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Keymakh M, Benton JA, Fluss R, Alavi SAN, Martin AM, Chin S, Kobets AJ. Clear cell meningiomas-case presentation, review of radiographic identifiers, and treatment approaches. Childs Nerv Syst 2024; 40:1989-1996. [PMID: 38637336 PMCID: PMC11180007 DOI: 10.1007/s00381-024-06390-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
Spinal clear cell meningiomas (CCMs) are a rare histological subtype of meningiomas that pose preoperative diagnostic challenges due to their radiographic similarities with other lesions. They are also more aggressive, exhibiting higher rates of recurrence, particularly in pediatric patients. Overcoming diagnostic challenges of these tumors can improve patient outcomes. In this report, we describe a case of a pediatric patient presenting with a lumbar CCM in whom we were able to obtain gross total resection. Our report reviews previously identified predictors of CCM recurrence, including the Ki-67 proliferation index, number of spinal segments involved, and hormonal influences related to age and sex. We describe the characteristic radiographic features that differentiate spinal CCMs from other tumors to improve pre-operative diagnosis. Furthermore, we provide our rationale for adjuvant therapy for pediatric patients to refine treatment protocols for these rare tumors.
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Affiliation(s)
- Margaret Keymakh
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA.
| | - Joshua A Benton
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Rose Fluss
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Seyed Ahmad Naseri Alavi
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
| | - Allison M Martin
- Department of Pediatrics, Albert Einstein College of Medicine and Division of Pediatric Hematology, Oncology and Cellular Therapy, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Steven Chin
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew J Kobets
- The Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 2nd Floor, Bronx, NY, 10467, USA
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2
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Wei Z, Jose SG, Agarwal P, Worrell S, Kulich S, Donohue JK, Deng H, Hadjipanayis CG, Niranjan A, Lunsford LD. Adjuvant Stereotactic Radiosurgery for Clear Cell Meningiomas. World Neurosurg 2024; 184:e784-e793. [PMID: 38360207 DOI: 10.1016/j.wneu.2024.02.043] [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: 11/21/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Clear cell meningiomas (CCM) are an uncommon meningioma subtype marked by aggressive growth and high rates of recurrence despite initial resection. The present study evaluates the adjuvant benefit of stereotactic radiosurgery (SRS) for residual or recurrent tumors. METHODS After review of our prospectively maintained database, we identified 6 patients (3 female) with histologically confirmed Grade 2 CCMs. The median age of the patients at the time of SRS was 45 years. Five patients had undergone prior gross total surgical resection and 1 patient had subtotal resection before SRS. The median SRS treatment volume was 4.7 cc and the median radiosurgical margin dose was 13 Gy (range: 10-15 Gy). RESULTS The median follow-up time was 35.5 months (range 6-168 months). Three patients achieved tumor control after the first SRS procedure. Three patients experienced tumor progression at 4, 22, and 32 months after initial SRS. Tumor control was obtained in 2 of these patients after additional SRS. One patient with multiple SRS procedures had suspected adverse radiation effect that was successfully treated with corticosteroids followed by bevacizumab. CONCLUSIONS Tumor control was maintained in 5 of 6 patients after one or more SRS procedures. SRS should be considered for early intervention after surgical resection of CCM. To maximize the tumor control rate, patients with diagnosed CCM should be treated more generously and higher margin dose should be prescribed. Patients with CCM should be counselled that more than one SRS may be necessary to provide sustained tumor control.
