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Zhu X, Liu Y, Guo W, Liang Q, Pan C, Tan B, Yu Y. Epidemiology, characteristics, and prognostic factors of lymphoplasmacyte-rich meningioma: a systematic literature review. BMC Cancer 2024; 24:110. [PMID: 38254159 PMCID: PMC10801983 DOI: 10.1186/s12885-023-11811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUNDS Lymphoplasmacyte-rich meningioma(LPM) is a rare subtype of meningioma with a low degree of malignancy and an overall preferable prognosis. The purpose of this article is to increase the understanding of the disease, reduce misdiagnosis, and improve prognosis. METHODS A search was conducted in the PubMed database for English articles published from 1993 to 2023. The keywords were "lymphoplasmacyte-rich (all fields) and meningioma (all fields) and English (lang)" and "lymphoplasmacyte-rich meningioma (title/abstract) and English (lang)".We further analyzed the clinical manifestations, imaging manifestations, pathological features, treatment strategies, and prognosis of LPM.The possible prognostic indicators were analyzed by the log-rank test and Pearson's chi-squared test. RESULTS Fourteen reports with 95 LPM patients were included in this report, including 47 males and 48 females who were diagnosed between the ages of 9 and 79, with an average age of 45 years. The most common clinical manifestations are headache and limb movement disorders. In most cases, the tumor occurred on the convex portion of the brain. All tumors showed significant enhancement, with homogeneous enhancement being more common, and most patients showed peritumoral edema. Postoperative pathological EMA, LCA, and vimentin positivity were helpful for the final diagnosis of the patient. Log-rank tests showed a correlation between complete resection and better prognosis and recurrence. CONCLUSION There is a lack of significant differences in the clinical symptoms and imaging manifestations of LPM compared to other diseases that need to be differentiated, and a clear diagnosis requires pathological examination. After standardized surgical treatment, the recurrence rate and mortality rate of LPM are both low. Complete surgical resection of tumors is associated with a better prognosis and lower recurrence rate.
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Affiliation(s)
- Xiaoxi Zhu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Yanhua Liu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Weiwei Guo
- The Hospital of Northeast Normal University, Changchun, China
| | - Qi Liang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Chengliang Pan
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Bin Tan
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China
| | - Ying Yu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, China.
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Fukui K, Tsuji O, Suzuki S, Nori S, Nagoshi N, Okada E, Yagi M, Okita H, Fujita N, Watanabe K, Nakamura M, Matsumoto M. A rare case of dumbbell-shaped lymphoplasmacyte-rich meningioma arising at the upper cervical spinal cord. J Orthop Sci 2023; 28:1439-1444. [PMID: 34030941 DOI: 10.1016/j.jos.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Kenichiro Fukui
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Okita
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, Aichi, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Ren L, Hua L, Deng J, Cheng H, Wang D, Chen J, Xie Q, Wakimoto H, Gong Y. Favorable Long-Term Outcomes of Chordoid Meningioma Compared With the Other WHO Grade 2 Meningioma Subtypes. Neurosurgery 2023; 92:745-755. [PMID: 36512828 PMCID: PMC9988284 DOI: 10.1227/neu.0000000000002272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND WHO grade 2 meningiomas, including atypical, chordoid, and clear cell subtypes, form a heterogenous group of meningiomas with varying aggressiveness and clinical behavior. OBJECTIVE To demonstrate the differences of clinical-histopathological characteristics and long-term outcomes among these 3 subtypes. METHODS A total of 609 consecutive patients diagnosed with WHO grade 2 meningiomas (543 atypical meningiomas [AMs], 36 chordoid meningiomas [CMs], and 30 clear cell meningiomas [CCMs]) from 2010 to 2018 were enrolled in this study. We compared the clinical-histopathological characteristics and long-term outcomes in these 3 subtypes and assessed survival differences among the subtypes. Targeted panel sequencing of meningioma-relevant genes was performed in the cases of CM. RESULTS The patients with CCM were significantly younger than those with AM ( P < .001) and CM ( P = .016). CMs were more likely to receive gross total resection than AMs and CCMs ( P = .033). The Ki-67 index was lower ( P < .001) while the progesterone receptors-positive rate was higher ( P = .034) in CM than in AM and CCM. Importantly, survival analysis demonstrated that CM had better progression-free survival ( P = .022) and overall survival ( P = .0056) than non-CM tumors. However, the PFS of CM was still worse than WHO grade 1 meningiomas ( P < .001). Alterations in NF2 (20.6%) and KMT2C (26.5%) were associated with poorer PFS in CM ( P = .013 for NF2 ; P = .021 for KMT2C ). CONCLUSION Patients with CM had better long-term postoperative outcomes than the other WHO grade 2 subtypes. A lower Ki-67 index, higher PR status, higher extent of resection, and lower frequency of NF2 alteration might contribute to favorable clinical outcomes of CM.
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Affiliation(s)
- Leihao Ren
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Lingyang Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Jiaojiao Deng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Haixia Cheng
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Daijun Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Jiawei Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
| | - Hiroaki Wakimoto
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Institute of Neurosurgery, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Fudan University, Shanghai, China
- Department of Critical Care Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Unilateral Orbitopathy Caused by Skull Base Chordoid Meningioma. Diagnostics (Basel) 2023; 13:diagnostics13050815. [PMID: 36899959 PMCID: PMC10001141 DOI: 10.3390/diagnostics13050815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023] Open
Abstract
Chordoid meningioma (CM) makes up only 1% of all meningiomas. Most cases of this variant are locally aggressive, have high growth potential, and are likely to recur. Although CMs are known to be invasive, they rarely extend into the retro-orbital space. Herein, we report a case of a central skull base CM in a 78-year-old woman whose only manifestation was unilateral proptosis with impaired vision resulting from the tumor extending into the retro-orbital space through the superior orbital fissure. The diagnosis was confirmed by analysis of specimens collected during endoscopic orbital surgery, which simultaneously relieved the protruding eye and restored the patient's visual acuity by decompressing the oppressed orbit. This rare presentation of CM reminds physicians there may be lesions outside the orbit that can cause unilateral orbitopathy and that endoscopic orbital surgery can be used to confirm its diagnosis as well as treat it.
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Tahta A, Genc B, Cakir A, Sekerci Z. Chordoid meningioma: report of 5 cases and review of the literature. Br J Neurosurg 2023; 37:41-44. [PMID: 33332220 DOI: 10.1080/02688697.2020.1861436] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chordoid meningioma is a rare, more aggressive subtype of meningioma. This study documents the histological, radiological and clinical features of seven tumours in five patients among 131 meningioma patients who were treated in the Department of Neurosurgery at Istanbul Medipol University between 2014 and 2019. There were two males and three females. All tumours were supratentorial. Surgical Simpson grade II resection was achieved in two cases, grade I in one and grade IV in two. One case relapsed and underwent further surgeries and adjuvant treatment. The chances of survival without recurrence after the Simpson grade I-II resection are high but close follow-up is recommended particularly if grade I cannot be achieved.
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Affiliation(s)
- Alican Tahta
- School of Medicine, Department of Neurosurgery, Istanbul Medipol University, Istanbul, Turkey
| | - Berkhan Genc
- School of Medicine, Department of Neurosurgery, Istanbul Medipol University, Istanbul, Turkey
| | - Asli Cakir
- School of Medicine, Department of Pathology, Istanbul Medipol University, Istanbul, Turkey
| | - Zeki Sekerci
- School of Medicine, Department of Neurosurgery, Istanbul Medipol University, Istanbul, Turkey
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Raghunathan A, Giannini C. Histopathology of Meningiomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:35-45. [PMID: 37432618 DOI: 10.1007/978-3-031-29750-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Meningiomas are considered to arise from meningothelial cells, whose cytomorphology they recapitulate. In this chapter, we review the characteristic histological features of meningioma, including classic architectural and cytological features. There exists a broad spectrum of morphological variants of meningioma. The 2021 WHO Classification recognizes nine benign (grade 1), three intermediate-grade (grade 2), and three malignant (grade 3) variants. We review the characteristic histological features of these meningioma variants, describe immunohistochemical stains, which may assist with establishing a diagnosis, and discuss differential diagnostic considerations that may prove challenging for a diagnosis of meningioma.
