The Diagnostic Odyssey: Papillary Meningioma - A Rare and Aggressive Entity

Background: Papillary meningioma (PM), a rare subtype, accounts for less than 1% of all meningiomas, has a high potential for metastasis, a higher rate of recurrence, and a worse prognosis than other types of meningiomas, categorized as WHO Grade 3 malignant tumors. Case details: A 39-year-old male came with complaints of swelling and proptosis of the left eye, left-sided hemicranial headache for the last two months, and blurring of vision for the last month. On MRI scan, a likely diagnosis of hemangiopericytoma with a differential diagnosis of metastatic deposits was given. Excision of the eye swelling was done, and histopathological examination revealed the diagnosis of papillary meningioma (histological grade 3), which was further confirmed on immunohistochemistry. Conclusion: Papillary meningioma is an exceptional variant of meningioma with an increased incidence of local recurrences and potential for distant metastasis. Its timely recognition may have important implications for management as well as prognostication in order to reduce morbidity and mortality.