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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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2
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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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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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4
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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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5
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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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6
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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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7
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Malgulwar PB, Kakkar A, Sharma MC, Ghosh R, Pathak P, Sarkar C, Suri V, Singh M, Kale SS, Faruq M. Loss of SMARCB1/INI1 Immunoexpression in Chordoid Meningiomas. Neurol India 2020; 67:1492-1497. [PMID: 31857543 DOI: 10.4103/0028-3886.273647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Chordoid meningiomas have an aggressive clinical course characterized by frequent recurrences. Recent whole-genome sequencing studies demonstrated Chr22 loss in chordoid meningiomas not accounted for by NF2 mutations. SMARCB1/INI1 is a candidate gene on Chr22, which has not been analyzed extensively in meningiomas. AKT1 mutation has been recently identified to be a driver of meningiomagenesis. Materials and Methods Cases of chordoid meningioma were retrieved along with meningiomas of other subtypes for comparison. INI1 immunohistochemistry was performed. SMARCB1 and AKT1 were analyzed by sequencing. Results Sixteen chordoid meningiomas were identified (1.1% of all meningiomas). Six cases (37.5%) showed loss of INI1 immunoexpression. All other meningioma subtypes (n = 16) retained INI1 immunoexpression. AKT1 E17K mutation was identified in one case (16.7%). Notably, SMARCB1 mutations were not identified in any of the chordoid meningiomas analyzed, including those showing INI1 loss immunohistochemically. Conclusion This is the first study to demonstrate loss of SMARCB1/INI1 immunoexpression in chordoid meningiomas, adding to the tumors with INI1 loss. However, in absence of INI1 mutation, mechanisms for INI1 loss require further evaluation. Identification of AKT1 mutation opens up new avenues for targeted therapy in patients with such aggressive tumors.
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Affiliation(s)
- Prit B Malgulwar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ranajoy Ghosh
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Pathak
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine, Institute of Genomics and Integrative Biology-Council of Scientific and Industrial Research, New Delhi, India
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8
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Yagi C, Yamamuro S, Ozawa Y, Yoshimura S, Sumi K, Yoshino A. A Case of Tuberculum Sellae Chordoid Meningioma Treated via Extended Endoscopic Endonasal Trans-sphenoidal Surgery. NMC Case Rep J 2020; 7:53-56. [PMID: 32322451 PMCID: PMC7162809 DOI: 10.2176/nmccrj.cr.2019-0083] [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: 04/22/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022] Open
Abstract
A 68-year-old female was admitted to our hospital with right-sided hemianopsia. Magnetic resonance imaging (MRI) demonstrated a well-enhanced tuberculum sellae region tumor. The patient underwent surgical tumor resection via an extended endoscopic endonasal trans-sphenoidal approach and the tumor was totally removed. The mass was extremely soft and there was no clear attachment between it and the dura mater. Furthermore, the histopathological findings obtained for the tumor during intra-operative rapid diagnosis were divergent from typical meningioma. We therefore diagnosed the tumor intra-operatively as a pituitary adenoma. However, the post-operative pathological diagnosis for the tumor was chordoid meningioma (CM). CM is a rare subtype of meningioma, and most of such tumors arise in the convexity. In the preoperative MRI in the present case, meningioma was suspected; however, since we did not consider CM for differential diagnosis, we failed to reach an accurate diagnosis during the operation. Tuberculum sellae CM is very rare, and only a few cases have been reported previously. The surgical strategy will differ greatly depending on whether the tumor is a meningioma or a pituitary adenoma, especially when treatment involves the dura mater. The pre and/or intra-operative diagnosis is thus very important for developing an accurate treatment strategy. We report here the details of our rare case and describe the intra-operative features of tuberculum sellae CM.
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Affiliation(s)
- Chihiro Yagi
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Shun Yamamuro
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshinari Ozawa
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Sodai Yoshimura
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Koichiro Sumi
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
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9
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Luo W, Xu Y, Yang J, Liu Z, Liu H. Fourth Ventricular Meningiomas. World Neurosurg 2019; 127:e1201-e1209. [PMID: 31004862 DOI: 10.1016/j.wneu.2019.04.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Fourth ventricular meningiomas (FVMs) are extremely rare. Here, we report a series of 11 patients at a single institution. A comprehensive literature analysis is conducted. METHODS Information about 11 patient was extracted from the patient data. Reports of cases in English were obtained from the literature. Including our 11 patients, 71 patients were analyzed in this study. RESULTS The most common age of onset was from the third decade to sixth decade of life. The female/male ratio was about 1.16:1. The most frequent subtype of meningioma was fibrous meningioma. FVMs had specific imaging features, such as calcification (20%), peritumoral edema (30.3%), heterogeneous enhancement (22.5%), cystic formation (4.3%), and hydrocephalus (52.8%). The proportion of total tumor resection was about 94.9%, with 15.3% of postoperative complications. During follow-up, the recurrent rate of FVMs was about 6.8%. There was no significant difference in the analysis of correlation between hydrocephalus and the maximum diameter of tumors, correlation between hydrocephalus and the volume of tumor, or correlation between peritumoral edema and the volume of tumor, as well as correlation between heterogeneous enhancement and the grade of meningiomas. CONCLUSIONS FVMs have their own characteristics in age of onset, gender ratio, histologic types, and imaging features. The recommended treatment is surgical treatment via the telovelar approach with suboccipital craniotomy/craniectomy. Adjuvant therapy is needed in some high-grade meningiomas and in patients undergoing partial resection. The prognosis is relatively good, with fewer postoperative complications and a higher rate of total resection.
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Affiliation(s)
- Wei Luo
- Department of Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yulun Xu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongmin Liu
- Department of Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hai Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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10
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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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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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12
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Pathogenesis of peri-tumoral edema in intracranial meningiomas. Neurosurg Rev 2017; 42:59-71. [DOI: 10.1007/s10143-017-0897-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/23/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022]
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13
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Zakhari N, Torres C, Castillo M, Nguyen TB. Uncommon Cranial Meningioma: Key Imaging Features on Conventional and Advanced Imaging. Clin Neuroradiol 2017; 27:135-144. [PMID: 28466126 DOI: 10.1007/s00062-017-0583-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/04/2017] [Indexed: 11/29/2022]
Abstract
Given the high incidence of intracranial meningiomas encountered in clinical practice, it is not uncommon to find rare subtypes of meningioma, with unusual imaging findings. These commonly represent a diagnostic challenge. In this article, we review the imaging appearance of typical meningioma on conventional and advanced imaging as well as the key imaging features of multiple uncommon subtypes: cystic, microcystic, lipomatous, chordoid, angiomatous, intraosseous, extracranial, atypical/malignant, and tumor-to-tumor metastasis (also known as collision tumors). Some of these uncommon subtypes, however, demonstrate imaging features that may allow for a more specific diagnosis, or features, which can influence patient's management.
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Affiliation(s)
- Nader Zakhari
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada
| | - Carlos Torres
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326 Old Infirmary Building, Manning Drive, 27599-7510, Chapel Hill, NC, USA
| | - Thanh B Nguyen
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, 1053 Carling Avenue, K1Y 4E9, Ottawa, Ontario, Canada
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14
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Barresi V, Caffo M, Tuccari G. Classification of human meningiomas: lights, shadows, and future perspectives. J Neurosci Res 2016; 94:1604-1612. [DOI: 10.1002/jnr.23801] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Valeria Barresi
- Department of Human Pathology “G. Barresi,”; University of Messina; Messina Italy
| | - Maria Caffo
- Department of Neuroscience; University of Messina; Messina Italy
| | - Giovanni Tuccari
- Department of Human Pathology “G. Barresi,”; University of Messina; Messina Italy
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15
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Jiménez-Heffernan JA, Urquía-Renke A, Bárcena C, Fraga J. Utility of diff-quik stained smears in the cytologic diagnosis of chordoid meningioma. Diagn Cytopathol 2016; 44:811-3. [PMID: 27534736 DOI: 10.1002/dc.23555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 11/09/2022]
Affiliation(s)
- José A Jiménez-Heffernan
- Department of Pathology, Hospital Universitario La Princesa, Madrid, Spain. .,Department of Pathology, Labco Pathology, Madrid, Spain.
| | | | - Carmen Bárcena
- Department of Pathology, Labco Pathology, Madrid, Spain.,Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier Fraga
- Department of Pathology, Hospital Universitario La Princesa, Madrid, Spain.,Department of Pathology, Labco Pathology, Madrid, Spain
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Sadashiva N, Rao S, Srinivas D, Shukla D. Primary intra-fourth ventricular meningioma: Report two cases. J Neurosci Rural Pract 2016; 7:276-8. [PMID: 27114661 PMCID: PMC4821938 DOI: 10.4103/0976-3147.178665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Meningioma's occurring intraventricular region are rare and these occurring in the fourth ventricle is even rare. Because of the rarity, it is not usually considered as a differential diagnosis in any age group. Clinical features and Imaging is not characteristic, and most of them are thought to be some different tumor. Here, we discuss two cases harboring a primary fourth ventricular meningioma Grade II, which was surgically excised successfully. Total excision was achieved in both cases and as the tumor was firm to soft and vermian splitting was not required. Understanding the clinical features and a careful preoperative radiological examination is required to differentiate this tumor from more commonly occurring lesions at this location.
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Affiliation(s)
- Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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17
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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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18
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Domingues P, González-Tablas M, Otero Á, Pascual D, Miranda D, Ruiz L, Sousa P, Ciudad J, Gonçalves JM, Lopes MC, Orfao A, Tabernero MD. Tumor infiltrating immune cells in gliomas and meningiomas. Brain Behav Immun 2016. [PMID: 26216710 DOI: 10.1016/j.bbi.2015.07.019] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Tumor-infiltrating immune cells are part of a complex microenvironment that promotes and/or regulates tumor development and growth. Depending on the type of cells and their functional interactions, immune cells may play a key role in suppressing the tumor or in providing support for tumor growth, with relevant effects on patient behavior. In recent years, important advances have been achieved in the characterization of immune cell infiltrates in central nervous system (CNS) tumors, but their role in tumorigenesis and patient behavior still remain poorly understood. Overall, these studies have shown significant but variable levels of infiltration of CNS tumors by macrophage/microglial cells (TAM) and to a less extent also lymphocytes (particularly T-cells and NK cells, and less frequently also B-cells). Of note, TAM infiltrate gliomas at moderate numbers where they frequently show an immune suppressive phenotype and functional behavior; in contrast, infiltration by TAM may be very pronounced in meningiomas, particularly in cases that carry isolated monosomy 22, where the immune infiltrates also contain greater numbers of cytotoxic T and NK-cells associated with an enhanced anti-tumoral immune response. In line with this, the presence of regulatory T cells, is usually limited to a small fraction of all meningiomas, while frequently found in gliomas. Despite these differences between gliomas and meningiomas, both tumors show heterogeneous levels of infiltration by immune cells with variable functionality. In this review we summarize current knowledge about tumor-infiltrating immune cells in the two most common types of CNS tumors-gliomas and meningiomas-, as well as the role that such immune cells may play in the tumor microenvironment in controlling and/or promoting tumor development, growth and control.
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Affiliation(s)
- Patrícia Domingues
- Centre for Neurosciences and Cell Biology and Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal; Centre for Cancer Research (CIC-IBMCC; CSIC/USAL; IBSAL) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - María González-Tablas
- Centre for Cancer Research (CIC-IBMCC; CSIC/USAL; IBSAL) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Álvaro Otero
- Neurosurgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | - Daniel Pascual
- Neurosurgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | - David Miranda
- Neurosurgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | - Laura Ruiz
- Neurosurgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | - Pablo Sousa
- Neurosurgery Service of the University Hospital of Salamanca, Salamanca, Spain
| | - Juana Ciudad
- Centre for Cancer Research (CIC-IBMCC; CSIC/USAL; IBSAL) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | | | - María Celeste Lopes
- Centre for Neurosciences and Cell Biology and Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - Alberto Orfao
- Centre for Cancer Research (CIC-IBMCC; CSIC/USAL; IBSAL) and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - María Dolores Tabernero
- Centre for Cancer Research (CIC-IBMCC; CSIC/USAL; IBSAL) and Department of Medicine, University of Salamanca, Salamanca, Spain; Neurosurgery Service of the University Hospital of Salamanca, Salamanca, Spain; Instituto de Estudios de Ciencias de la salud de Castilla y León (IECSCYL-IBSAL) and Research Unit of the University Hospital of Salamanca, Salamanca, Spain.
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19
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WU LIANG, YANG TAO, FANG JINGYI, ZHANG JUNTING, XU YULUN. Spinal chordoid meningioma in a child: A case report and review of the literature. Oncol Lett 2015; 10:3727-3731. [PMID: 26788198 PMCID: PMC4665262 DOI: 10.3892/ol.2015.3765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 09/04/2015] [Indexed: 11/06/2022] Open
Abstract
As an uncommon subtype of meningioma, chordoid meningioma (CM) of the spinal canal is extremely rare. There have been only two reported cases of intraspinal CM in the literature, and this lesion has not been previously reported in the pediatric age group. To the best of our knowledge, the present study reports the first case of spinal chordoid meningioma in a pediatric patient. A 12-year-old female presented with a 3-month history of progressive numbness and weakness in the right-side limbs, and intermittent pain in the neck and right shoulder. Spinal magnetic resonance imaging (MRI) revealed an intraspinal lesion at the C2-3 level with irregularly heterogeneous enhancement. The patient underwent a C2-3 laminotomy. Due to adhesion to the dura and proximity to the vertebral artery, the tumor was partially removed intraoperatively. The post-operative course was uneventful and the symptoms were apparently relieved. The patient experienced recurrence 5 years subsequent to surgery. MRI revealed an extradural regrown tumor at the C2-5 level. Partial removal combined with radiotherapy was performed. However, the patient experienced progression of tetraplegia and succumbed to severe pneumonia and respiratory failure 5 months subsequent to the second surgery. In the present study, the clinicoradiological findings and treatment outcome of this rare entity are discussed, in addition to a review of the relevant literature. Spinal CMs should be included in the differential diagnosis of intraspinal tumors of the pediatric spine. Multidisciplinary treatment, consisting of total surgical removal and adjuvant radiotherapy, should be considered due to the aggressive nature of this abnormality and the risk of long-term recurrence.