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Affiliation(s)
- Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Jie D, Liu Z, He W, Wang S, Teng H, Xu J. Clinical features, radiological findings, and prognostic factors for primary intracranial chordoid meningioma. Front Neurol 2022; 13:1002088. [PMID: 36438949 PMCID: PMC9684187 DOI: 10.3389/fneur.2022.1002088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/10/2022] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVES Chordoid meningioma (CM) is an infrequent histologic subtype of meningiomas. Owing to its low occurrence, this subtype has been rarely described. Our subject was to explore the clinical features, radiological characteristics, and prognostic factors of primary intracranial chordoid meningioma. METHODS We reviewed the medical records and collected follow-up information of 34 cases who had been surgically treated and histologically diagnosed with CM at the Department of Neurosurgery, West-China Hospital of Sichuan University, from January 2009 to December 2021. RESULTS Among all 7,950 meningioma cases, the proportion of primary intracranial CM was 0.43% (34/7,950). The median diagnosis age was 47 (ranging from 12 to 74) and the gender ratio (male to female) was 2.1:1. For radiological features, heterogeneous enhancement, skull base, and ventricular localization, cystic degeneration and dural tail sign were common in CM cases. In treatment, gross total resection (GTR) was achieved in 22/34 cases (64.7%) and subtotal resection (STR) was achieved in 12/34 cases (35.3%). Further, 11/34 patients (32.4%) had received postoperative adjuvant radiotherapy (RT). The follow-up duration ranged from 4 to 157 months after operation. The progression rate was 20.7% (6/29) and the median of PFS was 38 months. By survival analysis, accepting adjuvant radiotherapy and achieving GTR were correlated with longer progression-free survival for prognosis. CONCLUSION CM is a rare subtype of meningiomas. In our series, it mainly involved adults and did not show a predilection for women compared with meningiomas in general. For a better prognosis, gross total resection and postoperative adjuvant radiotherapy are recommended. Nevertheless, due to the restriction of the series sample, patients lost for follow-up and inherent biases of a retrospective study, more cases and a shorter follow-up duration are needed for better management of chordoid meningioma.
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Affiliation(s)
- Danyang Jie
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhiyong Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wenbo He
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Shumin Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Haibo Teng
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
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Daoud EV, Zhu K, Mickey B, Mohamed H, Wen M, Delorenzo M, Tran I, Serrano J, Hatanpaa KJ, Raisanen JM, Snuderl M, Cai C. Epigenetic and genomic profiling of chordoid meningioma: implications for clinical management. Acta Neuropathol Commun 2022; 10:56. [PMID: 35440040 PMCID: PMC9020042 DOI: 10.1186/s40478-022-01362-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
Chordoid meningioma is a morphological variant of meningioma designated as WHO grade 2. However, the recurrence rates varied widely in different case series, and to date, a unifying molecular genetic signature has not been identified. Among 1897 meningiomas resected at our institution, we identified 12 primary chordoid meningiomas from 12 patients. Histologically, all 12 cases had predominant (> 50%) chordoid morphology. Ten were otherwise grade 1, and two were also atypical. We performed DNA global methylation profile, copy number variation analysis, and targeted next-generation sequencing on 11 chordoid meningiomas, and compared to those of 51 non-chordoid, mostly high grade meningiomas. The chordoid meningiomas demonstrated a unique methylation profile in tSNE, UMAP, and hierarchical heatmap clustering analyses of the most differentially methylated CpGs. The most common copy number variation in chordoid meningioma was loss of 1p (7/11, 64%). Three chordoid meningiomas had 2p loss, which was significantly higher than the non-chordoid control cohort (27% vs 7.2%, p = 0.035). 22q loss was only seen in the two cases with additional atypical histological features. Chordoid meningiomas were enriched in mutations in chromatin remodeling genes EP400 (8/11,73%) KMT2C (4/11, 36%) and KMT2D (4/11, 36%), and showed low or absent NF2, TERT, SMO, and AKT1 mutations. Prognosis wise, only one case recurred. This case had atypical histology and high-grade molecular features including truncating NF2 mutation, 1p, 8p, 10, 14, 22q loss, and homozygous deletion of CDKN2A/B. Progression free survival of chordoid, otherwise grade 1 meningioma was comparable to non-chordoid WHO grade 1 meningioma (p = 0.75), and significantly better than chordoid WHO grade 2 meningioma (p = 0.019). Conclusion: the chordoid histology alone may not justify a universal WHO grade 2 designation. Screening for additional atypical histological or molecular genetic features is recommended.
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Prokopienko M, Wierzba-Bobrowicz T, Grajkowska W, Stępień T, Sobstyl M. Chordoid Meningioma. Case Report and Review of the Literature. Niger J Clin Pract 2022; 25:1-4. [PMID: 35046187 DOI: 10.4103/njcp.njcp_667_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Chordoid meningioma is an uncommon histopathological type of meningioma, frequently associated with Castleman's syndrome. Histologically, chordoid meningiomas are similar to chordomas. Because of their high proliferative index, they present aggressive biological behavior and high risk of postoperative recurrence. We report a case of chordoid meningioma in an adult patient without Castleman's syndrome manifestation. As its chordoid feature is related with a rapid recurrence after incomplete removal, meticulous histopathological examination is crucial for the adequate postoperative treatment plan.
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Affiliation(s)
- M Prokopienko
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Sobieskiego, Warsaw, Poland
| | - T Wierzba-Bobrowicz
- Department of Neuropathology, Institute of Psychiatry and Neurology, Sobieskiego, Warsaw, Poland
| | - W Grajkowska
- Department of Neuropathology, Institute of Psychiatry and Neurology, Sobieskiego, Warsaw, Poland
| | - T Stępień
- Department of Neuropathology, Institute of Psychiatry and Neurology, Sobieskiego, Warsaw, Poland
| | - M Sobstyl
- Department of Neuropathology, Institute of Psychiatry and Neurology, Sobieskiego, Warsaw, Poland
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Alugol R, Jadhav N, Mudumba V, Uppin M. Orbital Chordoid Meningioma. Neurol India 2022; 70:2156-2158. [DOI: 10.4103/0028-3886.359271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Tan NJH, Pratiseyo PD, Wahjoepramono EJ, Kuick CH, Goh JY, Chang KTE, Tan CL. Intracranial myxoid angiomatoid fibrous histiocytoma with "classic" histology and EWSR1:CREM fusion providing insight for reconciliation with intracranial myxoid mesenchymal tumors. Neuropathology 2021; 41:306-314. [PMID: 34254369 DOI: 10.1111/neup.12737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 01/31/2023]
Abstract
Angiomatoid fibrous histiocytoma (AFH) is an uncommon soft tissue neoplasm that can exhibit diverse morphological features, including myxoid change. Rarely, the tumor occurs intracranially and poses considerable diagnostic challenges to neuropathologists. This is compounded by a recently coined entity, referred to as intracranial myxoid mesenchymal tumor (IMMT). These tumors show significant overlaps with intracranial myxoid AFH from clinicopathological and molecular genetic viewpoints. We described an unusual intracranial tumor in a 30-year-old man. The tumor exhibited "classic" histological features of myxoid AFH and EWSR1:CREM fusion, a relatively novel variant of EWSR1:CREB family fusion, first identified in IMMT. We also performed a comprehensive literature review comparing the clinicopathological features of intracranial AFHs and IMMTs. Peritumoral lymphoplasmacytic cuffing appears to be the only morphological finding that is consistently absent in reported cases of IMMT while being present in most intracranial AFHs. Otherwise, both tumors showed considerable overlaps in clinical, histological, and immunohistochemical features and have a common molecular genetic signature of EWSR1:CREB family fusion, including EWSR1:CREM fusion. Our case appeared to be the first described EWSR1:CREM-fused intracranial tumor to show prominent peritumoral lymphoplasmacytic cuffing and myxoid change in addition to most of the other "classic" morphologic features of AFH. As such, while the current literature appears to be lacking when it comes to defining intracranial myxoid AFH and IMMT as separate nosological entities, they likely represent a morphological spectrum of a common entity characterized by EWSR1 rearrangement, akin to solitary fibrous tumors and hemangiopericytomas with the signal transducer and activator of transcription 6 gene (STAT6) rearrangement.
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Affiliation(s)
- Nicholas J H Tan
- Department of Pathology, National University Health System, Singapore, Singapore
| | | | - Eka J Wahjoepramono
- Department of Neurosurgery, Siloam Hospital Lippo Village Karawaci, Tangerang, Indonesia
| | - Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jian Yuan Goh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kenneth T E Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Char Loo Tan
- Department of Pathology, National University Health System, Singapore, Singapore.,Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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12
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Hammed A, Mahfoud M, Sulaiman A, Najm A, Hammed S. Pure posterior chordoid foramen magnum meningioma: A case report and review of literature. Ann Med Surg (Lond) 2021; 65:102325. [PMID: 33996057 PMCID: PMC8100088 DOI: 10.1016/j.amsu.2021.102325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/11/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction and importance Meningiomas are extra-axial central nervous system (CNS) tumors that arise from the arachnoid cells of the dura mater. Only 1.8–3.2% of all meningiomas are located at foramen magnum (FM) and pure posterior FM meningioma are very rare. The diagnosis of malignancy in patients with meningiomas has been a controversial issue. Only a histological study can confirm this situation. Case presentation We report a case of A 52-year-old female presented with a history of neck pain with progressive spastic quadriparesis. Clinical discussion Magnetic resonance imaging MRI T1 and T2 weighted images revealed well-defied pure posterior foramen magnum Lesion. Although the lesion was very sticky to neurovascular components. Simpson grade I was achieved. Histopathology revealed Chordoid meningioma. The patient had a dramatic recovery. Conclusion Although choroid meningioma is usually well circumscribed, sticky tumors should be suspected. Recurrence of Chordoid meningioma should be suspected. Total excision should be achieved and routine follow-up should be informed. Reports about chordoid meningioma aren't common, but reports on choroid foramen magnum meningioma are very rare. The opportunity to give the patient a symptom-free and normal life should not be missed in such cases.
