Anaplastic Meningioma of the Orbit

An 83-year-old woman presented with 2 months of progressive painful vision loss of the right eye. She had a previous World Health Organization (WHO) grade 1 right sphenoid wing meningioma, status postsurgical resection 2 years prior. Examination revealed a large orbital tumor and a nonformed, inferolaterally displaced globe (A). Imaging revealed a 7.5 cm × 3.8 cm × 4.2 cm intraorbital mass with intracranial extension along the temporal lobe and cavernous sinus (B). A right cranio-orbital craniotomy, orbital exenteration, and resection of the anterior/middle fossa tumor was performed (C). Histology revealed a WHO grade 3, anaplastic meningioma with frequent mitotic activity (D, circled). Given the patient’s history and nature of meningiomas, the tumor origin was likely intracranial, primarily presenting with orbital involvement (Magnified version of Figure A-D is available online at www.aaojournal.org).