Meningioma differential diagnosis
1. multiple meningiomas: 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. Gliosarcomas, 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.
The differential for dural lesions is extensive and includes 1):
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 2).
Inflammatory pseudotumors
Plasma cell granulomas
Castleman disease
Xanthomas
Rheumatoid nodules
In the setting of hyperostosis consider:
Sclerotic metastases (e.g. prostate and breast carcinoma)
Specific location differentials include: