Introduction:

Meningiomas are the most common benign intracranial neoplasm which are encountered in clinical practice. Intradiploic meningioma is a rare subset of meningiomas, which can present as osteoblastic, osteolytic or mixed calvarial lesion. Aggressive lesions tend to involve soft tissue and are osteolytic in nature. The presented case allows us to review its diagnostic approach and emphasize the importance of the doctor-patient relationship when facing a patient who presents himself with an unusual medical condition.

Case report:

A 58-year-old Caucasian female, with an irrelevant medical history, attended the open consultation referring a hollow head sensation and pain in a specific scalp point for two months. She denied any neurological complaints or history of trauma. During examination, palpation showed a soft and tender area of about 1 cm located in the right parieto-occipital region, without skin lesions. The neurological examination showed no abnormalities. In the plain X-ray skull film, a hyper-transparent image was observed in the right paramedian aspect of the occipital region. To further study the lesion, a CT scan was requested, which showed a lytic lesion, with complete erosions of both tables of the skull, and a small epidural soft tissue component. The patient was referred for secondary health care where the evaluation was complemented with a brain MRI, which confirmed the lesion in the mentioned topography. The patient underwent craniotomy for tumor excision and cranioplasty, and the postoperative period was uneventful.

Comments:

These lesions are usually asymptomatic but may cause neurological symptoms depending on their location, type of growth and local aggressiveness. The diagnostic delay is between one day and 40 years. This case highlights the importance of the family doctor in the early diagnosis of uncommon medical conditions, which may present with nonspecific symptoms and may compromise patients’ quality of life.

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