measured about 10.0 cm by 6.0 cm and was closely associated with the chest wall and diaphragm
  • The pathological diagnosis was right pleural meningioma (gritty type). The tumor was positive for EMA, Ki67 was less than 5%, and CD34 was scattered positive.
  • The patient recovered well. At the 4-month follow-up, imaging showed no tumor recurrence or distant metastasis.
  • In the discussion, the authors cited literature that mesothelioma with calcified plaques is mostly associated with asbestos contact, with plaques on the pleural surface. They contrasted this with the widely and unevenly distributed calcified plaques within this tumor.
• The authors' conclusion: The authors concluded that primary ectopic meningioma is rare, lacks specific clinical signs and is hard to diagnose on imaging. They stated that knowing its imaging features and pathological changes helps with diagnosis and with distinguishing it from other diseases.
• Limitations the authors state:
  • No MRI scan was done on the patient, which the authors said could have provided additional information

Topics

Medical terms in this study, explained in our Lexicon: Pleura, CT Scan, Pleural Mesothelioma, Differential Diagnosis.

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