Microcystic meningioma presenting as a cystic lesion with an enhancing mural nodule in elderly women: report of three cases

Cystic meningioma with an enhancing mural nodule is uncommon and can present as a radiologic and clinical dilemma with wide differential. We report a series of rare and unique presentation of microcystic meningioma in three elderly women aged 76 (case 1), 72 (case 2), and 76 (case 3) years, respectively. The first patient presented with a 3-year history of vertigo and past history of carotid artery stenosis, hypertension, and hypothyroidism. The second patient presented with headache and an acute episode of weakness in her legs. The third patient presented with headache, vomiting, and confusion. Magnetic resonance imaging for these three cases showed a cystic lesion with an enhancing mural nodule in the right frontal lobe. The preoperative differential diagnoses included hemangioblastoma and well-circumscribed gliomas for the first two cases. Glioblastoma and metastatic tumor were the working diagnoses for the third case because of vasogenic brain edema and marked mass effect. The final pathological diagnosis was microcystic meningioma for all three cases. Case reports are mainly of fibrous or meningothelial meningiomas with cystic formation. Male predominance and young age are most commonly reported. Our series is unique because of the rare and unusual clinical-radiologic presentation of microcystic meningioma in elderly women.