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Affiliation(s)
- LIANG WU
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - TAO YANG
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - JINGYI FANG
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, P.R. China
| | - JUNTING ZHANG
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - YULUN XU
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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20
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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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21
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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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22
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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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23
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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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Lee J, Yu HJ, Lee J, Kim JH, Shin HJ, Suh YL, Lee M. Chordoid meningioma in a pediatric patient with tuberous sclerosis complex. KOREAN JOURNAL OF PATHOLOGY 2014; 48:302-6. [PMID: 25214863 PMCID: PMC4160594 DOI: 10.4132/koreanjpathol.2014.48.4.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 11/23/2022]
Affiliation(s)
- Jiwon Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Joon Yu
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Department of Radiology and Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Munhyang Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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25
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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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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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Jabini R, Moradi A, Afsharnezhad S, Ayatollahi H, Behravan J, Raziee HR, Mosaffa F. Pathodiagnostic parameters and evaluation of O⁶- methyl guanine methyl transferase gene promoter methylation in meningiomas. Gene 2014; 538:348-53. [PMID: 24398011 DOI: 10.1016/j.gene.2013.12.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/30/2013] [Accepted: 12/16/2013] [Indexed: 12/28/2022]
Abstract
Histopathological evaluation and grading of meningioma give important prognostic information. We evaluated retrospectively monotonous sheeting, necrosis, hypercellularity, nuclear pleomorphism, small cell changes, brain invasion, mitosis, mast cells, psammoma bodies, MIB-1 labeling index (MIB-1 LI) and histological grade of 230 primary meningioma tumors according to the latest World Health Organization (WHO) classification. To reveal any possible association between clinical features and promoter hypermethylation of O(6)-methylguanine-DNA methyltransferase (MGMT) as an important epigenetic modification in many human cancers, we also evaluated the methylation status of MGMT in meningiomas by a SYBR-green-based real-time PCR method. There was a female predominance (2.38 to 1) in the meningiomas. The mean age of the patients was 49.9 ± 12.6 years (range 16 to 78 years). Transitional meningiomas were the most common subtype of the meningiomas (35.21%, n=81). Most of the meningiomas were located in the falx and parasagital area. There was a significant correlation between histopathological features of malignancy. These features were observed more frequently and with statistical relation to grade II rather than grade I. Mast cells, psammoma bodies and nuclear pleomorphism had poor associations (P>0.05). When we re-evaluated the tumor grading, 31 patients with grade I meningiomas were upgraded to grade II. None of the meningiomas tested by MSQP were methylated in MGMT promoter sequence. High MIB-1 LI could be indicative for higher grade of meningioma. Continuous revision of the classification system is needed to improve the accuracy of prognostic judgments in meningioma. The data confirm that there is no rationale to test meningiomas for MGMT methylation status.
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Affiliation(s)
- Raheleh Jabini
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad 91775-1365, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 91775-1365, Iran.
| | - Afshin Moradi
- Cancer Research Center, Shohada Hospital, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran 1931746345, Iran.
| | - Sima Afsharnezhad
- Department of Biochemistry, Mashhad Branch, Islamic Azad University of Mashhad, Mashhad 91735/413, Iran.
| | - Hossein Ayatollahi
- Cancer Molecular Pathology Research Center, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad 91766-99199, Iran.
| | - Javad Behravan
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad 91775-1365, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 91775-1365, Iran.
| | - Hamid Reza Raziee
- Department of Radiation Oncology, University of Toronto, Toronto M2N0C8, Canada.
| | - Fatemeh Mosaffa
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad 91775-1365, Iran; Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 91775-1365, Iran.
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Wang XQ, Chen H, Zhao L, Li ST, Hu J, Mei GH, Jiang CC. Intracranial Papillary Meningioma. Neurosurgery 2013; 73:777-90; discussion 789. [DOI: 10.1227/neu.0000000000000133] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
BACKGROUND:
Papillary meningioma (PM) is an uncommon meningioma subtype, and the clinical characteristics remain unclear.
OBJECTIVE:
To determine the clinical characteristics and prognosis of PM.
