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Surg Neurol IntSurg Neurol IntSNISurgical Neurology International2229-50972152-7806Medknow Publications & Media Pvt Ltd India SNI-9-14910.4103/sni.sni_68_18Unique Case Observations: Image ReportIntraventricular metastasis mimicking meningioma Singh Saraj K. dr.sarajkumarsingh@gmail.com*Agarwal Himanshu 1himanshu.20rd@gmail.comSingh Prakash prakash.singha@maxhealthcare.comGoel Khushbu 2Khushbugoel@yahoo.comDepartment of Neurosurgery, Max Super Speciality Hospital, Saket, New Delhi, India1 Department of Neurointervention, Max Super Speciality Hospital, Saket, New Delhi, India2 Department of Neurology, Max Super Speciality Hospital, Saket, New Delhi, India* Corresponding author
2018 26 7 2018 9 14902 3 2018 12 6 2018 Copyright: © 2018 Surgical Neurology International2018This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
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A 69-year-old male patient presented with multiple episodes of fall for 6 months. Magnetic resonance imaging of the brain showed T1 isointensity, T2 hyperintensity, and homogenous enhancement on contrast [Figure 1a–f]. Intraoperatively, the tumor was completely intraventricular without any attachment to the surrounding thalamus or tela choroidea. This unique case was managed as (according to history and imaging) meningioma, but biopsy came out as metastatic deposit of squamous cell carcinoma from the lung [Figure 2a–d].

Figure 1 (a-c) Contrast-enhanced brain MRI (axial, coronal and sagittal sequences, respectively) showing homogenously enhancing lesion at the posterior third ventricular region. (d) Axial T2 brain MRI sequence showing hyperintense mass attached to tela choroidea. (e) FLAIR sequence of brain MRI showing hyperintense lesion. (f) DWI sequence of brain MRI showing diffusion restriction in the lesion

Figure 2 (a) Microphotograph showing tumor cell population (H and E, ×100). (b-d) High-power view (H and E, ×400) of the carcinoma cells with focal keratinization

Intraventricular metastasis presents with various aspects of enhancement (uniform, punctate, ring) which can often lead to misdiagnosis of meningioma.[12] This case is educational for both neurosurgeons and radiologist as missing proper diagnosis can affect both the management and outcome of patients.

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Conflicts of interest
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http://surgicalneurologyint.com/Intraventricular-metastasis-mimicking-meningioma/
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REFERENCES
1 Tagle P  Villanueva P  Torrealba G  Huete I   Intracranial metastasis or meningioma?. An uncommon clinical diagnostic dilemma Surg Neurol 2002 58 241 5 12480230 
2 Brant WE  Helms CA   Fundamentals of diagnostic radiology 2007 3rd ed Philadelphia Lippincott Williams & Wilkins 143