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Affiliation(s)
- Ali Hammed
- Tishreen University Hospital, Department of Neurosurgery, Lattakia, Syria
| | - Moufid Mahfoud
- Tishreen University Hospital, Department of Neurosurgery, Lattakia, Syria
| | - Alaa Sulaiman
- Tishreen University Hospital, Department of Neurosurgery, Lattakia, Syria
| | - Adnan Najm
- Tishreen University Hospital, Department of Neurosurgery, Lattakia, Syria
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Utility of multiparametric pre-operative magnetic resonance imaging in differentiation of chordoid meningioma from the other histopathological subtypes of meningioma-a retrospective study. Neuroradiology 2021; 64:253-264. [PMID: 33837805 DOI: 10.1007/s00234-021-02690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the magnetic resonance imaging (MRI) features which could pre-operatively differentiate chordoid meningioma (CM) from other histopathological subtypes of meningioma. METHODS Retrospective analysis of pre-operative MRI of cases with histopathologically confirmed diagnosis of meningioma during the last 5 years at our institute was done. T1W, T2W, FLAIR sequences, and post-contrast enhancement were evaluated on a qualitative scale. Normalized ADC ratios (nADCR) and normalized fractional anisotropy ratios (nFAR) were derived. The intratumoral susceptibility score (ITSS), presence of sunburst pattern of vasculature, bone changes, tumour-parenchyma interface, and oedema-to-tumour ratio were also determined. RESULTS A total of 81 lesions were analyzed out of which 15 were CM. CM showed a higher relative contrast enhancement as compared to all other subtypes except for angiomatous and microcystic meningioma. Relative signal intensity on FLAIR could differentiate CM from transitional meningioma. nFAR was found to be significantly higher in fibroblastic meningioma and significantly lower in microcystic meningiomas as compared to CM. Anaplastic meningiomas were remarkable for bone changes and an ill-defined tumour-brain interface in significantly higher proportion of cases as compared to CM. nADCR > 1.5 was found to be an independent predictor of CM with a sensitivity of 84.6%, specificity of 89.8%, positive predictive value of 64.7%, and negative predictive value of 96.4%. CONCLUSION Routine pre-operative MRI may be able to differentiate CM from other meningioma subtypes and a cut-off value of greater than 1.5 for nADCR could be predictive of > 50% chordoid histology of meningioma with a high sensitivity, specificity, and negative predictive value.
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14
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Guini M, Khoulali M, Raouzi N, Oulali N, Moufid F. [Extra-axial chordoid meningioma: a case report]. Pan Afr Med J 2021; 38:123. [PMID: 33912293 PMCID: PMC8051272 DOI: 10.11604/pamj.2021.38.123.20437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
Une découverte fortuite d'une lésion de novo chez une patiente de 45 ans, la tomodensitométrie cérébrale réalisée montre une lésion ptérionale gauche intra-diploïque isodense avec une lyse osseuse, qui se rehausse de façon homogène après injection de produit de contraste, l'imagerie par résonnance magnétique montre une lésion hypointense en T1 et spontanément hyperintense en T2 FLAIR, et se rehausse très fortement après injection de Gadolinium. Une résection complète de la tumeur a été réalisée. Le diagnostic histologique était de méningiome chordoïde.
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Affiliation(s)
- Mohammed Guini
- Service de Neurochirurgie, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Mohammed Khoulali
- Service de Neurochirurgie, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Nabil Raouzi
- Service de Neurochirurgie, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Noureddine Oulali
- Service de Neurochirurgie, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
| | - Fayçal Moufid
- Service de Neurochirurgie, Centre Hospitalier Universitaire Mohammed VI, Oujda, Maroc
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Abdulqader SB, Almujaiwel N, Alshakweer W, Alzhrani G. High-grade spheno-orbital meningioma in patients with systemic lupus erythematosus: Two case reports and literature review. Surg Neurol Int 2020; 11:367. [PMID: 33194300 PMCID: PMC7656016 DOI: 10.25259/sni_583_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Spheno-orbital meningiomas (SOMs) are often benign. The association of meningioma and systemic lupus erythematosus (SLE) is rarely discussed in the literature. Here, we report two patients with high-grade, SOMs with a prolonged history of SLE and review the literature. Case Description: The first case is a 52-year-old female patient with a 15-year history of SLE diagnosis who was referred to our center with a 1-year history of proptosis and excessive tearing of the left eye. This patient was operated for the left SOM with histopathological diagnosis of the World Health Organization (WHO) Grade III rhabdoid meningioma. The second case is a 36-year-old female patient with a 12-year history of SLE diagnosis who presented to our clinic with a 5-year-history of progressive right eye proptosis and occasional headaches. She was operated for the right SOM with histopathological diagnosis of the WHO Grade II chordoid meningioma. Conclusion: Rhabdoid and chordoid SOMs are uncommon and no previous report discussed their occurrence in patients with SLE. The association of high-grade meningiomas and SLE deserves further exploration.
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Affiliation(s)
- Sarah Bin Abdulqader
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Wafa Alshakweer
- Department of Pathology and Clinical Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Gmaan Alzhrani
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Abstract
Meningiomas in children are poorly understood because they are rare. Recent reports have provided a more complete description of their incidence, genetics, imaging features, and outcome. In general, meningiomas in children are more likely to be higher grade, present in atypical locations, and have a higher risk of recurrence. The challenges encountered in children with respect to surgical and postoperative management are unique. Improved understanding of pediatric meningiomas, as well as the availability of new surgical, medical, and radiation therapies, creates opportunities to improve outcomes in this unique population.
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Affiliation(s)
- David Phillips
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Kurtis I Auguste
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Nalin Gupta
- Division of Pediatric Neurosurgery, Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States.
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Abstract
Meningiomas are a diverse group of neoplasms that exhibit a wide range of morphologies and clinical behavior. They are generally accepted to originate from arachnoid cap cells within the leptomeninges. Classic histologic features include whorl formations, psammoma bodies, nuclear holes, and nuclear pseudoinclusions. Meningiomas are classified as benign, atypical, or anaplastic (grades I, II, or III) based on histologic features including mitotic activity, brain invasion, and presence of other minor criteria. There are numerous histologic variants of meningiomas, and some are associated with worse clinical outcomes and therefore are assigned a higher grade. The majority of meningiomas show diffuse positivity for vimentin and epithelial membrane antigen, supporting the dual mesenchymal and epithelial nature of meningothelial cells. The presence of an elevated proliferation index (as measured by Ki-67 immunohistochemical stain) and loss of progesterone receptor expression are associated with the higher grade. Pathologic features including histologic variants, grading criteria, and ancillary tests such as special and immunohistochemical stains are discussed.
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Affiliation(s)
- David A Solomon
- Division of Neuropathology, Department of Pathology, University of California San Francisco, San Francisco, CA, United States.
| | - Melike Pekmezci
- Division of Neuropathology, Department of Pathology, University of California San Francisco, San Francisco, CA, United States
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18
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Baal JD, Chen WC, Solomon DA, Pai JS, Lucas CH, Hara JH, Oberheim Bush NA, McDermott MW, Raleigh DR, Villanueva-Meyer JE. Preoperative MR Imaging to Differentiate Chordoid Meningiomas from Other Meningioma Histologic Subtypes. AJNR Am J Neuroradiol 2019; 40:433-439. [PMID: 30819773 DOI: 10.3174/ajnr.a5996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Chordoid meningiomas are uncommon WHO grade II primary intracranial neoplasms that possess unique chordoid histology and follow an aggressive clinical course. Our aim was to assess the utility of qualitative MR imaging features and quantitative apparent diffusion coefficient values as distinguishing preoperative MR imaging metrics to identify and differentiate chordoid histology from other meningioma histologic subtypes. MATERIALS AND METHODS Twenty-one patients with meningiomas with chordoid histology, which included both chordoid meningiomas (>50% chordoid histology) and meningiomas with focal chordoid histology (<50% chordoid histology) with available preoperative MR imaging examinations, including diffusion-weighted imaging, were identified. Qualitative imaging features and quantitative ADC values were compared between meningiomas with chordoid histology and 42 nonchordoid meningiomas (29 WHO grade I, eleven WHO grade II, and 2 WHO grade III). RESULTS The median ADC (10-3mm2/s) of meningiomas with chordoid histology was significantly higher than nonchordoid meningiomas (1.16 versus 0.92, P < .001), as was the median normalized ADC (1.60 versus 1.19, P < .001). In subgroup analysis, the median and normalized ADC values of chordoid meningiomas (n = 11) were significantly higher than those in meningiomas with focal chordoid histology (n = 10, P < .001 and P < .001, respectively) or nonchordoid meningiomas (n = 42, P < .001 and <0.001, respectively). Median and normalized ADC values were not significantly different between the meningiomas with focal chordoid histology and nonchordoid meningiomas (P = .816 and .301, respectively). Among the qualitative imaging features, only DWI signal intensity was significantly associated with meningiomas with chordoid histology diagnosis. CONCLUSIONS ADC values are higher in chordoid compared with nonchordoid meningiomas and may be used to discriminate the degree of chordoid histology in meningiomas. While qualitative MR imaging features do not strongly discriminate chordoid from nonchordoid meningiomas, DWI may allow preoperative identification of chordoid meningiomas.
