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Li G, Tian Q, Wang S, Li K, Zhang Y, Cai Q. Superficial meningioma with bone involvement: surgical strategies and clinical outcomes. J Neurooncol 2024; 168:27-33. [PMID: 38689116 DOI: 10.1007/s11060-024-04604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Meningiomas with bone involvement account for 4.5-17% of all intracranial meningiomas. Little is known about whether these meningiomas (WHO grade I) behave differently than meningiomas without bone involvement. We sought to study the relatively uncommon imaging manifestations of meningioma and to evaluate their clinical significance. METHODS A single-institution retrospective cohort study of surgically treated superficial meningioma patients between 2011 and 2022 was conducted. Age, sex, preoperative imaging, operative data, and surgical outcomes were reviewed. Imaging variables and outcomes were reported for patients with bone-invading meningiomas and compared with those with nonbone-invading meningiomas. Univariate analyses were also conducted. RESULTS Of 577 total superficial meningiomas treated surgically, 47 (8.1%) exhibited bone invasion. Most bone-invading meningiomas were parasagittal (n = 29, 61.7%). A total of 12.7% (n = 6) of patients with bone-invading meningioma had recurrence, whereas 9.1% (n = 48) of patients with non-bone-invading meningioma had recurrence (p = 0.426). No significant difference in the median time to recurrence was observed between patients with bone-invading meningiomas and patients with nonbone-invading meningiomas (69.8 months, Q1:53.1; Q3:81.4 months vs. 69.7 months, Q1:47.5; Q3:96.7; p = 0.638). CONCLUSIONS Superficial meningioma with bone involvement had similar outcomes compared to those of superficial meningioma without bone involvement. Hyperostosis in meningioma (WHO grade I) may not be a surrogate for aggressive meningioma behavior.
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Affiliation(s)
- Gang Li
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Qilong Tian
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Shoujie Wang
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Kailu Li
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Yu Zhang
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China.
| | - Qing Cai
- Department of Neurosurgery, Tangdu hospital, Air Force Medical University, Xi'an, Shaanxi, China.
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Song X, Li Z. Coexistence of meningioma and craniofacial fibrous dysplasia: a case series of clinicopathological study and literature review. Orphanet J Rare Dis 2024; 19:30. [PMID: 38287340 PMCID: PMC10826192 DOI: 10.1186/s13023-024-03032-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The co-existence of meningioma and craniofacial fibrous dysplasia (CFD) is rare. Due to the similar radiological characteristics, it is challenging to differentiate such co-existence from solitary hyperostotic meningioma resulting in a dilemma of prompt diagnosis and appropriate intervention. METHOD We conducted a retrospective review of the data from 21 patients with concomitant meningioma and CFD who were treated at Beijing Tiantan Hospital from 2003 to 2021. We summarized their clinicopathological features and performed a comprehensive literature review. Additionally, we tested the characteristic pathogenic variants in exon 8 and 9 of GNAS gene and the expression of corresponding α-subunit of the stimulatory G protein (Gαs) related to CFD to explore the potential interactions between these two diseases. RESULTS The cohort comprised 4 men and 17 women (mean age, 45.14 years). CFD most commonly involved the sphenoid bone (n = 10) and meningiomas were predominantly located at the skull base (n = 12). Surgical treatment was performed in 4 CFD lesions and 14 meningiomas. Simpson grade I-II resection was achieved in 12 out of the 14 resected meningiomas and almost all of them were classified as WHO I grade (n = 13). The mean follow-up duration was 56.89 months and recurrence was noticed in 2 cases. Genetic study was conducted in 7 tumor specimens and immunohistochemistry was accomplished in 8 samples showing that though GNAS variant was not detected, Gαs protein were positively expressed in different degrees. CONCLUSIONS We presented an uncommon case series of co-diagnosed meningioma and CFD and provided a detailed description of its clinicopathological features, treatment strategy and prognosis. Although a definite causative relationship had not been established, possible genetic or environmental interplay between these two diseases could not be excluded. It was challenging to initiate prompt diagnosis and appropriate treatment for concomitant meningioma and CFD because of its similar radiological manifestations to meningioma with reactive hyperostosis. Personalized and multi-disciplinary management strategies should be adopted for the co-existence of meningioma and CFD.
