What variety of tumour is the kindest?

I plugged in the cerebral angiogram films against the white light of the view box and explained the imaging findings to Ryan Ryan was a handsome 38yearold software engineerHe wore rimless glasses dark washed jeans and clean dress shoesmdasha minimalist look that typified his profession He had recurring headaches that did not seem to get better with regular medication His family physician had ordered a scan The brain MRI showed a 55 cm tumour arising from the meninges the protective tissue covering the brain pressing down on itThis in all probability is a very vascular meningioma I said with the modest authority that comes from pattern recognition after seeing scans every day for a decadeOma I went on to explain means tumour or growth The word preceding it indicates the source or the cell of origin In his case the source was meningesA tumour is a collection of abnormal cells in the body There are a multitude of genetic molecular and environmental factors that trigger this growth but we havent yet been able to fully understand what causes this to occur The angiogram was additionally performed on Ryan to determine the vascular supply of the tumour and plan a surgical strategy around it trace the main arterial feeders tackle those first and the rest of the operation would be relatively bloodlessI ran my pointer delineating the tumour blush on the angiogram You can see that in this area the extensive blood supply comes early stays late and is very dense In medical parlance we call this the motherinlaw sign I quipped to ease the tension I saw building as he tried to make sense of what was going on inside his head without his knowledge He broke into a slight smile flicking the sweat off his forehead with his index finger and thumbSo what do we do about itSurgery is the only option We will get the whole thing out plus we know the exact grade and aggressiveness of the tumour when we send it for histopathological testingRisks of surgeryhellip he interjectedLess than one per cent chance of death paralysis bleeding infectionhellip I continued with a laundry list that didnt seem to disturb him at allSometimes these tumours can return after a few years even if we remove them completely I added as a word of cautionAll the more reason to call them motherinlaw tumours he quipped having by now eased into the consultationWould you call this a cancer he asked after having processed the information Im not sure if he was taking the motherinlaw theme to the next level but I went on to explain that 50 per cent of brain tumours are benign meaning not cancerous And the rest are malignant Im pretty certain this belongs to the former category but whether we need to give you radiation after surgery will depend on how aggressive this tumour is which we will ascertain once we test it in the lab Sometimes even benign tumours need radiating just to ensure they dont become locally invasive If I had to choose one brain tumour to have I would choose this one I saidA few days later Ryan was in the operating room his face the picture of calm and confidence This positivity of a patient helps the surgeon perform better I feel After induction of general anaesthesia we fixed the head on a clamp shaving only around the incision site We went through the routine of cleaning and draping the sterile field and then opened the skull to reach the main blood supply to the tumour as planned Ryans tumour was removed perfectly As we controlled the last bit of nagging ooze that we often see after excising tumours like these I asked my assistant if he knew why these tumours were called motherinlaw tumours I could see him smile through his mask as I buzzed the final bleeding point dry through the lens of the microscope I toh love my motherinlaw he said out of the blue She makes my dabba every dayRyan made an excellent recovery with a complete resolution of his headache and was discharged within a few days The postoperative CT scan looked clean The final report turned out to indicate benign lowgrade meningioma not requiring any further adjuvant therapyIs there anything I can do to prevent it from returning he asked one final time as he got off the bed thanking meBe nice to your motherinlawThe writer is practising neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of HospitalsCatch up on all the latest Crime National International and Hatke news here Also download the new midday Android and iOS apps to get latest updates