Meningioma differential diagnosis [Neurosurgery Wiki]

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====== Meningioma differential diagnosis ======

{{ ::meningioma.png?200|}}

1. [[multiple meningioma]]s: suggests [[neurofibromatosis type 2]] ([[NF2]]).

2. [[pleomorphic xanthoastrocytoma]] (PXA): may mimic meningiomas since they tend to be
peripherally located and may have a dural tail

3. [[Gliosarcoma]]s, especially ones that are predominantly carcinomatous

4. [[Rosai-Dorfman disease]]: especially if extracranial lesions are also identified. A connective tissue
disorder with sinus histiocytosis and massive painless lymphadenopathy (most have cervical lymphadenopathy). Usually in young adults. Isolated intracranial involvement is rare. MRI: dural- based enhancing mass with signal characteristics similar to meningioma, may have a dural tail. Most common intracranial locations: cerebral convexities, parasagittal, suprasellar, cavernous sinus. Pathology: dense fibro collagenous connective tissue with spindle cells and lymphocytic infiltration, stains for CD68 & S-100. Histiocytic proliferation without malignancy. Foamy histiocytes are characteristic. Surgery and immunosuppressive therapy not effective. Low-dose XRT may be the best option.

see also [[Parasagittal Meningioma Differential Diagnosis]].
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The differential for dural lesions is extensive and includes
((Johnson MD, Powell SZ, Boyer PJ, Weil RJ, Moots PL: Dural
lesions mimicking meningiomas. Hum Pathol 33:1211–1226,
2002)):

[[Dural metastases]] (e.g. breast cancer)

[[Solitary fibrous tumor]]/[[hemangiopericytoma]] (SFT/HPC) and meningioma exhibit similar radiographic features, however, they differ in their prognoses. Preoperative differentiation between them is important for determining the treatment and follow-up plan.

Age and [[myo-inositol]] level calculated from [[MRS]] are useful factors for distinguishing SFT/HPC from meningioma preoperatively
((Ohba S, Murayama K, Nishiyama Y, Adachi K, Yamada S, Abe M, Hasegawa M, Hirose
Y. Clinical and radiographic features for differentiating solitary fibrous
tumor/hemangiopericytoma from meningioma. World Neurosurg. 2019 Jun 21. pii:
S1878-8750(19)31646-8. doi: 10.1016/j.wneu.2019.06.094. [Epub ahead of print]
PubMed PMID: 31233926.
)).
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[[Leiomyosarcoma]]s

[[Melanocytoma]]s

[[Hodgkin lymphoma]]

[[Plasmacytoma]]s

Inflammatory pseudotumors

[[Neurosarcoidosis]]

Plasma cell granulomas

Castleman disease

Xanthomas

Rheumatoid nodules

[[Tuberculoma]]s
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In the setting of hyperostosis consider:

[[Paget's disease]]

[[Fibrous dysplasia]]

Sclerotic metastases (e.g. prostate and breast carcinoma)
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Specific location differentials include:

[[Cerebellopontine angle]]

[[Vestibular schwannoma]]

===== Pituitary region: =====

[[Pituitary macroadenoma]].

[[Craniopharyngioma]].

===== Base of the skull =====

[[Hypertrophic pachymeningitis]].

[[Extramedullary hematopoiesis]].

[[Chondrosarcoma]].

[[Chordoma]].

===== References =====