METHODS:
The clinical data of 30 PM patients were collected, the samples were reexamined, and the patients' prognoses were based on clinical observations and calculated according to the Kaplan-Meier method.
RESULTS:
The 30 patients included 16 males and 14 females (median: 34.0 years upon initial diagnosis). Of the 48 intracranial operations in the 30 patients, total removal was attained in 34 surgeries, and subtotal removal in 14 surgeries. Radiotherapy was provided in 20 patients. In 40 specimens with follow-up, 29 attained the positive aggressive factors. Six tumors showed positive progestogen receptor (PR) combined with negative Bcl-2. The median follow-up period was 39.0 months. Tumor recurrence occurred in 18 patients (median: 17.0 months); the recurrence rates following total removal and subtotal removal were 57.1% and 100%, respectively. Fourteen patients died of the recurrence. In the univariate analyses, positive aggressive factors (P = .021), positive PR combined with negative Bcl-2 immunoreactivity (P = .011), the extent of resection (P = .001), and radiotherapy (P = .002) were significantly related to progression-free survival. The MIB-1 labeling index was not significantly related to progression-free survival (P = .88).
CONCLUSION:
PM is a rare subtype of meningioma with a tendency of recurrence. The extent of resection is an important prognosis factor. The presence of positive histopathological index increases the recurrence risk. Positive PR combined with negative Bcl-2 immunoreaction might predict a good prognosis. Postoperative radiotherapy may play a vital role in prolonging the time to tumor recurrence.
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Affiliation(s)
- Xiao-Qiang Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Chen
- Department of Neuropathology, 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
| | - Jie Hu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guang-Hai Mei
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Cheng-Chuan Jiang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
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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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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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32
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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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Neuroradiological findings and clinical features of fourth-ventricular meningioma: A study of 10 cases. Clin Radiol 2012; 67:455-60. [DOI: 10.1016/j.crad.2011.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 10/24/2011] [Accepted: 10/27/2011] [Indexed: 11/16/2022]
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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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35
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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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36
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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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Lin JW, Ho JT, Lin YJ, Wu YT. Chordoid meningioma: a clinicopathologic study of 11 cases at a single institution. J Neurooncol 2010; 100:465-73. [PMID: 20454999 DOI: 10.1007/s11060-010-0211-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/14/2010] [Indexed: 10/19/2022]
Abstract
Chordoid meningioma is an uncommon variant of meningioma, which histologically bears a great resemblance to chordoma and often follows an aggressive clinical course. We examine clinicopathologic features of 11 cases of this rare tumor to further elucidate its behavior. Thirteen specimens of chordoid meningioma belonging to 11 patients were obtained at a single institution from 1995 to 2009. Correlations of histologic parameters, immunohistochemical study, and clinical features were assessed. This series included six men and five women with a mean age of 60.8 years at first surgery. Aside from one patient (case 5) who died of disease immediately after the first operation, the mean postoperative follow-up period for the other 10 patients was 41.4 months. Two patients each had a local tumor recurrence. The mean time to recurrence was 10.4 years. No systemic manifestations of Castleman syndrome, such as iron-refractory hypochromic/microcytic anemia and dysgammaglobulinemia, were found. Six tumors (46%) were classified as benign (grade I) and seven tumors (54%) atypical (grade II), if based solely on histologic grading irrespective of chordoid or clear cell components in our cases. Lymphoplasmacytic infiltrate was moderate in one tumor (7%), mild in eight tumors (62%), and absent in four tumors (31%). The inflammatory cells were predominantly T cells (CD3+), with only scarce B cells (CD20+). There was a wide range of MIB-1 labeling indices (0.3-25.8%, mean 7.5%), which increased following tumor recurrence. Our study demonstrates that chordoid meningiomas are not always associated with Castleman's Syndrome, and that this histologic category can be seen in the elderly as opposed to only in younger age groups.