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Affiliation(s)
- Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shalini G Jose
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Prateek Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stephen Worrell
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Scott Kulich
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jack K Donohue
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Costas G Hadjipanayis
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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3
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Horikawa T, Nozawa S, Suzui N, Yamada K, Iwai C, Akiyama H. Lumbar clear cell meningioma mimicking schwannoma 7 years after resection of the same type of intracranial tumor: a case report. J Med Case Rep 2024; 18:82. [PMID: 38321548 PMCID: PMC10845630 DOI: 10.1186/s13256-024-04411-8] [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: 07/28/2022] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Meningioma is the second most common intradural extramedullary tumor, following schwannoma. Meningioma is primarily categorized as benign World Health Organization grade 1, but clear cell meningioma is grade 2 of the intermediate malignant category. Clear cell meningiomas are rare, accounting for less than 1% of all meningioma tumors. There is no previous report of multiple intraspinal clear cell meningiomas without dural attachment. CASE PRESENTATION A 27-year-old Asian male patient presented with lower right extremity pain, and had undergone tumor resection for intracranial clear cell meningioma 7 years previously, with re-resection and radiotherapy for local tumor recurrence at our hospital's department of neurosurgery being carried out 4 years previously. No recurrence was observed since then. Preoperative lumbar magnetic resonance imaging showed two tumors at the L1 and L4 levels, both mimicking schwannoma with well-defined margins, no dural tail sign and homogeneous internal contrast. Intraoperative findings on tumor resection showed two tumors contiguous with the right L2 and L5 roots, which were not attached to the dura mater, similar to a schwannoma. After gross total resection, the postoperative pathology revealed no nuclear SMARCE1 antibody staining. The patient was diagnosed with clear cell meningioma. The patient's postoperative course went well, with no symptoms of nerve dropout and no recurrence 2 years after surgery. In this case, both lumbar lesions were well demarcated and spherical in shape, occurring with single roots. Tumor characteristics suggested a primary rather than a metastatic lesion. Clear cell meningioma is characterized by a SMARCE1 mutation and is different from other types of meningiomas. CONCLUSION To the best of our knowledge, this is the first report of multiple intraspinal clear cell meningiomas without dural attachment at the lumbar spine after resection of intracranial clear cell meningioma. We speculate that the two tumors were de novo lesions on the basis of the features of the tumors, although they were detected 7 years after the resection of intracranial clear cell meningioma.
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Affiliation(s)
- Tomoyuki Horikawa
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
- Department of Orthopaedic Surgery, Mino Municipal Hospital, Mino, Japan
| | - Satoshi Nozawa
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan.
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu, Japan
| | - Kazunari Yamada
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Chizuo Iwai
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1 Yanagido, Gifu, Gifu, 501-1194, Japan
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4
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Oliveira LDB, Palavani LB, Batista S, Soares C, Punukollu A, Bertani R. Letter to the Editor: Central nervous system clear cell meningioma: a systematic literature review. Neurosurg Rev 2024; 47:56. [PMID: 38243033 DOI: 10.1007/s10143-024-02302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Affiliation(s)
| | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cid Soares
- University Center UNiAtenas, Paracatu, Minas Gerais, Brazil
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Liang Q, Ge P, Liu Y, Zhu X, Lu S, Pan C, Ji Z, Wang Q, Wang Y. Central nervous system clear cell meningioma: a systematic literature review. Neurosurg Rev 2024; 47:35. [PMID: 38183517 DOI: 10.1007/s10143-023-02251-6] [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: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
Clear cell meningiomas are a rare histological subtype of World Health Organization (WHO) grade II meningioma. Despite its relatively low frequency, clear cell meningioma has attracted considerable attention because of its unique pathological characteristics, clinical behavior, and challenging management considerations. The purpose of our systematic review is to provide clinicians with a better understanding of this rare disease. PubMed was searched for articles in the English language published from 1988 to 2023 June. The keywords were as follows: "clear cell meningioma," "clear cell" and "meningioma." We analyzed clinical manifestations, radiological manifestations, pathological features, comprehensive treatment strategies, and prognosis to determine the factors influencing recurrence-free survival (RFS). Recurrence-free survival curves of related factors were calculated by the Kaplan‒Meier method. The log-rank test and Cox univariate analysis were adopted to assess the intergroup differences and seek significant factors influencing prognosis and recurrence. Fifty-seven papers met the eligibility criteria, including 207 cases of clear cell meningioma (CCM), which were confirmed by postoperative pathology. The fifty-seven articles involved 84 (40.6%) males and 123 (59.4%) females. The average age at diagnosis was 27.9 years (range, 14 months to 84 years). Among the symptoms observed, headache, neurologic deficit, and hearing loss were the most commonly reported clinical manifestations. Most tumors (47.8%) were located in the skull base region. Most tumors showed significant enhancement, and homogeneous enhancement was more common. A total of 152 (74.1%) patients underwent gross total resection (GTR), and 53 (25.9%) patients underwent subtotal resection (STR). During the follow-up, the tumor recurred in 80 (39.4%) patients. The log-rank test and the Cox univariate analysis revealed that tumor resection range (GTR vs. STR) and adjuvant treatment (YES vs. NO) were significant predictors of recurrence-free survival (RFS). Clear cell meningioma is a rare type of meningioma with challenging diagnosis and therapy. The prognosis of this disease is different from that of regular meningiomas. Recurrence remains a possibility even after total tumor resection. We found that the surgical resection range and adjuvant treatment affected the recurrence period. This finding provides significant guidance for the treatment of clear cell meningioma.
