ID #127 Childhood onset jugular foramen meningioma mimicking tonsillar mass a case report
Oranooj Lertkovit, Nuengjit Rojanawatsirivej, Kan Radeesri, Kitiporn SriamornrattanakulAbstract
Background
Meningiomas are rare in childhood, representing less than 5% of pediatric central nervous system (CNS) tumors. While these tumors commonly arise in intracranial or spinal sites, jugular foramen meningiomas are exceedingly rare, with limited cases reported in pediatric population. This paucity of data makes clinical presentation, diagnosis, and management particularly challenging in this age group. We present a case of childhood-onset jugular foramen meningioma with an unusual oropharyngeal presentation mimicking a tonsillar mass.
Methods
Case report, Retrospective chart review
Results
A 12-year-old Thai boy presented with fever and right tonsillar and oropharyngeal bulging. MRI revealed a large lobulated heterogeneous lesion with vivid contrast enhancement originating from the right jugular foramen, with both intracranial and extracranial components. The mass extended into the cerebellopontine angle and parapharyngeal space, encasing the right internal carotid artery and obliterating the internal jugular vein. Audiometry demonstrated severe mixed hearing loss of the right side. During five months of follow-up, the mass showed significant interval enlargement with progressive involvement of right lower cranial nerves including CN VII, VIII, X, XI, and XII. The patient underwent digital subtraction angiography (DSA) followed by surgical resection. Histopathology revealed a round-cell neoplasm with immunohistochemistry positive for SSTR2A and EMA and negative for synaptophysin, chromogranin A, S100, and GATA-3, excluding paraganglioma and confirming meningothelial meningioma (CNS WHO grade I).
Conclusion
This case highlights the diagnostic challenges of pediatric jugular foramen meningioma presenting with unusual oropharyngeal manifestations. Enhanced recognition of progressive cranial nerve involvement and characteristic imaging features may facilitate earlier diagnosis and appropriate multidisciplinary management.