An unexpected diagnosis of malignant supratentorial intraparenchymal cystic meningioma mimicking high-grade glioma: case report and literature review

Meningiomas are generally dura-based extra axial tumours without cystic components, whereas high-grade gliomas are intra-axial with or without cystic component. This case describes an adult female who presented with clinical and radiological features suggestive of a high-grade astrocytoma; however, histology diagnosis was papillary meningioma (World Health Organization Grade III). A 58-year-old female presented with a 4-month history of recurrent generalized tonic–clonic seizures and a 1-week history of altered sensorium. Her Glasgow Coma Scale Score was 10. Magnetic resonance image revealed a large intra-axial heterogeneous solid mass with multiple cystic areas in the right parietal lobe. She subsequently had craniotomy and tumour excision and the histologic diagnosis was papillary meningioma (WHO Grade III). Rarely, meningioma can present as an intra-axial tumour and may mimic other lesions like high-grade astrocytoma.