Malignant meningioma of the cerebellopontine angle in a 2-year-old girl: a case report and literature review
A 2-year-old girl with no significant medical history presented at our department in July 2006, describing a 4-month clinical history of droop of the right corner of the mouth and an inability to close the right eye normally and a 2-month history of aggravated headache. A physical examination at admission was abnormal: the right side of her face presented a distorted commissure and hypophasis. Computed tomography (CT) scan of the brain revealed an inordinate globate and defined slightly high-density lesion in the right cerebellopontine angle (). Magnetic resonance imaging (MRI) showed that the lesion had a slightly short T1 signal () and a long T2 signal (). Contrast-enhanced MRI revealed that the lesion had a conspicuous heterogeneous enhancement, with patchy un-enrichment in the lesion. The dural tail sign was visible and measured approximately 38.7 mm × 31.2 mm × 34.7 mm (). A meningioma was diagnosed before the histopathologic examination.\nResection with a right suboccipital retrosigmoid approach was performed. During the operation, the lesion was observed to arise from the meninges of the right cerebellopontine angle and have obscure boundaries. The lesion was grayish-red and tenacious, with copious blood supply. The tumor was completely removed and subjected to pathologic examination immediately.\nThe tumor tissue was processed and stained with hematoxylin & eosin (HE). The histopathologic examination demonstrated that the tumor was composed of cells with nuclear pleomorphism, prominent nucleoli, a high mitotic index, and a high nucleus/cytoplasm ratio. The mitoses occurred at a rate of approximately 15-20/10 hpf (highest possible frequency) (). Immunohistochemically, the tumor cells were positive for vimentin (), epithelial membrane antigen (EMA) (), and S-100 () and negative for Syn () and glial fibrillary acidic protein (GFAP), leading to a final diagnosis of malignant meningioma (WHO grade III).\nThe patient had no complications after the operation. After surgery, the patient was sent to the neurosurgery intensive care unit (NICU) for vital sign surveillance and neurologic observation. Head CT was performed and showed no residual lesion. Routine follow-up was performed and was scheduled at 1, 6, and 12 months and annually thereafter. The clinical and radiological findings were normal during a 6-year follow-up. No radiotherapy or chemotherapy was administered after surgery.