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Affiliation(s)
- Jui-Wei Lin
- Department of Pathology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung County, Taiwan, ROC
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38
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Moiyadi AV, Sridhar E, Gupta T, Ramadwar M. A primary optic nerve sheath chordoid meningioma. J Clin Neurosci 2010; 17:397-9. [DOI: 10.1016/j.jocn.2009.05.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 05/28/2009] [Indexed: 10/20/2022]
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39
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Tena-Suck ML, Collado-Ortìz MA, Salinas-Lara C, García-López R, Gelista N, Rembao-Bojorquez D. Chordoid meningioma: a report of ten cases. J Neurooncol 2010; 99:41-8. [PMID: 20094774 DOI: 10.1007/s11060-009-0097-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Accepted: 12/07/2009] [Indexed: 11/30/2022]
Abstract
Chordoid meningioma is a rare variant of meningioma with histological features resembling those of chordoma. This tumor has a great risk of recurrence and aggressive growth (WHO grade II). This study was done to document the clinical and pathological features of ten patients with chordoid meningioma who submitted to surgery at the National Institute of Neurology and Neurosurgery in Mexico City. Clinical, histological and immunohistochemical features were examined. The age range was from 30 to 67 years old (mean, 34.2 years). Seven patients were female and three male. The duration of symptoms varied from 3.5 months to 5 years (mean, 14.1 months). No systemic symptoms were noted. The tumor was localized in eight cases in the supratentorial compartments. Histologically, the tumors were characterized by strands and cords of meningothelial cells arranged in a mucinous stroma. Two of the ten tumors showed metaplasic changes, and seven showed brain invasion. Tumor cells demonstrated CK7, EMA and focal S-100 protein and Ep-CAM. Cytokeratin AE1/AE3, GFAP and synaptophysin were negative. The MIB-1 proliferative index was from 6 to 9% (mean 7.8). PCNA Li was 6 to 20% (mean, 14), and microvascular density was 6-16 (mean, 14.5). The mean rate of the MIB-1 labeling index in recurrences was 7.1% versus 6.33% for no tumor recurrence. Chordoid meningioma, World Health Organization grade II, is an uncommon variant of meningioma with a propensity for aggressive behavior and increased likelihood of recurrence. Chordoid meningiomas are predominantly tumors of young adults with a predilection for the supratentorial location. Intraventricular location and absence of systemic manifestations, despite the presence of abundant B-lymphocytes, mast cells and low MIB-1 LI, are some of the interesting findings in the present series that need further study. Hence, a larger number of cases with adequate follow-up data need to be studied further to establish the clinical relevance of this variant.
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Affiliation(s)
- Martha Lilia Tena-Suck
- Department of Neuropathology, National Institute of Neurology and Neurosurgery, Mexico City, DF, Mexico.
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Hayashi T, Haba R, Kushida Y, Kadota K, Katsuki N, Bando K, Miyai Y, Shibuya S, Funamoto Y, Shindo A, Miyake K, Tamiya T. Cytopathologic features of orbital intraosseous chordoid meningioma: Report of a case and distinction from other myxoid/mucoid tumors. Diagn Cytopathol 2010; 38:818-21. [DOI: 10.1002/dc.21326] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Medic N, Lorenzon P, Vita F, Trevisan E, Marchioli A, Soranzo MR, Fabbretti E, Zabucchi G. Mast cell adhesion induces cytoskeletal modifications and programmed cell death in oligodendrocytes. J Neuroimmunol 2009; 218:57-66. [PMID: 19906445 DOI: 10.1016/j.jneuroim.2009.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 10/13/2009] [Accepted: 10/13/2009] [Indexed: 11/18/2022]
Abstract
In this paper we show that rat peritoneal mast cells (RPMC) adhere to rat oligodendrocytes (ODC) in culture and switch on a bi-directional signal affecting both adhering cell and its target. Following heterotypic interaction, RPMC release granule content and ODC show morphological changes and enter the apoptotic programme. Altogether, these findings indicate that the interaction of MC with ODC could play a role in the mechanism of CNS damage induced by the inflammatory reaction.
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Affiliation(s)
- Nevenka Medic
- Department of Life Sciences, University of Trieste, via A. Valerio, 28, 34127, Trieste, Italy
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Distinguishing chordoid meningiomas from their histologic mimics: an immunohistochemical evaluation. Am J Surg Pathol 2009; 33:669-81. [PMID: 19194275 DOI: 10.1097/pas.0b013e318194c566] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Chordoid meningioma, World Health Organization grade II, is an uncommon variant of meningioma with a propensity for aggressive behavior and increased likelihood of recurrence. As such, recognition of this entity is important in cases that show similar morphologic overlap with other chondroid/myxoid neoplasms that can arise within or near the central nervous system. A formal comparison of the immunohistochemical features of chordoid meningioma versus tumors with significant histologic overlap has not been previously reported. In this study, immunohistochemical