Primary extracranial meningioma of the pelvis discovered on screening pelvic examination

Abstract

Many conditions that affect a woman's health can be evaluated through the pelvic examination. Early detection and treatment of a range of gynaecologic and non-gynaecological conditions, including unusual pelvic masses, may decrease a woman's morbidity and mortality. Here, we have a female patient in her early 20s who was found to have a mass on her first screening pelvic examination. Subsequent imaging followed by surgical resection were performed with the final diagnosis of a pelvic meningioma. Routine pelvic examinations in asymptomatic women may be more useful than merely screening for cervical cancer and sexually transmitted infections. Once detected, the differential diagnosis of a pelvic mass may include aetiologies outside of the gynaecological organ system.

Keywords: Healthcare improvement and patient safety; Neurosurgery; Obstetrics and gynaecology; Pathology; Radiology.

Figure 1

Pelvic ultrasound was notable for considerable gas in the colon of the right lower quadrant. There was significant shadowing from the pelvic mass.

Figure 2

MRI (axial T1 postcontrast image with fat suppression).

Figure 3

MRI (T2-weighted coronal image).

Figure 4

Intraoperative picture from midline incision on lower abdomen showing retroperitoneal firm mass.

Figure 5

Pelvic mass after excision.

Figure 6

Tumour prior to removal.

Figure 7

10× view demonstrating psammoma bodies (arrows).

Figure 8

4× view demonstrating highly calcified tumour (arrows indicating calcifications).

Figure 9

4× view, positive S-100 staining (red arrow), significant calcifications present (blue arrow).