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Intraosseous Meningioma Masquerading as Fibrous Dysplasia

Solomon S Shaftel, Ramzi M Alameddine, Sang-Rog Oh, Bobby S Korn, Jonathan H Lin and Don O Kikkawa

Background: Intraosseous meningiomas often display clinical and radiologic features that can be confused for fibrous dysplasia. Histopathology usually confirms the diagnosis. We present a case initially misdiagnosed as fibrous dysplasia by histopathology.
Methods: A 58-year-old male presented with worsening proptosis and vision loss. He was previously diagnosed with fibrous dysplasia at an outside institution, with histologic confirmation of the diagnosis during orbital decompression.
Results: On examination there was evidence of optic neuropathy and mild restriction of gaze. Imaging revealed a large ossified mass of the greater sphenoid wing. Craniotomy and surgical decompression resulted in improved vision and symptoms. Histopathology revealed meningioma with bony and dural components.
Conclusions: This case emphasizes the need for a high level of suspicion and representative biopsies to reach prompt diagnosis of meningiomas in cases of recurrent or atypical fibrous dysplasia