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Affiliation(s)
- Qi Liang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Pengfei Ge
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yanhua Liu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Xiaoxi Zhu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Shan Lu
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Chengliang Pan
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Zhilin Ji
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Qingxuan Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, 71 Xinmin Street, Changchun, 130021, Jilin, People's Republic of China.
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Fiorentini E, Giunti L, Di Rita A, Peraio S, Fonte C, Caporalini C, Buccoliero AM, Censullo ML, Gori G, Noris A, Pasquariello R, Battini R, Pavone R, Giordano F, Giglio S, Rinaldi B. SMARCE1-related meningiomas: A clear example of cancer predisposing syndrome. Eur J Med Genet 2023; 66:104784. [PMID: 37164167 DOI: 10.1016/j.ejmg.2023.104784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/23/2023] [Accepted: 05/06/2023] [Indexed: 05/12/2023]
Abstract
We report the case of a 16-year-old girl presenting with spinal clear-cell multiple meningiomas (CCMs). In view of this presentation, we sequenced a bioinformatic panel of genes associated with susceptibility to meningioma, identifying a germline heterozygous variant inSMARCE1. Somatic DNA investigations in the CCM demonstrated the deletion of the wild-type allele (loss of heterozygosity, LOH), supporting the causative role of this variant. Family segregation study detected the SMARCE1 variant in the asymptomatic father and in the asymptomatic sister who, nevertheless, presents 2 spinal lesions. Germline heterozygous loss-of-function (LoF) variants in SMARCE1, encoding a protein of the chromatin-remodeling complex SWI/SNF, have been described in few familial cases of susceptibility to meningioma, in particular the CCM subtype. Our case confirms the role of NGS in investigating predisposing genes for meningiomas (multiple or recurrent), with specific regard to SMARCE1 in case of pediatric CCM. In addition to the age of onset, the presence of familial clustering or the coexistence of multiple synchronous meningiomas also supports the role of a genetic predisposition that deserves a molecular assessment. Additionally, given the incomplete penetrance, it is of great importance to follow a specific screening or follow-up program for symptomatic and asymptomatic carriers of pathogenic variants in SMARCE1.
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Affiliation(s)
- Erika Fiorentini
- Medical Genetics Unit, Department of Clinical and Experimental Biomedical Sciences 'Mario Serio', University of Florence, Firenze, Italy.
