Fig. 4

An olfactory groove meningioma. a Preoperative image, MRI with contrast (axial) showed mass lesion occupied the frontal region. b MRI with contrast (sagittal) demonstrated mass lesion arising from the floor of the anterior cranial fossa. The tumor was surrounded by marked edema. Geriatric Scoring System (GSS) score = 12 C). Four years postoperative MRI with contrast, c axial and d sagittal views showed recurrence of the tumor with extension into the third ventricle. The patient family refused surgery. Geriatric Scoring System (GSS) score = 11. e Six year postoperative MRI with contrast. e Axial cut represented progressive large tumor widening and splaying the arteries of the circle of Willis and the cerebral peduncles. f Sagittal view revealed the tumor was abutting the optic chiasma and reached the anterior and inferior aspect of the 3rd ventricle. It sent a distal metastasis into the left frontal cortical region. The family again refuse the surgery, and the patient were at high risk with repeated convulsion, and totally blind. g The slide represented an atypical meningioma WHO grade II. At power 10× the slide showed hypercellular tumor tissue formed of whorls of pleomorphic meningothelial cells showing pleomorphic and moderately hyperchromatic nuclei with frequent mitotic figures