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Affiliation(s)
- Xiaowen Song
- Department of Radiology, Center of Interventional Radiology and Vascular Surgery, Zhongda Hospital, Medical School, Southeast University, Nanjing, 210009, Jiangsu Province, China
- Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Zhi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Umbach G, Tran EB, Eaton CD, Choudhury A, Morshed R, Villanueva-Meyer JE, Theodosopoulos PV, Magill ST, McDermott MW, Raleigh DR, Goldschmidt E. Epidemiology, Genetics, and DNA Methylation Grouping of Hyperostotic Meningiomas. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01018. [PMID: 38189372 DOI: 10.1227/ons.0000000000001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Meningiomas are the most common primary intracranial tumors and are among the only tumors that can form lamellar, hyperostotic bone in the tumor microenvironment. Little is known about the epidemiology or molecular features of hyperostotic meningiomas. METHODS Using a retrospective database of 342 meningiomas treated with surgery at a single institution, we correlated clinical, tumor-related, targeted next-generation DNA sequencing (n = 39 total, 16 meningioma-induced hyperostosis [MIH]), and surgical variables with the presence of MIH using generalized linear models. Meningioma DNA methylation grouping was analyzed on a separate population of patients from the same institution with preoperative imaging studies sufficient for identification of MIH (n = 200). RESULTS MIH was significantly correlated with anterior fossa (44.3% of MIH vs 17.5% of non-MIH were in the anterior fossa P < .001, c2) or skull base location (62.5% vs 38.3%, P < .001, c2) and lower MIB-1 labeling index. Gross total resection was accomplished in 27.3% of tumors with MIH and 45.5% of nonhyperostotic meningiomas (P < .05, t test). There was no association between MIH and histological World Health Organization grade (P = .32, c2). MIH was significantly more frequent in meningiomas from the Merlin-intact DNA methylation group (P < .05). Somatic missense mutations in the WD-repeat-containing domain of the TRAF7 gene were the most common genetic alteration associated with MIH (n = 12 of 15, 80%, P < .01, c2). CONCLUSION In this article, we show that MIH has a predilection for the anterior skull base and affected tumors are less amenable to gross total resection. We find no association between MIH and histological World Health Organization grade, but show that MIH is more common in the Merlin-intact DNA methylation group and is significantly associated with TRAF7 somatic missense mutations. These data provide a framework for future investigation of biological mechanisms underlying MIH.
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Affiliation(s)
- Gray Umbach
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Edwina B Tran
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Charlotte D Eaton
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Abrar Choudhury
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Ramin Morshed
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Javier E Villanueva-Meyer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Philip V Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois, USA
| | | | - David R Raleigh
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
| | - Ezequiel Goldschmidt
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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Abstract
Meningiomas comprise a histologically and clinically diverse set of tumors arising from the meningothelial lining of the central nervous system. In the past decade, remarkable progress has been made in deciphering the biology of these common neoplasms. Nevertheless, effective systemic or molecular therapies for meningiomas remain elusive and are active areas of preclinical and clinical investigation. Thus, standard treatment modalities for meningiomas are limited to maximal safe resection, radiotherapy, or radiosurgery. This review examines the history, clinical rationale, and future directions of radiotherapy and radiosurgery as integral and effective treatments for meningiomas.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Calixto-Hope G Lucas
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL 60611, USA
| | - C Leland Rogers
- Radiation Oncology, GammaWest Cancer Services, Salt Lake City, UT, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
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Dincer A, Morales-Valero SF, Robert SM, Tabor JK, O'Brien J, Yalcin K, Fulbright RK, Erson-Omay Z, Dunn IF, Moliterno J. Surgical strategies for intracranial meningioma in the molecular era. J Neurooncol 2023; 162:253-265. [PMID: 37010677 PMCID: PMC10167142 DOI: 10.1007/s11060-023-04272-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/16/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Surgical resection has long been the treatment of choice for meningiomas and is considered curative in many cases. Indeed, the extent of resection (EOR) remains a significant factor in determining disease recurrence and outcome optimization for patients undergoing surgery. Although the Simpson Grading Scale continues to be widely accepted as the measure of EOR and is used to predict symptomatic recurrence, its utility is under increasing scrutiny. The influence of surgery in the definitive management of meningioma is being re-appraised considering the rapid evolution of our understanding of the biology of meningioma. DISCUSSION Although historically considered "benign" lesions, meningioma natural history can vary greatly, behaving with unexpectedly high recurrence rates and growth which do not always behave in accordance with their WHO grade. Histologically confirmed WHO grade 1 tumors may demonstrate unexpected recurrence, malignant transformation, and aggressive behavior, underscoring the molecular complexity and heterogeneity. CONCLUSION As our understanding of the clinical predictive power of genomic and epigenomic factors matures, we here discuss the importance of surgical decision-making paradigms in the context of our rapidly evolving understanding of these molecular features.