staining was performed with antibodies against D2-40, S100, pankeratin, epithelial membrane antigen (EMA), brachyury, and glial fibrillary acidic protein (GFAP) in 4 cases of chordoid glioma, 6 skeletal myxoid chondrosarcomas, 10 chordoid meningiomas, 16 extraskeletal myxoid chondrosarcoma, 18 chordomas, 22 low-grade chondrosarcomas, and 27 enchondromas. Staining extent and intensity were evaluated semiquantitatively and mean values for each parameter were calculated. Immunostaining with D2-40 showed positivity in 100% of skeletal myxoid chondrosarcomas, 96% of enchondromas, 95% of low-grade chondrosarcomas, 80% of chordoid meningiomas, and 75% of chordoid gliomas. Staining with S100 demonstrated diffuse, strong positivity in all (100%) chordoid gliomas, skeletal myxoid chondrosarcomas, low-grade chondrosarcomas, and enchondromas, 94% of chordomas, and 81% of extraskeletal myxoid chondrosarcomas, with focal, moderate staining in 40% of chordoid meningiomas. Pankeratin highlighted 100% of chordoid gliomas and chordomas, 38% of extraskeletal myxoid chondrosarcomas, and 20% of chordoid meningiomas. EMA staining was positive in 100% of chordoid gliomas, 94% of chordomas, 90% of chordoid meningiomas, and 25% of extraskeletal myxoid chondrosarcomas. Brachyury was positive only in the chordomas (100%), whereas GFAP was positive only in the chordoid gliomas (100%). EMA was the most effective antibody for differentiating chordoid meningioma from skeletal myxoid chondrosarcoma, low-grade chondrosarcoma, and enchondroma, whereas D2-40 was the most effective antibody for differentiating chordoid meningioma from extraskeletal myxoid chondrosarcoma and chordoma. Our findings demonstrate that in conjunction with clinical and radiographic findings, immunohistochemical evaluation with a panel of D2-40, EMA, brachyury, and GFAP is most useful in distinguishing chordoid meningioma from chordoid glioma, skeletal myxoid chondrosarcoma, extraskeletal myxoid chondrosarcoma, chordoma, low-grade chondrosarcoma, and enchondroma. A lack of strong, diffuse S100 reactivity may also be useful in excluding chordoid meningioma. Among the neoplasms evaluated, brachyury and GFAP proved to be both sensitive and specific markers for chordoma and chordoid glioma, respectively. Of note, this study is the first to characterize the D2-40 immunoprofile in extraskeletal myxoid chondrosarcoma, results that could be of utility in differential diagnostic assessment.
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Kano T, Nakazato Y, Tamura M, Ohye C, Zama A, Saito F, Tomizawa S. Ultrastructural and immunohistochemical study of an adult case of chordoid meningioma. Brain Tumor Pathol 2009; 26:37-42. [DOI: 10.1007/s10014-009-0245-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 02/17/2009] [Indexed: 11/29/2022]
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Song KS, Park SH, Cho BK, Wang KC, Phi JH, Kim SK. Third ventricular chordoid meningioma in a child. J Neurosurg Pediatr 2008; 2:269-72. [PMID: 18831662 DOI: 10.3171/ped.2008.2.10.269] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Meningiomas are rare in children. Chordoid meningioma is a very rare variant, as only 16 cases in children have been reported. The authors report the first case of a chordoid meningioma in the third ventricle. A 12-year-old boy presented with headache, abnormal behaviors, and ataxia. Brain MR imaging revealed a 2-cm, well-enhanced mass in the third ventricle and hydrocephalus. Positron emission tomography with [18F]fluorodeoxyglucose showed that the mass was hypermetabolic. Gross-total removal of the mass was performed using a left frontal transcortical and transventricular approach. The mass originated from the left caudate head and was connected to the choroid plexus. A chordoid meningioma was diagnosed on the basis of the histological characteristics of the tumor, which was composed of cords and nests of eosinophilic vacuolated cells with an abundant myxoid matrix, similar to the features of a chordoma. A typical focal meningiomatous pattern was observed. The tumor cells were immunoreactive for vimentin and epithelial membrane antigen. The patient's headache and gait disturbance improved after the tumor was removed. The tumor showed no signs of recurrence during 12 months of follow-up.
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Affiliation(s)
- Kyung Sun Song
- Division of Pediatric Neurosurgery, Department of Pathology, Seoul National University Children's Hospital, Seoul, Republic of Korea
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Medic N, Vita F, Abbate R, Soranzo MR, Pacor S, Fabbretti E, Borelli V, Zabucchi G. Mast cell activation by myelin through scavenger receptor. J Neuroimmunol 2008; 200:27-40. [PMID: 18657868 DOI: 10.1016/j.jneuroim.2008.05.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 05/29/2008] [Accepted: 05/30/2008] [Indexed: 10/21/2022]
Abstract
A role for mast cells (MC) in the pathogenesis of multiple sclerosis (MS) has been suggested, based on the analysis of human lesions and on an animal model of the disease (EAE). What role MC play in the development of MS is not well understood. We hypothesized that the link connecting MC with demyelinating diseases may be represented by their interaction with myelin. Here we show that myelin can activate mast cells. This process could be a key event in the mast cell function required for inducing EAE in mice and possibly in MS in man.