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Affiliation(s)
- J D Baal
- From the Departments of Radiology and Biomedical Imaging (J.D.B., J.E.V.-M.)
| | - W C Chen
- Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.)
| | | | - J S Pai
- Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.)
| | | | - J H Hara
- Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.)
| | - N A Oberheim Bush
- Neurological Surgery (N.A.O.B., M.W.M.), University of California San Francisco, San Francisco, California
| | - M W McDermott
- Neurological Surgery (N.A.O.B., M.W.M.), University of California San Francisco, San Francisco, California
| | - D R Raleigh
- Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.)
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Radiologic and Histopathologic Features in an Intracranial Localized Castleman Disease: A Case Report and Review of Literature. Neurologist 2018; 24:33-36. [PMID: 30586033 DOI: 10.1097/nrl.0000000000000203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Castleman disease (CD) is a rare pathologic process of unknown etiology, characterized by non-neoplastic lymph node enlargement. Two distinct histologic patterns are recognized; the hyaline-vascular type and the less common plasma cells type. Another intermediate type has been described. The clinical features are classified into 2 categories, localized (unicentric) and generalized (multicentric), the later associated with systemic manifestations and poor prognosis. CD affecting the central nervous system is extremely rare. We report a new case of localized intracranial CD and we accomplish a review of the literature. CASE REPORT A 30-year-old man presented with a generalized tonic-clonic seizure. Computerized tomography and magnetic resonance imaging showed a small mass in the right temporoparietal convexity with homogenous enhancement after contrast administration. Extensive vasogenic edema in comparison with the size of the mass was also identified and based on the neuroradiologic finding, a suspected diagnosis of meningoangiomatosis was formulated. The mass was completely resected and his histologic examination identified the hyaline-vascular type of CD. One year after surgery, the patient remains seizure free, without evidence of systemic involvement or recurrence of the mass. CONCLUSIONS Our case and review of the literature show the value of the extensive brain edema on neuroimaging finding to the differential diagnosis for a solitary mass arising from the meninges. We emphasize on the need for histologic examination when the diagnosis of meningioma is not entirely clear.
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Sievers P, Stichel D, Hielscher T, Schrimpf D, Reinhardt A, Wefers AK, Reuss D, Jones DTW, Bewerunge-Hudler M, Hartmann C, Baumgarten P, Wirsching HG, Winther-Kristensen B, Brokinkel B, Ketter R, Idoate Gastearena MA, Lamszus K, Seiz-Rosenhagen M, Mawrin C, Harter PN, Felsberg J, Hänggi D, Herold-Mende C, Berghoff AS, Weller M, Pfister SM, Wick W, Reifenberger G, Preusser M, von Deimling A, Sahm F. Chordoid meningiomas can be sub-stratified into prognostically distinct DNA methylation classes and are enriched for heterozygous deletions of chromosomal arm 2p. Acta Neuropathol 2018; 136:975-978. [PMID: 30382370 DOI: 10.1007/s00401-018-1924-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Philipp Sievers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annekathrin Reinhardt
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Glioma Research Group, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Peter Baumgarten
- Institute of Neurology (Edinger Institute), University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Bjarne Winther-Kristensen
- Department of Pathology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Ralf Ketter
- Department of Neurosurgery, University Hospital Saarland, Homburg, Saar, Germany
| | | | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christian Mawrin
- Department of Neuropathology, University Magdeburg, Magdeburg, Germany
| | - Patrick N Harter
- Institute of Neurology (Edinger Institute), University Hospital and Medical Faculty, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt, Germany
| | - Jörg Felsberg
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Sophie Berghoff
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Düsseldorf, Germany
| | - Matthias Preusser
- Clinical Division of Oncology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany.
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Zhang GJ, Zhang YS, Zhang GB, Yan XJ, Li CB, Zhang LW, Li D, Wu Z, Zhang JT. Prognostic Factors, Survival, and Treatment for Intracranial World Health Organization Grade II Chordoid Meningiomas and Clear-Cell Meningiomas. World Neurosurg 2018; 117:e57-e66. [DOI: 10.1016/j.wneu.2018.04.226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 04/29/2018] [Accepted: 04/30/2018] [Indexed: 10/16/2022]
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22
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Karimi S, Vyas MV, Gonen L, Tabasinejad R, Ostrom QT, Barnholtz-Sloan J, Suppiah S, Zadeh G, Aldape K. Prognostic significance of preoperative neutrophilia on recurrence-free survival in meningioma. Neuro Oncol 2018; 19:1503-1510. [PMID: 28531342 DOI: 10.1093/neuonc/nox089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Meningioma is the most common primary intracranial tumor and recurrence is one of the important challenges in patient management. Prognostic factors for tumor recurrences in these patients especially before surgical resection are not fully characterized. Several studies have indicated an association between changes in hematologic laboratory parameters with patient outcomes in solid malignancies. We aimed to assess the association between hematologic parameters and tumor recurrence in patients with meningioma. Methods Preoperative complete blood count (CBC) data were analyzed in patients with newly diagnosed meningioma (n = 222). Clinical data, including history of corticosteroid therapy, tumor characteristics, and follow-up, were obtained. Recurrence-free survival (RFS) was evaluated using Cox proportional hazards models and log-rank tests. Results Using preoperative CBC data from patients prior to any steroid therapy, 51 (23%) patients had neutrophilia. In univariate analysis, neutrophilia was significantly associated with meningioma recurrence (hazard ratio [HR] 2.73; P < 0.01). Neither leukocytosis nor lymphocytosis was associated with RFS. In multivariate analysis, after adjusting for tumor grade, tumor size, and extent of resection, neutrophilia remained an independent prognostic factor for RFS (HR 2.23, P = 0.01). Forty-six (21%) patients had low hemoglobin levels indicative of anemia, and the presence of anemia showed a trend toward high risk for recurrence (HR 1.83; P = 0.06). Conclusions The presence of neutrophilia was associated with higher rate of tumor recurrence in patients with meningioma. Validation of these results and the biologic role of neutrophilic inflammatory/immune reaction in meningioma requires further investigation.
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Affiliation(s)
- Shirin Karimi
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Manav V Vyas
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Lior Gonen
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Raha Tabasinejad
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Quinn T Ostrom
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jill Barnholtz-Sloan
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Suganth Suppiah
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Gelareh Zadeh
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Kenneth Aldape
- MacFeeters-Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
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Georgescu MM, Olar A, Mobley BC, Faust PL, Raisanen JM. Epithelial differentiation with microlumen formation in meningioma: diagnostic utility of NHERF1/EBP50 immunohistochemistry. Oncotarget 2018; 9:28652-28665. [PMID: 29983887 PMCID: PMC6033365 DOI: 10.18632/oncotarget.25595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/24/2018] [Indexed: 01/09/2023] Open
Abstract
Meningioma is a primary brain tumor arising from the neoplastic transformation of meningothelial cells. Several histological variants of meningioma have been described. Here we show that NHERF1/EBP50, an adaptor protein required for structuring specialized polarized epithelia, can distinguish meningioma variants with epithelial differentiation. NHERF1 decorates the membrane of intracytoplasmic lumens and microlumens in the secretory variant, consistent with a previously described epithelial differentiation of this subtype. NHERF1 also labels microlumens in chordoid meningioma, an epithelial variant not previously known to harbor these structures, and ultrastructural analysis confirmed the presence of microlumens in this variant. NHERF1 associates with the ezrin-radixin-moesin (ERM)-NF2 cytoskeletal proteins, and moesin but not NF2 was detectable in the microlumens. In a meningioma series from 83 patients, NHERF1 revealed microlumens in 87.5% of the chordoid meningioma (n = 25) and meningioma with chordoid component (n = 7) cases, and in 100% of the secretory meningioma cases (n = 12). The most common WHO grade I meningioma variants lacked microlumens. Interestingly, 20% and 66.6% of WHO grades II (n = 20) and III (n = 3) meningiomas, respectively, showed microlumen-like NHERF1 staining of ultrastructural tight microvillar interdigitations, mainly in rhabdoid, papillary-like or sheeting areas, revealing a new subset of high grade meningiomas with epithelial differentiation. NHERF1 failed to detect microlumens in 12 additional cases of chordoid glioma of the 3rd ventricle, chordoma and chondrosarcoma, neoplasms that may mimic the histological appearance of chordoid meningioma. This study uncovers features of epithelial differentiation in meningioma and proposes NHERF1 immunohistochemistry as a method of discriminating chordoid meningioma from neoplasms with similar appearance.
