• Xiaoqin Qu, Jingcheng Jiang, Han Wang, Chao Zhang, Qingshan Deng, Xiaoping Xu, Shijun Zhou, Yong Yi, and Lihua Qiu.
• Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
• Medicine (Baltimore). 2023 Mar 31; 102 (13): e33409e33409.

RationaleMeningiomas are mostly benign brain tumors with minimal malignant cases. Anaplastic meningioma has malignant morphological characteristics and a World Health Organization grade of III.Patient ConcernsThe present study reports a case of an occipital meningioma in a patient who initially chose observation and follow-up after diagnosis. The patient ultimately underwent surgery due to the enlargement of the tumor and the development of visual field defects after a decade of imaging follow-up. The postoperative pathology slides indicated the presence of an anaplastic meningioma (World Health Organization-grade III).DiagnosesThe patient's diagnosis was established through cranial magnetic resonance imaging, which revealed an irregular mixed mass in the right occipital region with isointense T1 and hypointense T2 signal, irregular lobulation, and a maximum diameter of approximately 5.4 cm. Heterogenous enhancement was observed in the contrast-enhanced scan.InterventionsThe patient opted for surgical intervention to remove the tumor, and the pathology slides of the tumor sample confirmed the diagnosis of anaplastic meningioma. The patient also received radiotherapy (40Gy/15fr).OutcomesNo recurrence was observed during the 9-month follow-up.LessonsThis case highlights the potential for low-grade meningiomas to undergo malignant transformation, particularly in the presence of irregular lobulation, peritumoral brain edema, and heterogeneous enhancement on contrast-enhanced scans. Total excision (Simpson grade I) is the preferred treatment option, and long-term imaging follow-up is recommended.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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