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Affiliation(s)
- Nevenka Medic
- Department of Physiology and Pathology, University of Trieste, via A. Fleming 22, 34127 Trieste Italy
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Marhx-Bracho A, Rueda-Franco F, Ibarra-de la Torre A, García-González O, Bornstein-Quevedo L, de León-Bogorge B. Chordoid meningioma of the foramen magnum in a child: a case report and review of the literature. Childs Nerv Syst 2008; 24:623-7. [PMID: 18214497 DOI: 10.1007/s00381-007-0568-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Indexed: 11/30/2022]
Abstract
We report a 3-year-6-month-old boy with chordoid meningioma in the foramen magnum. Chordoid meningioma represents between 0.5 and 1.0% of all meningiomas, and it is frequently located in the supratentorial region. The patient started with an episode of instability, falls, and headache; after which, he developed cuadriparesis, cervical pain, and neck stiffness, which slightly improved after medical treatment, so he was referred to our hospital. Physical examination revealed left hemiparesis and cervical muscle spasm with left torticollis. Magnetic resonance imaging (MRI) demonstrated an intradural-extramedullary well-circumscribed, homogeneous enhancing mass, in the anterior part of the foramen magnum with cervical extension. The operative technique was the extreme-lateral craniocervical retrocondylar approach with total removal and dural coagulation. Histopathological examination demonstrated a chordoid meningioma, with meningotelial basophilic mucoid chordoma-like component in 80% of the tissue. The immunohistochemical stains were positive to epithelial membrane antigen, vimentin, and S-100 protein. At 10 months follow-up, the patient showed improvement in his neurological deficit with physical rehabilitation, and motor response in his extremities are now normal; neck stiffness with cervical spasm disappeared postoperatively. MRI showed no residual tumor. To our knowledge, this is the first report of a chordoid meningioma on the foramen magnum in a child.
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Affiliation(s)
- Alfonso Marhx-Bracho
- Department of Pediatric Neurosurgery, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Colonia Cuicuilco, Delegación Coyoacán, C.P. 04530, Mexico, DF, Mexico.
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Kozler P, Beneš V, Netuka D, Kramář F, Hrabal P, Charvát F. Chordoid meningioma: presentation of two case reports, review of the literature, and plea for data standardisation. J Neurooncol 2008; 88:115-20. [DOI: 10.1007/s11060-008-9541-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 02/04/2008] [Indexed: 11/29/2022]
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Park SC, Oh DE, Suh YL, Kim YD. Orbital Chordoid Meningioma: a Rare Subtype of Meningioma. Ophthalmic Plast Reconstr Surg 2007; 23:246-8. [PMID: 17519674 DOI: 10.1097/iop.0b013e31803eb1b9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 34-year-old woman presented with progressive proptosis of the right eye for 2 years. MRI revealed a well-demarcated mass in the right intraconal space, which was isointense on T(1)- and hyperintense on T(2)-weighted images with bright uniform enhancement. The mass was resected through a lateral orbitotomy. Histopathologic examination revealed cords and clusters of spindle and epithelioid cells embedded in a myxoid matrix, with vacuolated eosinophilic cytoplasm and round nuclei. The tumor cells were diffusely positive for epithelial membrane antigen and vimentin. These findings helped confirm the diagnosis of chordoid meningioma, a rare variant of meningioma with a greater risk of recurrence and aggressive growth. Many of the clinical manifestations and imaging findings were indistinguishable from those of cavernous hemangiomas, solitary fibrous tumors, neurofibromas, and other variants of meningiomas. Given the prognostic significance of chordoid meningioma, extra care and attention should be given during surgery, histopathologic assessment, and follow-up.
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Affiliation(s)
- Sung Chul Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Korea
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Braham E, Bellil S, Ben Hamouda K, Bettaieb I, Mekni A, Bellil K, Haouet S, Zitouna M, Kchir N. Le méningiome chordoïde. À propos de deux cas. Neurochirurgie 2007; 53:39-42. [PMID: 17337015 DOI: 10.1016/j.neuchi.2006.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Accepted: 11/22/2006] [Indexed: 11/20/2022]
Abstract
Chordoid meningioma is an uncommon histopathological variant of meningioma frequently confused with chordoma. Recurrence is not uncommon. The aim of our study is to present the clinical and pathological characteristics of this entity and a review of the literature. We report two cases of chordoid meningioma occurring in two women aged 47 and 63 years. Both women presented neurological signs without systemic disease. Radiological findings were temporoparietal and temporofrontal lesions with intense enhancement after contrast injection. Complete surgical resection was performed. Histopathologic findings were consistent with chordoid meningioma.
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Affiliation(s)
- E Braham
- Service d'anatomie et de cytologie pathologiques, hôpital La Rabta, 1007 Bab-Saadoun, Tunis, Tunisie.
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