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Affiliation(s)
- Maria-Magdalena Georgescu
- Department of Pathology, Louisiana State University and Feist-Weiller Cancer Center, Shreveport, 71103, LA, USA
| | - Adriana Olar
- Department of Pathology and Laboratory Medicine and Neurosurgery, Medical University of South Carolina and Hollings Cancer Center, Charleston, 29425, SC, USA
| | - Bret C Mobley
- Department of Pathology, Vanderbilt University Medical Center, Nashville, 37232, TN, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University, New York, 10032, NY, USA
| | - Jack M Raisanen
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, 75390, TX, USA
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Chordoid meningioma: a clinico-pathological study of an uncommon variant of meningioma. J Neurooncol 2018; 137:575-582. [DOI: 10.1007/s11060-018-2748-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
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25
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EWSR1 Fusions With CREB Family Transcription Factors Define a Novel Myxoid Mesenchymal Tumor With Predilection for Intracranial Location. Am J Surg Pathol 2017; 41:482-490. [PMID: 28009602 DOI: 10.1097/pas.0000000000000788] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recurrent gene fusions involving EWSR1 with members of the cAMP response element binding protein (CREB) family (ATF1 and CREB1) have been reported in a diverse group of tumors including angiomatoid fibrous histiocytoma (AFH), soft tissue and gastrointestinal clear cell sarcoma, primary pulmonary myxoid sarcoma, and hyalinizing clear cell carcinoma of salivary gland. We have recently encountered a group of 5 myxoid mesenchymal tumors positive for EWSR1 fusions with one of the CREB family member (ATF1, CREB1, and CREM), with histologic features distinct from any of the previously described pathologic entities. Tumors occurred in children or young adults (12 to 23 y; mean, 18 y), with equal sex distribution. All except 1 were intracranial (intra-axial, 2; meningeal, 2), whereas 1 was perirectal. Histologically, the tumors were well circumscribed, often lobulated, composed of uniform ovoid to round cells, and arranged in cord-like or reticular structures in a myxoid background. All except 1 displayed unique sunburst amianthoid fibers. Immunohistochemically, tumors were positive for epithelial membrane antigen (5/5; 4 focal, 1 diffuse) and desmin (3/5). A novel EWSR1-CREM fusion was identified by RNA sequencing in the perirectal tumor, which was further confirmed by fluorescence in situ hybridization (FISH) and reverse transcription-polymerase chain reaction (RT-PCR). A second case with similar EWSR1-CREM fusion was identified by RT-PCR and FISH in a meningeal tumor. The remaining cases studied by FISH showed the presence of EWSR1-CREB1 fusion in 2 cases and EWSR1-ATF1 in 1. In conclusion, we report a distinct group of myxoid mesenchymal neoplasms occurring in children or young adults with a predilection for intracranial locations. Although the immunoprofile [epithelial membrane antigen (EMA), desmin] and the fusion type raise the possibility of a myxoid AFH, none of the typical histologic findings of AFH were present, suggesting a novel entity.
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Grossbach AJ, Mahaney KB, Menezes AH. Pediatric meningiomas: 65-year experience at a single institution. J Neurosurg Pediatr 2017; 20:42-50. [PMID: 28474981 DOI: 10.3171/2017.2.peds16497] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Meningiomas are relatively common, typically benign neoplasms in adults; however, they are relatively rare in the pediatric population. Pediatric meningiomas behave very differently from their adult counterparts, tending to have more malignant histological subtypes and recur more frequently. The authors of this paper investigate the risk factors, pathological subtypes, and recurrence rates of pediatric meningiomas. METHODS A retrospective chart review was conducted at the University of Iowa to identify patients 20 years old and younger with meningiomas in the period from 1948 to 2015. RESULTS Sixty-seven meningiomas in 39 patients were identified. Eight patients had neurofibromatosis, 2 had a family history of meningioma, and 3 had prior radiation exposure. Twelve (31%) of the 39 patients had WHO Grade II or III lesions, and 15 (38%) had recurrent lesions after resection. CONCLUSIONS Pediatric meningiomas should be considered for early treatment and diligent follow-up.
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Affiliation(s)
- Andrew J Grossbach
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Kelly B Mahaney
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Arnold H Menezes
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
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Gonzalez-Quarante LH, Ruiz-Juretschke F, Iza-Vallejo B, Scola-Pliego E, Poletti D, Sola Vendrell E. Expanded Endoscopic Transclival Approach for Resection of a Chordoid Meningioma without Dural Attachment (MWODA) Located in the Prepontine Cistern. World Neurosurg 2016; 91:675.e5-675.e10. [DOI: 10.1016/j.wneu.2016.04.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/17/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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Tanaka J, Fujita A, Hosoda K, Kohmura E. Cerebral angiitis associated with subarachnoid hemorrhage in Castleman's disease: report of two cases. BMC Neurol 2016; 16:60. [PMID: 27146847 PMCID: PMC4857415 DOI: 10.1186/s12883-016-0585-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background Multicentric Castleman’s disease (MCD) is characterized by a systemic lymphoproliferative disorder affecting systemic lymph nodes. Cerebrovascular involvements have rarely been reported, and to our knowledge, cerebral angiitis causing subarachnoid hemorrhage (SAH) in patients with Multicentric Castleman’s disease (MCD) has not been previously described. Case presentation We identified two cases of MCD with SAH who were receiving immunosuppressive therapy with low dose prednisolone. Both patients presented with sudden-onset headache and were diagnosed with cortical SAH in the sulci by a computed tomography scan. Digital subtraction angiography showed segmental stenosis in the peripheral area of the middle cerebral artery. In both cases, cerebral angiitis causing SAH induced by a systemic inflammatory condition and elevated levels of interleukin (IL) -6 were suspected and resolved over a period of several months. Conclusion Our cases highlight the clinical diversity of the potential causes of cerebral angiitis and expand the association of MCD and cortical SAH; however, cortical SAH patients have a more favorable outcome than aneurysmal SAH patients.
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Affiliation(s)
- Jun Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kohkichi Hosoda
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Yang Y, Li D, Cao XY, Hao SY, Wang L, Wu Z, Zhang JT. Clinical Features, Treatment, and Prognostic Factors of Chordoid Meningioma: Radiological and Pathological Features in 60 Cases of Chordoid Meningioma. World Neurosurg 2016; 93:198-207. [PMID: 27060511 DOI: 10.1016/j.wneu.2016.03.097] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 01/28/2023]
Abstract
OBJECTIVE As one subtype of meningiomas, chordoid meningiomas (CMs) are rarely described. In this study, the authors aimed to analyze the incidence, clinical features, treatment, and prognostic factors of CMs. METHODS Among 9873 cases of meningioma surgically treated between 2003 and 2013 at Beijing Tiantan Hospital, cases of CM were chosen for analysis and were reviewed retrospectively. To ascertain which factors were related with progression-free survival (PFS), statistical analysis was performed. RESULTS Sixty cases of pathologically confirmed and surgically treated CMs were identified. They accounted for 0.61 % of the entire series of meningioma. Simpson Grade I, II, III, and IV resection was performed in 26, 19, 9, and 6 patients, respectively. Fifty-four patients were followed up for 25-141 months after operation. Of these patients, 19 received postoperative adjuvant radiotherapy. Seventeen patients experienced tumor progression, and median PFS was 54 months. The 3- and 5-year PFS rates were 89.7% and 57.1%, respectively. Two patients died of tumor recurrence and 1 died of unrelated reason. Univariate analysis demonstrated tumor shape and extent of resection were significantly associated with prognosis. Multivariate analysis revealed only extent of resection was an independent prognosis factor for PFS. CONCLUSIONS CM is a rare subtype of World Health Organization grade II meningioma. It more frequently involved the adult patients and was without sex predilection. The confirmed diagnosis relied on pathological validation. Total resection whenever possible is recommended to prolong PFS of patients. The value of adjuvant radiotherapy for CM need to be further studied.
