INTERESTING IMAGE

Extracranial Meningioma-Pelvic Bone on FDG PET/CT: A Rare of

the Rarest Site
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Tarun Kumar Jain, MD,* Mansha Bohra, MBBS,* Anushree Punia, MD,†
Maneesh Kumar Vijay, MD,‡ and Hemant Malhotra, MD§
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Abstract: Meningiomas are benign extra-axial tumors of the central ner-
vous system. Extracranial meningiomas are extremely rare (2%) and can de-
velop as a direct extension from a primary intracranial meningioma or as a
true primary extracranial meningioma originating from ectopic arachnoid
cells. We report an extremely unusual case of a 61-year-old woman who
was diagnosed with pelvic meningioma with the help of PET/CT and
PET/CT-guided biopsy. The clinicopathological features of the patient and
immunoprofile of the tumor are presented.
Key Words: primary extracranial meningioma, 18F FDG PET/CT, PET/CT-
guided biopsy, pelvis
(Clin Nucl Med 2024;49: e158–e160)
Received for publication July 8, 2023; revision accepted December 7, 2023.
From the Departments of *Nuclear Medicine, †Radiation Oncology, ‡Histopa-
thology; and §Radiation Oncology, Mahatma Gandhi Medical College and
Hospital, Jaipur, Rajasthan, India.
Conflicts of interest and sources of funding: none declared.
Correspondence to: Tarun Kumar Jain, MD, Department of Nuclear Medicine,
Mahatma Gandhi Medical College & Hospital, Riico Institutional Area,
Sitapura, Tonk Rd, Jaipur, Rajasthan 302022. E-mail: tarun4891@gmail.com.
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 0363-9762/24/4904–e158
DOI: 10.1097/RLU.0000000000005080
ACKNOWLEDGMENT
The authors would like to thank all technologists of the PET/CT de-
partment for acquiring the data.
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 Clinical Nuclear Medicine • Volume 49, Number 4, April 2024 Pelvic Bone Meningioma
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FIGURE 1. A 61-year-old woman came with suddenly developed severe pain in her lower back and right gluteal region. Pain was
nonradiating in nature, and there was no history of trauma. CECT of the lower lumbar and pelvic region revealed lytic lesion
with soft tissue component in the right iliac bone, and initially, she was suspected with differentials of multiple myeloma,
plasmacytoma, soft tissue sarcoma, or a metastatic skeletal lesion. She underwent PET/CT for disease staging and
characterization. MIP image (A) reveals focal increased tracer uptake in the right hemipelvic region. Corresponding transaxial
(B and C) and coronal (D and E) PET/CT and CECT images revealed FDG-avid (SUVmax, 10.9) lytic lesion with relatively
homogenously enhancing soft tissue compartment involving the right iliac bone, right ala of sacrum, and right sacroiliac joint.
The right-sided gluteus medius muscle was found to be infiltrating by the lesion. F and G, Moreover, a few low-grade FDG-avid
pleural-based and parenchyma soft tissue density lung nodules were noticed in the bilateral lung fields (largest in the superior
segment of RUL [SUVmax, 1.7; ~1.0  1.0 cm]). H and I, In addition, there was a heterogeneous mildly FDG-avid
homogenously enhancing large meningeal base extra-axial soft tissue density mass (SUVmax, 8.0; ~4.5  4.4  6.5 cm) in the
right parietal cortex, and the rest of the body remains unremarkable.

FIGURE 2. A PET/CT-guided biopsy from the right iliac bone (A–D) was performed, and the specimen was submitted for
histopathological examination.

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FIGURE 3. Microscopic findings (A and B) identified a tumor in lobulated architecture, containing “meningothelial” whorls,
syncytial cells with indistinct cell membranes, and eosinophilic cytoplasm. The cells depicted round uniform nuclei and
intranuclear pseudo-inclusions. Accordingly, a panel of immunohistochemical stains (C–F) was performed including Vimentin,
EMA, PR, CK, CK-7, p63, SOX-10, and TLE-1. The staining with antibodies against Vimentin, EMA, and PR was positive, whereas
the others exhibited no reactivity. Considering the microscopic findings and immunostaining features together, the
histopathological diagnosis was a primary extracranial meningioma (PEM). Extracranial meningiomas are rare; the reported
incidence is 1%–2% of all meningiomas.1 Although intraosseous meningiomas have been documented, which are usually
confined to head and neck region.2,3 Our patient presented with right pelvic bone primary intraosseous meningioma.
The possible explanation of occurrence of PEM is growth of ectopic embryonic rests of arachnoid cells.4,5 The unusual
histopathological such as PEM of the pelvis organs and lymph node is well described in published literature,6,7 but our case was
completely different since the PEM was arising from the pelvic bone. So the present case is highlighting the abnormal rare
presentation of the tumor in the pelvis.

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