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Affiliation(s)
- Alper Dincer
- Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA
| | - Saul F Morales-Valero
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Stephanie M Robert
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Joanna K Tabor
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Joseph O'Brien
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Kanat Yalcin
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Robert K Fulbright
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Medical Center, Oklahoma City, OK, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA.
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA.
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Wang EJ, Haddad AF, Young JS, Morshed RA, Wu JPH, Salha DM, Butowski N, Aghi MK. Recent advances in the molecular prognostication of meningiomas. Front Oncol 2023; 12:910199. [PMID: 36686824 PMCID: PMC9845914 DOI: 10.3389/fonc.2022.910199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 11/17/2022] [Indexed: 01/05/2023] Open
Abstract
Meningiomas are the most common primary intracranial neoplasm. While traditionally viewed as benign, meningiomas are associated with significant patient morbidity, and certain meningioma subgroups display more aggressive and malignant behavior with higher rates of recurrence. Historically, the risk stratification of meningioma recurrence has been primarily associated with the World Health Organization histopathological grade and surgical extent of resection. However, a growing body of literature has highlighted the value of utilizing molecular characteristics to assess meningioma aggressiveness and recurrence risk. In this review, we discuss preclinical and clinical evidence surrounding the use of molecular classification schemes for meningioma prognostication. We also highlight how molecular data may inform meningioma treatment strategies and future directions.
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Affiliation(s)
- Elaina J. Wang
- Department of Neurological Surgery, Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Alexander F. Haddad
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jacob S. Young
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Ramin A. Morshed
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Joshua P. H. Wu
- Department of Neurological Surgery, Brown University, Rhode Island Hospital, Providence, RI, United States
| | - Diana M. Salha
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Nicholas Butowski
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Manish K. Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Manish K. Aghi,
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Brunasso L, Bonosi L, Costanzo R, Buscemi F, Giammalva GR, Ferini G, Valenti V, Viola A, Umana GE, Gerardi RM, Sturiale CL, Albanese A, Iacopino DG, Maugeri R. Updated Systematic Review on the Role of Brain Invasion in Intracranial Meningiomas: What, When, Why? Cancers (Basel) 2022; 14:cancers14174163. [PMID: 36077700 PMCID: PMC9454707 DOI: 10.3390/cancers14174163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Meningioma is still the most common adult tumor of the CNS, most of which are slow-growing, benign tumors and could even be accidentally diagnosed; nonetheless, they sometimes show more aggressive behavior with higher recurrence rates and relatively reduced overall survival. Assuming this, in recent years, scientific research has been accelerated, looking for new insights and applications that could improve preoperative investigation, tailor surgical planning, and strongly impact meningioma patients’ prognosis. Many fields have been developed, and the detection of brain invasion has firmly gained its potential role, leading to the revised version of WHO for CNS tumors in 2016 as a further criterion for defining atypia. Further studies are still ongoing to assess a widely accepted application of BI evaluation in intracranial meningioma management. Abstract Several recent studies are providing increasing insights into reliable markers to improve the diagnostic and prognostic assessment of meningioma patients. The evidence of brain invasion (BI) signs and its associated variables has been focused on, and currently, scientific research is investing in the study of key aspects, different methods, and approaches to recognize and evaluate BI. This paradigm shift may have significant repercussions for the diagnostic, prognostic, and therapeutic approach to higher-grade meningioma, as long as the evidence of BI may influence patients’ prognosis and inclusion in clinical trials and indirectly impact adjuvant therapy. We intended to review the current knowledge about the impact of BI in meningioma in the most updated literature and explore the most recent implications on both clinical practice and trials and future directions. According to the PRISMA guidelines, systematic research in the most updated platform was performed in order to provide a complete overview of characteristics, preoperative applications, and potential implications of BI in meningiomas. Nineteen articles were included in the present paper and analyzed according to specific research areas. The detection of brain invasion could represent a crucial factor in meningioma patients’ management, and research is flourishing and promising.