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Affiliation(s)
- Yang Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing; Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing; Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Xiao-Yu Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing; Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Shu-Yu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing; Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing; Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing; Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing; Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
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Predictors of recurrence in the management of chordoid meningioma. J Neurooncol 2015; 126:107-116. [PMID: 26409888 DOI: 10.1007/s11060-015-1940-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/12/2015] [Indexed: 12/25/2022]
Abstract
Management of chordoid meningiomas (CMs) is complicated by high rates of recurrence, particularly following subtotal resection. Optimal management is not established given the paucity of published experience. To identify prognostic factors for recurrence following resection, the authors conducted the largest systematic review of CMs to date. A comprehensive search on MEDLINE (OVID and Pubmed), Scopus, Embase, and Web of Science utilizing the search terms "chordoid" AND "meningioma" was performed to identify all reports of pathologically confirmed intracranial CMs. A total of 221 patients were included, comprising 120 females and 101 males. Mean age, MIB-1/Ki67, and tumor size was 45.5 years, 4.3% (range 0.1-26.6%), and 4.1 cm (range 0.8-10 cm), respectively. 5-, and 10- year progression free survival was 67.5 and 54.4%, respectively. Gross total resection (GTR) and subtotal resection was achieved in 172 and 48 patients, respectively. Adjuvant radiotherapy (RT) was given to 30 patients. Multivariate analysis found GTR was strongly correlated with decreased recurrence rates (HR 0.04, p = <0.0001), while higher MIB-1 labeling index (≥5 vs <5%) was associated with increased recurrence (HR 7.08; p = 0.016). Adjuvant RT, age, gender, and tumor location were not associated with recurrence. GTR resection is the strongest predictor of tumor control, and should be the goal to minimize local progression. Additionally, higher MIB-1 labeling was associated with increased rates of tumor recurrence. Tumors that are subtotally resected or demonstrate higher MIB-1 are at greater recurrence and warrant consideration for RT and close long term follow up.
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Polyzoidis S, Koletsa T, Panagiotidou S, Ashkan K, Theoharides TC. Mast cells in meningiomas and brain inflammation. J Neuroinflammation 2015; 12:170. [PMID: 26377554 PMCID: PMC4573939 DOI: 10.1186/s12974-015-0388-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 09/01/2015] [Indexed: 11/24/2022] Open
Abstract
Background Research focus in neuro-oncology has shifted in the last decades towards the exploration of tumor infiltration by a variety of immune cells and their products. T cells, macrophages, B cells, and mast cells (MCs) have been identified. Methods A systematic review of the literature was conducted by searching PubMed, EMBASE, Google Scholar, and Turning Research into Practice (TRIP) for the presence of MCs in meningiomas using the terms meningioma, inflammation and mast cells. Results MCs have been detected in various tumors of the central nervous system (CNS), such as gliomas, including glioblastoma multiforme, hemangioblastomas, and meningiomas as well as metastatic brain tumors. MCs were present in as many as 90 % of all high-grade meningiomas mainly found in the perivascular areas of the tumor. A correlation between peritumoral edema and MCs was found. Interpretation Accumulation of MCs in meningiomas could contribute to the aggressiveness of tumors and to brain inflammation that may be involved in the pathogenesis of additional disorders.
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Affiliation(s)
| | | | - Smaro Panagiotidou
- Molecular Immunopharmacology and Drug Discovery, Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, 136 Harrison Avenue, Suite J304, Boston, MA, 02111, USA. .,Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA.
| | | | - Theoharis C Theoharides
- Molecular Immunopharmacology and Drug Discovery, Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, 136 Harrison Avenue, Suite J304, Boston, MA, 02111, USA. .,Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA. .,Department of Internal Medicine, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA. .,Department of Psychiatry, Tufts University School of Medicine, Tufts Medical Center, Boston, MA, USA. .,Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, 136 Harrison Avenue, Suite J304, Boston, MA, 02111, USA.
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Pond JB, Morgan TG, Hatanpaa KJ, Yetkin ZF, Mickey BE, Mendelsohn DB. Chordoid Meningioma: Differentiating a Rare World Health Organization Grade II Tumor from Other Meningioma Histologic Subtypes Using MRI. AJNR Am J Neuroradiol 2015; 36:1253-8. [PMID: 25882286 DOI: 10.3174/ajnr.a4309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/22/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Meningiomas are very commonly diagnosed intracranial primary neoplasms, of which the chordoid subtype is seldom encountered. Our aim was to retrospectively review preoperative MR imaging of intracranial chordoid meningiomas, a rare WHO grade II variant, in an effort to determine if there exist distinguishing MR imaging characteristics that can aid in differentiating this atypical variety from other meningioma subtypes. MATERIALS AND METHODS Ten cases of WHO grade II chordoid meningioma were diagnosed at our institution over an 11-year span, 8 of which had preoperative MR imaging available for review and were included in our analysis. Chordoid meningioma MR imaging characteristics, including ADC values and normalized ADC ratios, were compared with those of 80 consecutive cases of WHO grade I meningioma, 21 consecutive cases of nonchordoid WHO grade II meningioma, and 1 case of WHO grade III meningioma. RESULTS Preoperative MR imaging revealed no significant differences in size, location, signal characteristics, or contrast enhancement between chordoid meningiomas and other meningiomas. There were, however, clear differences in the ADC values and normalized ADC ratios, with a mean absolute ADC value of 1.62 ± 0.33 × 10(-3) mm(2)/s and a mean normalized ADC ratio of 2.22 ± 0.47 × 10(-3) mm(2)/s in chordoid meningiomas compared with mean ADC and normalized ADC values, respectively, of 0.88 ± 0.13 × 10(-3) mm(2)/s and 1.17 ± 0.16 × 10(-3) mm(2)/s in benign WHO grade I meningiomas, 0.84 ± 0.11 × 10(-3) mm(2)/s and 1.11 ± 0.15 × 10(-3) mm(2)/s in nonchordoid WHO grade II meningiomas, and 0.57 × 10(-3) mm(2)/s and 0.75 × 10(-3) mm(2)/s in the 1 WHO grade III meningioma. CONCLUSIONS Chordoid meningiomas have statistically significant elevations of ADC and normalized ADC values when compared with all other WHO grade I, II, and III subtypes, which enables reliable preoperative prediction of this atypical histopathologic diagnosis.
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Affiliation(s)
- J B Pond
- From the Departments of Neuroradiology (J.B.P., T.G.M., Z.F.Y., D.B.M.)
| | - T G Morgan
- From the Departments of Neuroradiology (J.B.P., T.G.M., Z.F.Y., D.B.M.)
| | | | - Z F Yetkin
- From the Departments of Neuroradiology (J.B.P., T.G.M., Z.F.Y., D.B.M.)
| | - B E Mickey
- Neurosurgery (B.E.M.), University of Texas Southwestern Medical Center, Dallas, Texas
| | - D B Mendelsohn
- From the Departments of Neuroradiology (J.B.P., T.G.M., Z.F.Y., D.B.M.)
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Di Ieva A, Laiq S, Nejad R, Schmitz EM, Fathalla H, Karamchandani J, Munoz DG, Cusimano MD. Chordoid meningiomas: Incidence and clinicopathological features of a case series over 18 years. Neuropathology 2014; 35:137-47. [DOI: 10.1111/neup.12174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Antonio Di Ieva
- Department of Surgery; Division of Neurosurgery; St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | - Simin Laiq
- Department of Laboratory Medicine and Pathology; St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | - Romina Nejad
- Department of Surgery; Division of Neurosurgery; St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | - Erika M. Schmitz
- Department of Surgery; Division of Neurosurgery; St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | - Hussein Fathalla
- Department of Surgery; Division of Neurosurgery; St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | - Jason Karamchandani
- Department of Laboratory Medicine and Pathology; St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | - David G. Munoz
- Department of Laboratory Medicine and Pathology; St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
| | - Michael D. Cusimano
- Department of Surgery; Division of Neurosurgery; St. Michael's Hospital; University of Toronto; Toronto Ontario Canada
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George B, Bresson D, Bouazza S, Froelich S, Mandonnet E, Hamdi S, Orabi M, Polivka M, Cazorla A, Adle-Biassette H, Guichard JP, Duet M, Gayat E, Vallée F, Canova CH, Riet F, Bolle S, Calugaru V, Dendale R, Mazeron JJ, Feuvret L, Boissier E, Vignot S, Puget S, Sainte-Rose C, Beccaria K. [Chordoma]. Neurochirurgie 2014; 60:63-140. [PMID: 24856008 DOI: 10.1016/j.neuchi.2014.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 02/14/2014] [Accepted: 03/11/2014] [Indexed: 12/28/2022]
Abstract
PURPOSES To review in the literature, all the epidemiological, clinical, radiological, histological and therapeutic data regarding chordomas as well as various notochordal entities: ecchordosis physaliphora, intradural and intraparenchymatous chordomas, benign notochordal cell tumors, parachordomas and extra-axial chordomas. To identify different types of chordomas, including familial forms, associations with tuberous sclerosis, Ollier's disease and Maffucci's syndrome, forms with metastasis and seeding. To assess the recent data regarding molecular biology and progress in targeted therapy. To compare the different types of radiotherapy, especially protontherapy and their therapeutic effects. To review the largest series of chordomas in their different localizations (skull base, sacrum and mobile spine) from the literature. MATERIALS The series of 136 chordomas treated and followed up over 20 years (1972-2012) in the department of neurosurgery at Lariboisière hospital is reviewed. It includes: 58 chordomas of the skull base, 47 of the craniocervical junction, 23 of the cervical spine and 8 from the lombosacral region. Similarly, 31 chordomas in children (less than 18 years of age), observed in the departments of neurosurgery of les Enfants-Malades and Lariboisière hospitals, are presented. They were observed between 1976 and 2010 and were located intracranially (n=22 including 13 with cervical extension), 4 at the craniocervical junction level and 5 in the cervical spine. METHODS In the entire Lariboisière series and in the different groups of localization, different parameters were analyzed: the delay of diagnosis, of follow-up, of occurrence of metastasis, recurrence and death, the number of primary patients and patients referred to us after progression or recurrence and the number