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Benign Meningioma With Rare Osteolytic Behavior

Homer, Natalie A. M.D.*; Huggins, Alison B. M.D.*; Durairaj, Vikram D. M.D., F.A.C.S.*,†

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Ophthalmic Plastic and Reconstructive Surgery: May/June 2020 - Volume 36 - Issue 3 - p e81
doi: 10.1097/IOP.0000000000001439
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A 62-year-old woman presented with an incidentally discovered osteolytic mass within the left greater wing of the sphenoid (Fig. B). The patient had intact visual acuity and full extraocular motility. The 9 × 13 × 7 mm3 mass extended into the extraconal inferolateral orbit and displaced the lateral rectus muscle, demonstrated on CT axial bone windows (Fig. A). A review of the patient’s CT imaging from 7 years prior showed interval expansion of previously unnoticed bony disruption (Fig. C). A lateral orbitotomy was performed and incisional biopsy revealed meningioma, WHO grade I (Fig. D). Further tumor resection was pursued via a craniotomy in conjunction with neurosurgery.

Fewer than 2% of all meningiomas are intraosseous, the majority of which display osteoblastic activity. Historical doctrine has suggested that meningioma-induced bony degradation infers malignant pathology. This case demonstrates rare osteolytic behavior of a histologically benign intraosseous meningioma.

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