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Affiliation(s)
- Lara Brunasso
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-0916554656
| | - Lapo Bonosi
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Roberta Costanzo
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Felice Buscemi
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Roberto Giammalva
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia SRL, 95125 Catania, Italy
| | - Vito Valenti
- Department of Radiation Oncology, REM Radioterapia SRL, 95125 Catania, Italy
| | - Anna Viola
- Department of Radiation Oncology, REM Radioterapia SRL, 95125 Catania, Italy
| | - Giuseppe Emmanuele Umana
- Gamma Knife Center, Trauma Center, Department of Neurosurgery, Cannizzaro Hospital, 95100 Catania, Italy
| | - Rosa Maria Gerardi
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Carmelo Lucio Sturiale
- Division of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Alessio Albanese
- Division of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00100 Rome, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic AOUP “Paolo Giaccone”, Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, 90127 Palermo, Italy
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NF2 Alteration/22q Loss Is Associated with Recurrence in WHO Grade 1 Sphenoid Wing Meningiomas. Cancers (Basel) 2022; 14:cancers14133183. [PMID: 35804955 PMCID: PMC9265038 DOI: 10.3390/cancers14133183] [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: 05/04/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023] Open
Abstract
Sphenoid wing meningiomas account for 11−20% of all intracranial meningiomas and have a higher recurrence rate than those at other sites. Recent molecular biological analyses of meningiomas have proposed new subgroups; however, the correlation between genetic background and recurrence in sphenoid wing meningiomas has not yet been fully elucidated. In this study, we evaluated the clinical characteristics, pathological diagnosis, and molecular background of 47 patients with sphenoid wing meningiomas. Variants of NF2, AKT1, KLF4, SMO, POLR2A, PIK3CA, TRAF7, and TERT were determined using Sanger sequencing, and 22q loss was detected using multiplex ligation-dependent probe amplification. Alterations were localized at NF2 in 11 cases, had other genotypes in 17 cases, and were not detected in 12 cases. Interestingly, WHO grade 1 meningiomas with NF2 alteration/22q loss (p = 0.008) and a MIB-1 labeling index > 4 (p = 0.03) were associated with a significantly shorter recurrence-free survival, and multivariate analysis revealed that NF2 alteration/22q loss was associated with recurrence (hazard ratio, 13.1). The duration of recurrence was significantly shorter for meningiomas with NF2 alteration/22q loss (p = 0.0007) even if gross-total resection was achieved. Together, these findings suggest that NF2 alteration/22q loss is associated with recurrence in WHO grade 1 sphenoid wing meningiomas.
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Sugiyama H, Tsutsumi S, Watanabe A, Nonaka S, Okura H, Izumi H, Ishii H. A large cystic meningioma incidentally detected during general examination for breast cancer. Radiol Case Rep 2022; 17:1777-1783. [PMID: 35369542 PMCID: PMC8965029 DOI: 10.1016/j.radcr.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 02/24/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
A 57-year-old woman who underwent needle biopsy for a subcutaneous mass in the breast was diagnosed with invasive ductal carcinoma. General examination incidentally revealed an intracranial tumor. At presentation, the patient showed memory disturbance but no focal neurological deficits. Cranial computed tomography (CT) revealed a large, hypodense cyst in the left frontotemporal region, involving a tumor with extensive hyperostotic changes in the left sphenoid and frontal bones. Magnetic resonance imaging showed that the tumor was attached to the dura mater of the pterional region and extensively enhanced, with involvement of the frontal and sphenoid bones. The less vascular tumor was removed en bloc by drilling the affected sphenoid and frontal bones as much as possible. The microscopic findings of the tumor were consistent with meningothelial meningioma with invasion into the dura mater and bone. Cystic meningioma should be considered when encountered with a dural-based cystic tumor, even in patients with cancer. In such circumstances, prompt and preferential resection may be indicated for intracranial tumors for timely initiation of the long-term treatment of cancer.