of deaths, recurrences and metastases. The influence of the quality of resection (total, subtotal and partial) on the prognosis is also presented. Kaplan-Meier actuarial curves of overall survival and disease free survival were performed in the entire series, including the different groups of localization based on the following 4 parameters: age, primary and secondary patients, quality of resection and protontherapy. In the pediatric series, a similar analysis was carried-out but was limited by the small number of patients in the subgroups. RESULTS In the Lariboisière series, the mean delay of diagnosis is 10 months and the mean follow-up is 80 months in each group. The delay before recurrence, metastasis and death is always better for the skull base chordomas and worse for those of the craniocervical junction, which have similar results to those of the cervical spine. Similar figures were observed as regards the number of deaths, metastases and recurrences. Quality of resection is the major factor of prognosis with 20.5 % of deaths and 28 % of recurrences after total resection as compared to 52.5 % and 47.5 % after subtotal resection. This is still more obvious in the group of skull base chordomas. Adding protontherapy to a total resection can still improve the results but there is no change after subtotal resection. The actuarial curve of overall survival shows a clear cut in the slope with some chordomas having a fast evolution towards recurrence and death in less than 4 years and others having a long survival of sometimes more than 20 years. Also, age has no influence on the prognosis. In primary patients, disease free survival is better than in secondary patients but not in overall survival. Protontherapy only improves the overall survival in the entire series and in the skull base group. Total resection improves both the overall and disease free survival in each group. Finally, the adjunct of protontherapy after total resection is clearly demonstrated. In the pediatric series, the median follow-up is 5.7 years. Overall survival and disease free survival are respectively 63 % and 54.3 %. Factors of prognosis are the histological type (atypical forms), localization (worse for the cervical spine and better for the clivus) and again it will depend on the quality of resection. CONCLUSIONS Many different pathologies derived from the notochord can be observed: some are remnants, some may be precursors of chordomas and some have similar features but are probably not genuine chordomas. To-day, immuno-histological studies should permit to differentiate them from real chordomas. Improving knowledge of molecular biology raises hopes for complementary treatments but to date the quality of surgical resection is still the main factor of prognosis. Complementary protontherapy seems useful, especially in skull base chordomas, which have better overall results than those of the craniocervical junction and of the cervical spine. However, we are still lacking an intrinsic marker of evolution to differentiate the slow growing chordomas with an indolent evolution from aggressive types leading rapidly to recurrence and death on which more aggressive treatments should be applied.
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Affiliation(s)
- B George
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
| | - D Bresson
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Bouazza
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Froelich
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - E Mandonnet
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S Hamdi
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Orabi
- Service de neurochirurgie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Polivka
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - A Cazorla
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - H Adle-Biassette
- Service d'anatomopathologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - J-P Guichard
- Service de neuroradiologie, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - M Duet
- Service de médecine nucléaire, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - E Gayat
- Service d'anesthésie-réanimation, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - F Vallée
- Service d'anesthésie-réanimation, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - C-H Canova
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Riet
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Bolle
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - V Calugaru
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Dendale
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J-J Mazeron
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - L Feuvret
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Boissier
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Vignot
- Service de radiothérapie et d'oncologie médicale, hôpital de la Salpêtrière, institut Gustave-Roussy, institut Curie, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Puget
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - C Sainte-Rose
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - K Beccaria
- Service de neurochirurgie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
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35
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Lal A, Dahiya S, Gonzales M, Hiniker A, Prayson R, Kleinschmidt-DeMasters BK, Perry A. IgG4 overexpression is rare in meningiomas with a prominent inflammatory component: a review of 16 cases. Brain Pathol 2014; 24:352-9. [PMID: 24467316 DOI: 10.1111/bpa.12128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 01/22/2014] [Indexed: 12/24/2022] Open
Abstract
Meningiomas with prominent inflammation are traditionally classified as "lymphoplasmacyte-rich meningioma" (LPM). Both inflammatory and neoplastic meningeal proliferations have recently been linked to IgG4 disease, although a potential association with LPM has not been previously explored. Sixteen meningiomas with inflammatory cells outnumbering tumor cells were further characterized by CD3, CD20, CD68 and/or CD163, CD138, kappa, lambda, IgG and IgG4 immunostains. There were 11 female and 4 male patients, ranging from 22 to 78 (median 59) years of age. Tumors consisted of 10 World Health Organization (WHO) grade I, 5 grade II and 1 grade III LPMs. Immunohistochemically, the most numerous cell type was the macrophage in all cases followed by CD3-positive T cells and fewer CD20-positive B cells. Plasma cells ranged from moderate-marked (N = 5) to rare (N = 7), or absent (N = 4). Maximal numbers of IgG4 plasma cells per high power field (HPF) ranged from 0 to 32, with only two cases having counts exceeding 10/HPF. The IgG4/IgG ratio was increased focally in only two cases (30% and 31%). Additionally, plasma cells represented only a minor component in most examples, whereas macrophages predominated, suggesting that "inflammation-rich meningioma" may be a more accurate term. The inflammatory stimulus for most cases remains to be elucidated.
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Affiliation(s)
- Aseem Lal
- Department of Pathology, University of California San Francisco, San Francisco, CA
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Wang XQ, Mei GH, Zhao L, Li ST, Gong Y, Zhong J, Chen H, Jiang CC. Clinical features and treatment of intracranial chordoid meningioma: a report of 30 cases. Histopathology 2013; 62:1002-17. [PMID: 23617629 DOI: 10.1111/his.12113] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 02/17/2013] [Indexed: 12/26/2022]
Affiliation(s)
- Xiao-Qiang Wang
- Department of Neurosurgery; Huashan Hospital; Fudan University; Shanghai; China
| | - Guang-Hai Mei
- Department of Neurosurgery; Huashan Hospital; Fudan University; Shanghai; China
| | - Lin Zhao
- Department of Neurosurgery; Huashan Hospital; Fudan University; Shanghai; China
| | - Shi-Ting Li
- Department of Neurosurgery; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai; China
| | - Ye Gong
- Department of Neurosurgery; Huashan Hospital; Fudan University; Shanghai; China
| | - Jun Zhong
- Department of Neurosurgery; Xinhua Hospital; Shanghai Jiaotong University School of Medicine; Shanghai; China
| | - Hong Chen
- Department of Neuropathology; Huashan Hospital; Fudan University; Shanghai; China
| | - Cheng-Chuan Jiang
- Department of Neurosurgery; Huashan Hospital; Fudan University; Shanghai; China
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Chordoid meningioma: a retrospective series of seven consecutive cases. Neurol Sci 2013; 34:1985-9. [DOI: 10.1007/s10072-013-1431-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 04/05/2013] [Indexed: 11/26/2022]
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Nambiar A, Pillai A, Parmar C, Panikar D. Intraventricular chordoid meningioma in a child: fever of unknown origin, clinical course, and response to treatment. J Neurosurg Pediatr 2012; 10:478-81. [PMID: 23061820 DOI: 10.3171/2012.9.peds11398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of an 11-year-old boy with an intraventricular chordoid meningioma, which is a rare presentation of prolonged fever of unknown origin due to a rare tumor in a rare location. The fever resolved after excision of the lesion. Subsequent imaging revealed recurrence at 1 year. After a repeat excision and fractionated radiotherapy, the patient has remained disease free 5 years after the first surgery. Very few cases of intraventricular chordoid meningioma have been reported to date. The pathological features and clinical course are described. A review of the literature describing management options for this tumor type, recently found to have a higher recurrence rate, is described herein.
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Affiliation(s)
- Ajit Nambiar
- Department of Neurosurgery, Amrita College of Medicine, Kochi, Kerala, India
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Lee KH, Lall RR, Chandler JP, Bigio EH, Mao Q. Pineal chordoid meningioma complicated by repetitive hemorrhage during pregnancy: Case report and literature review. Neuropathology 2012; 33:192-8. [DOI: 10.1111/j.1440-1789.2012.01337.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Xi S, Zhang Y, Lin S, Liang J, Zeng J, Wu Q. Intraparenchymal Chordoid Meningioma. Int J Surg Pathol 2012; 20:600-5. [DOI: 10.1177/1066896912449043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most meningiomas are benign and correspond to World Health Organization grade I, whereas chordoid meningioma is a rare subtype, which is regarded as grade II. This report presents 1 case of intraparenchymal chordoid meningioma. The intraparenchymal chordoid meningioma consisted predominantly of tissue that was histologically similar to chordoma, featuring cords or trabeculae of eosinophilic and often vacuolated cells in an abundant mucoid matrix background. Tumor cells were diffusing positive for epithelial membrane antigen and vimentin, and focusing positively for progesterone receptor, but showed lack of immunoreactivity with cytokeratin, S-100, and glial fibrillary acidic protein. Follow-up at 8 months showed no recurrence. Reports about chordoid meningioma are not uncommon, but reports on intraparenchymal lesion are rare. Besides, the result of magnetic resonance imaging in the present case suggested that intraparenchymal chordoid meningioma was a metastasis tumor. This report reminds of the importance of differential diagnosis in the case of intraparenchymal lesion.
