Differentials
Dural metastasis
SIGNS / SYMPTOMS
History of previous cancer (especially breast, lung, and prostate).
INVESTIGATIONS
Biopsy would reveal histologic evidence of metastatic tumor.
In patients with a cancer history and newly diagnosed possible meningioma, short-interval imaging is useful to differentiate typically slow-growing meningiomas from faster-growing cancer.
Granuloma
SIGNS / SYMPTOMS
Possible systemic symptoms consistent with sarcoid or tuberculosis.
INVESTIGATIONS
Chest x-ray and serum biochemistries often abnormal.
IgG4-related disease
SIGNS / SYMPTOMS
Can look identical and present like meningioma on imaging. Lymphadenopathy is common (not expected with meningioma). May also have other organ/non-central nervous system involvement or hypophysitis.
INVESTIGATIONS
Biopsy is the definitive differentiating test. Other noninvasive test results include elevated serum IgG4 levels, detection of relevant serum IgG subclasses, and abnormal serum complement levels.
Pituitary adenoma (in appropriate parasellar location)
SIGNS / SYMPTOMS
Possible hypersecretory symptoms of pituitary tumor.
INVESTIGATIONS
Hormonal studies, such as prolactin, growth hormone, cortisol, thyroid function tests, and gonadotropins, may indicate hyper- or hypo-secretion. CT scan may show thinning of bone (and no hyperostosis) along tuberculum/sella/planum.
Unlike meningiomas, pituitary tumors do not cause hyperostosis of underlying bone and do not typically narrow the carotid arteries in the cavernous sinus.
Schwannoma (especially in spine or at skull base)
SIGNS / SYMPTOMS
Possible radicular neurologic deficit or cranial nerve deficit.
Schwannomas typically arise from the cranial nerves and erode and scallop the adjacent bone (especially trigeminal schwannoma), while meningiomas can cause hyperostosis. Unlike meningiomas, schwannomas typically do not have a broad dural base.
INVESTIGATIONS
Biopsy would reveal characteristic Antoni A and Antoni B histologic features.
Central nervous system (CNS) lymphoma
SIGNS / SYMPTOMS
None.
INVESTIGATIONS
Bone marrow biopsy; may be negative if primary CNS lymphoma.
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