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Behling F, Fodi C, Wang S, Hempel JM, Hoffmann E, Tabatabai G, Honegger J, Tatagiba M, Schittenhelm J, Skardelly M. Increased proliferation is associated with CNS invasion in meningiomas. J Neurooncol 2021; 155:247-254. [PMID: 34800210 PMCID: PMC8651603 DOI: 10.1007/s11060-021-03892-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/30/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Meningiomas are the most common benign intracranial neoplasms. CNS invasion in meningiomas has been integrated into the 2016 WHO classification of CNS tumors as a stand-alone criterion for atypia. Since then, its prognostic impact has been debated based on contradictory results from retrospective analyses. The aim of the study was to elucidate whether histopathological evidence of CNS invasion is associated with increased proliferative potential. METHODS We have conducted a quantified measurement of the proliferation marker Ki67 and analyzed its association with CNS invasion determined by histology together with other established prognostic markers of progression. Routine, immunohistochemical staining for Ki67 were digitalized and automatic quantification was done using Image J software. RESULTS Overall, 1718 meningiomas were assessed. Histopathological CNS invasion was seen in 108 cases (6.7%). Uni- and multivariate analysis revealed a significantly higher Ki67 proliferation rate in meningiomas with CNS invasion (p < 0.0001 and p = 0.0098, respectively). CONCLUSIONS Meningiomas with histopathological CNS invasion show a higher proliferative activity.
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Affiliation(s)
- Felix Behling
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.
| | - Christina Fodi
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Sophie Wang
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Johann-Martin Hempel
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Elgin Hoffmann
- Department of Radiation-Oncology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Department of Radiation-Oncology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Tübingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), DKFZ partner site Tübingen, Tübingen, Germany
| | - Jürgen Honegger
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Jens Schittenhelm
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Department of Neuropathology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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11
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Robert SM, Vetsa S, Nadar A, Vasandani S, Youngblood MW, Gorelick E, Jin L, Marianayagam N, Erson-Omay EZ, Günel M, Moliterno J. The integrated multiomic diagnosis of sporadic meningiomas: a review of its clinical implications. J Neurooncol 2021; 156:205-214. [PMID: 34846640 PMCID: PMC8816740 DOI: 10.1007/s11060-021-03874-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/09/2021] [Indexed: 12/28/2022]
Abstract
Introduction Meningiomas are generally considered “benign,” however, these tumors can demonstrate variability in behavior and a surprising aggressiveness with elevated rates of recurrence. The advancement of next-generation molecular technologies have led to the understanding of the genomic and epigenomic landscape of meningiomas and more recent correlations with clinical characteristics and behavior. Methods Based on a thorough review of recent peer-reviewed publications (PubMed) and edited texts, we provide a molecular overview of meningiomas with a focus on relevant clinical implications. Results The identification of specific somatic driver mutations has led to the classification of several major genomic subgroups, which account for more than 80% of sporadic meningiomas, and can be distinguished using noninvasive clinical variables to help guide management decisions. Other somatic genomic modifications, including non-coding alterations and copy number variations, have also been correlated with tumor characteristics. Furthermore, epigenomic modifications in meningiomas have recently been described, with DNA methylation being the most widely studied and potentially most clinically relevant. Based on these molecular insights, several clinical trials are currently underway in an effort to establish effective medical therapeutic options for meningioma. Conclusion As we enhance our multiomic understanding of meningiomas, our ability to care for patients with these tumors will continue to improve. Further biological insights will lead to additional progress in precision medicine for meningiomas.
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Affiliation(s)
- Stephanie M Robert
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
| | - Shaurey Vetsa
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Arushii Nadar
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Sagar Vasandani
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Evan Gorelick
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Lan Jin
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
| | - Neelan Marianayagam
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - E Zeynep Erson-Omay
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Murat Günel
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, 15 York St, LLCI 810, New Haven, CT, 06520-8082, USA.
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital, New Haven, CT, USA.
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