Left spheno-orbital en plaque meningioma revealed by progressive exophthalmos: imaging features and a compartment-based approach to spheno-orbital hyperostosis
- 1Corresponding author.
- 2Department of Radiology, Mohammed V Military Teaching Hospital (HMIMV), Rabat, Morocco
Abstract
En plaque meningioma is an uncommon variant of meningioma (2–9% of cases), defined by a thin carpet-like sheet of tumor spreading along the dura together with bone hyperostosis that is disproportionate to the intradural component. The spheno-orbital region is the site of election, and because the dominant abnormality on imaging is a sclerotic bone lesion rather than a mass, the diagnosis is frequently delayed or mistaken for fibrous dysplasia. We report the case of a 75-year-old woman with no history of malignancy, cranio-orbital trauma, or infection, who presented with slowly progressive left orbital swelling, unilateral exophthalmos, and ipsilateral visual loss. Magnetic resonance imaging showed a left spheno-orbital lesion with broad-based dural thickening, isointense to cortex on T1-weighted images, iso- to slightly hyperintense on T2/FLAIR, with intense and relatively homogeneous enhancement after gadolinium, exerting mass effect on the orbital contents without adjacent parenchymal signal abnormality. Computed tomography demonstrated marked hyperostosis along the left greater sphenoid wing with mild narrowing of the ipsilateral optic canal. The association of a broad-based enhancing dural sheet with disproportionate hyperostosis was highly suggestive of an en plaque meningioma of dural origin. Histopathologic examination of the resected specimen confirmed a meningothelial meningioma, CNS WHO grade 1, with bone invasion. This case illustrates a compartment-based reading of spheno-orbital hyperostosis (orbital, osseous, or meningeal) and the value of imaging–pathology correlation: bone invasion was histologically confirmed in this patient, although meningioma-associated hyperostosis does not necessarily reflect direct neoplastic invasion in every case.
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BibTeX
@article{nouhababbar2026left,
title = {{Left spheno-orbital en plaque meningioma revealed by progressive exophthalmos: imaging features and a compartment-based approach to spheno-orbital hyperostosis}},
author = {Nouha Babbar, MD and Meryem Edderai, PhD and Ouijdane Zamani, PhD and Hassan En-Nouali, PhD and Rachida Saouab, PhD and Jamal El Fenni, PhD and Meriem Boui, PhD},
journal = {Radiology Case Reports},
year = {2026},
month = oct,
doi = {10.1016/j.radcr.2026.10.015},
url = {https://doi.org/10.1016/j.radcr.2026.10.015},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Left spheno-orbital en plaque meningioma revealed by progressive exophthalmos: imaging features and a compartment-based approach to spheno-orbital hyperostosis
AU - Nouha Babbar, MD
AU - Meryem Edderai, PhD
AU - Ouijdane Zamani, PhD
AU - Hassan En-Nouali, PhD
AU - Rachida Saouab, PhD
AU - Jamal El Fenni, PhD
AU - Meriem Boui, PhD
PY - 2026
DA - 2026/10/24
JO - Radiology Case Reports
DO - 10.1016/j.radcr.2026.10.015
UR - https://doi.org/10.1016/j.radcr.2026.10.015
AB - En plaque meningioma is an uncommon variant of meningioma (2–9% of cases), defined by a thin carpet-like sheet of tumor spreading along the dura together with bone hyperostosis that is disproportionate to the intradural component. The spheno-orbital region is the site of election, and because the dominant abnormality on imaging is a sclerotic bone lesion rather than a mass, the diagnosis is frequently delayed or mistaken for fibrous dysplasia. We report the case of a 75-year-old woman with no history of malignancy, cranio-orbital trauma, or infection, who presented with slowly progressive left orbital swelling, unilateral exophthalmos, and ipsilateral visual loss. Magnetic resonance imaging showed a left spheno-orbital lesion with broad-based dural thickening, isointense to cortex on T1-weighted images, iso- to slightly hyperintense on T2/FLAIR, with intense and relatively homogeneous enhancement after gadolinium, exerting mass effect on the orbital contents without adjacent parenchymal signal abnormality. Computed tomography demonstrated marked hyperostosis along the left greater sphenoid wing with mild narrowing of the ipsilateral optic canal. The association of a broad-based enhancing dural sheet with disproportionate hyperostosis was highly suggestive of an en plaque meningioma of dural origin. Histopathologic examination of the resected specimen confirmed a meningothelial meningioma, CNS WHO grade 1, with bone invasion. This case illustrates a compartment-based reading of spheno-orbital hyperostosis (orbital, osseous, or meningeal) and the value of imaging–pathology correlation: bone invasion was histologically confirmed in this patient, although meningioma-associated hyperostosis does not necessarily reflect direct neoplastic invasion in every case.
SN - 1930-0433
ER -