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Affiliation(s)
- Shaoyan Xi
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yu Zhang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Suxia Lin
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | | | - Jing Zeng
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Qiuliang Wu
- Sun Yat-Sen University Cancer Center, Guangzhou, China
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A clinicopathological study of the significance of the proportion of choroid morphology in chordoid meningioma. J Clin Neurosci 2012; 19:836-43. [DOI: 10.1016/j.jocn.2011.08.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 08/19/2011] [Accepted: 08/19/2011] [Indexed: 11/18/2022]
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Saito A, Nakazato Y, Yoshii Y, Hyodo A, Harakuni T, Toita T, Ogawa K, Horikawa K, Terada Y, Kinjo S, Minei S. Anaplastic meningioma with papillary, rhabdoid, and epithelial features: a case report. Brain Tumor Pathol 2012; 18:155-9. [PMID: 11908873 DOI: 10.1007/bf02479430] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A 74-year-old man manifested disturbed consciousness and right hemiparesis. Computed tomography revealed a left frontal parasagittal meningeal tumor with extensive peritumoral brain edema and skull invasion. Subtotal removal was performed. Five years later, he underwent two more operations of massive recurrences. Pathological studies revealed anaplastic meningioma with two different histological areas. One was an epithelial and meningothelial area, and the other was a papillary and rhabdoid area. In the papillary and rhabdoid area, small tumor cells with a high nucleus/cytoplasm ratio proliferated densely around the dilated central capillaries with a pseudopapillary pattern. Many rhabdoid cells (vimentin ++, cytokeratin AE1/AE3 +, epithelial membrane antigen [EMA] + +) tended to be distributed far from the central capillaries. There were many mitotic figures near the central vessels. Dense MIB1-positive nuclei were also observed near the central vessels. The trabecular pattern of the tumor cells in the epithelial area was quite different from the histological features of chordoid meningioma.
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Affiliation(s)
- A Saito
- Department of Neurosurgery, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan
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Abstract
This article constitutes a mini-review of the pathology and genetics of meningiomas. Meningiomas are the most common primary intracranial tumors. They are usually durally based and are often found adjacent to venous sinuses and dural infoldings. The majority of these tumors are WHO grade I, although a minority is WHO grade II, atypical, or WHO grade III, anaplastic. Grade II and III meningiomas show a greater tendency than Grade I tumors to recur and metastasize. The current WHO scheme recognizes 15 histologic subtypes of meningiomas. Nine of these are WHO grade I, three are grade II, and three are grade III. In addition to these histologic subtypes, meningiomas can also be graded on the basis of mitotic activity, evidence of brain invasion, growth pattern cellular density, nuclear atypia, and necrosis. Loss of the long arm of chromosome 22, which is usually associated with inactivation of the NF2 gene, is the most common genetic abnormality found in meningiomas. Other chromosomal abnormalities associated with tumorogenesis and increased gradeof meningiomas include loss of heterozygosity for chromosome 1p, loss of 14q, deletion of 9p21, abnormalities of chromosome 10 and 17q. Telomerase activity increases with meningiomas grade as well. The only proven environmental risk factor for meningiomas is ionizing radiation. Radiation-induced meningiomas are more often multiple and have higher recurrence rates than standard meningiomas.
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Affiliation(s)
- Hussein Alahmadi
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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Abstract
PURPOSE Optic neuropathy associated with proptosis and ocular motility restrictions is suggestive of a compressive etiology. This raises concern for a mass lesion involving the orbit or orbital apex. Meningiomas, which account for 4% of all intraorbital tumors and 20 to 30% of all intracranial tumors, are capable of compressing critical anatomic structures within the orbit or orbital apex, and thereby impairing both afferent and efferent visual function. The purpose of this case report is to present a case of chordoid meningioma associated with compressive optic neuropathy. METHODS A 51-year-old woman presented with clinicopathological features pathognomonic of compressive optic neuropathy and orbital apex syndrome. Radiologic and neuropathologic evaluation revealed a large right anterior temporal atypical meningioma with chordoid features associated with frontal intraparenchymal edema. The therapeutic intervention consisted of orbitozygomatic craniotomy and radiotherapy. RESULTS Postoperatively, the patient progressed very well with considerable improvement of her visual and oculomotor function. The MIB-1 labeling index of 5 to 7% calls for close observation because of an increased probability of recurrence. CONCLUSIONS This case highlights the importance of prompt diagnosis and treatment, because chordoid meningiomas exhibit a more aggressive biological behavior, with the potential to cause significant morbidity because of mass effect and higher risk of recurrence. To our knowledge, this is the first report of a rare case of a chordoid meningioma in the anterior temporal lobe that presented as a compressive optic neuropathy. The details of this case are presented with a review of relevant literature.
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Zhao SL, Li Y, Tian XY, Li Z, Huang Q, Li B. Intraparenchymal cystic chordoid meningioma: A case report and review of the literature. Neuropathology 2011; 31:648-53. [DOI: 10.1111/j.1440-1789.2011.01214.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Pediatric meningioma: current approaches and future direction. J Neurooncol 2011; 104:1-10. [DOI: 10.1007/s11060-010-0503-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 12/13/2010] [Indexed: 01/09/2023]
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47
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Report of two cases of chordoid meningioma in patients with Castleman syndrome. J Neurooncol 2010; 104:395-7. [DOI: 10.1007/s11060-010-0483-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
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48
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Jeon CJ, Kim MJ, Lee JS, Lee JH, Kong DS, Shin HJ, Suh YL, Kim KM, Choe YH. Castleman's disease associated with a cerebellar chordoid meningioma and intestinal lymphangiectasia. Childs Nerv Syst 2010; 26:1647-52. [PMID: 20567835 DOI: 10.1007/s00381-010-1196-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 06/04/2010] [Indexed: 11/26/2022]
Abstract
Castleman's disease (CD) is a rare nonneoplastic lymphoproliferative disorder of unknown etiology. It is characterized by enlarged hyperplastic lymph nodes, usually presenting as a localized mass. Although an intracranial location is very uncommon, it should be considered in the differential diagnosis of a chordoid meningioma. We describe a pediatric case of CD with a cerebellar chordoid meningioma and intestinal lymphangiectasia.
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Affiliation(s)
- Chul Jin Jeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Wind JJ, Jones RV, Roberti F. Fourth ventricular chordoid meningioma. J Clin Neurosci 2010; 17:1301-3. [DOI: 10.1016/j.jocn.2010.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 03/07/2010] [Indexed: 11/29/2022]
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50
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Mawrin C, Perry A. Pathological classification and molecular genetics of meningiomas. J Neurooncol 2010; 99:379-91. [PMID: 20809251 DOI: 10.1007/s11060-010-0342-2] [Citation(s) in RCA: 276] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 08/04/2010] [Indexed: 12/11/2022]
Abstract
Meningiomas are extremely common adult brain tumors originating from meningeal coverings of the brain and spinal cord. While most are slowly growing Word Health organization (WHO) grade I tumors, rare variants (clear cell, chordoid, papillary, and rhabdoid), as well as brain invasive (WHO grade II), atypical (WHO grade II), and anaplastic (WHO grade III) meningiomas are considerably more aggressive. This review summarizes the histopathological and genetic features of meningiomas, including differential diagnosis, pitfalls, and grading challenges. Early stages of meningioma tumorigenesis are closely linked to inactivation of one or more members of the 4.1 superfamily, including the neurofibromatosis type 2 (NF2) and 4.1B (DAL-1) genes, which interact with the 14-3-3 protein family. Other chromosome 22q genes implicated include BAM22, BCR (breakpoint cluster region), and TIMP-1, the last of which is implicated in higher-grade meningiomas. Atypical meningiomas also commonly show chromosomal losses of 1p, 6q, 10, 14q, and 18q, as well as multiple chromosomal gains. While most relevant genes remain unknown, two chromosome 14q candidates (MEG3 and NDRG2) have recently been identified. In addition to alterations of CDKN2A, p14(ARF), and CDKN2B tumor suppressor genes on 9p21, a contribution of the wingless (wnt) pathway with alterations of the E-cadherin and beta-catenin proteins, as well as alterations of the hedgehog signaling pathway have been implicated in anaplastic meningiomas. The integration of histopathological appearance, complex genetic/genomic data, and outcome will likely result in the identification of clinically distinct meningioma subgroups, which in turn can facilitate the development of targeted therapeutic strategies.
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Affiliation(s)
- Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke-University Magdeburg, Leipziger Strasse 44, Magdeburg, Germany.
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