| | - Laura Giunti
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Firenze, Italy
| | - Andrea Di Rita
- Division of Neurosurgery - Meyer Children's Hospital - University of Florence, Firenze, Italy
| | - Simone Peraio
- Division of Neurosurgery - Meyer Children's Hospital - University of Florence, Firenze, Italy
| | - Carla Fonte
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Firenze, Italy
| | - Chiara Caporalini
- Pathology Unit, A. Meyer Children's University Hospital, Firenze, Italy
| | | | - Maria Luigia Censullo
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Firenze, Italy
| | - Giulia Gori
- Medical Genetics Unit, Meyer Children's University Hospital, Firenze, Italy
| | - Alice Noris
- Division of Neurosurgery - Meyer Children's Hospital - University of Florence, Firenze, Italy
| | - Rosa Pasquariello
- Dpt. of Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy
| | - Roberta Battini
- Dpt. of Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy; Dpt. of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rossana Pavone
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Firenze, Italy
| | - Flavio Giordano
- Division of Neurosurgery - Meyer Children's Hospital - University of Florence, Firenze, Italy
| | - Sabrina Giglio
- Medical Genetics Unit, Department of Medical Sciences and Public Health and CeSAR, University Service for Research, University of Cagliari, 09124, Cagliari, Italy
| | - Berardo Rinaldi
- Medical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Maamri K, Hadj Taieb MA, Trifa A, Elkahla G, Njima M, Darmoul M. Spinal clear cell meningioma without dural attachment: a case report and literature review. Radiol Case Rep 2022; 17:1760-1764. [PMID: 35355528 PMCID: PMC8958463 DOI: 10.1016/j.radcr.2022.02.052] [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: 02/03/2022] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/12/2022] Open
Abstract
Clear cell meningiomas (CCM) are a very rare histologic subtype of meningioma usually affecting younger patients. The reported data on spinal CCM are extremely rare. Until today, only 89 cases have been reported. Furthermore, CCM without dural attachment is even rarer since only 19 cases have been reported in English literature. In this article, we present the twentieth case of a spinal CCM without dural attachment. Our patient was a 58-year-old female who was presented with pain in her lower back and bilateral sciatica for 6 months. Magnetic resonance imaging showed an intra-dural well-demarcated lesion at L3. Via a posterior approach, total resection was possible due to the lack of dural adhesion of the tumor. Histologic diagnosis was clear cell meningioma.
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Affiliation(s)
- Kais Maamri
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Mohamed Amine Hadj Taieb
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Amine Trifa
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Ghassen Elkahla
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Manel Njima
- Department of Pathology, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
| | - Mehdi Darmoul
- Neurosurgery Department, Fatouma Bourguiba Hospital, Faculty of Medicine of Monastir, Monastir, Tunisia
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8
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Tan X, Wang Y, Jiang W, Cao Y, Teng Y, Zhao G. Paediatric supra- and infratentorial multiple giant clear cell meningioma: A report of a rare case and review of the literature. Childs Nerv Syst 2021; 37:2661-2665. [PMID: 33216172 DOI: 10.1007/s00381-020-04975-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/12/2020] [Indexed: 12/01/2022]
Abstract
Clear cell meningiomas (CCMs) account for only approximately 0.2% of all meningiomas and are classified as grade II tumours by the World Health Organisation. Most of the previously described intracranial CCMs are single tumour entities. Multiple intracranial CCMs are extremely rare, and due to their low incidence, information on multiple CCM remains limited; hence, researchers and practitioners also have a limited understanding of its aetiology, clinical manifestations, and treatment options. Herein, we report a case of sporadic multiple intracranial CCM in a child that presented with a 3-month history of gait instability and mild dysphagia. Brain magnetic resonance imaging showed one lesion in the right frontoparietal lobe and another giant lesion on the ventral side of the brainstem, extending to the middle fossa. The lesions were completely resected in two stages. Postoperative histopathological examination confirmed CCM. The patient was followed up for 2 years without recurrence. To the best of our knowledge this is the first reported case of paediatric sporadic multiple intracranial CCM. In addition, we reviewed the relevant literature to discuss the pathogenesis, imaging findings, and treatment methods of this rare disease.
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Affiliation(s)
- Xuanyu Tan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Wei Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Yue Cao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yongliang Teng
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Gang Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China.
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Rahman M, Dutta P, Agarwala P, Ikram S, Ahsan E, Shourav MMI, Riviere-Cazaux C, Abuleil A, Milind Bhorkar A, Reza RR, Siddik AB. Clinical Manifestation, Management and Prognosis of Clear Cell Meningioma: An Evidence-Based Review. Int J Neurosci 2021; 133:648-653. [PMID: 34319820 DOI: 10.1080/00207454.2021.1956919] [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: 10/20/2022]
Abstract
Clear cell meningioma (CCM) is an uncommon histologic subtype of meningioma classified as a WHO grade II tumor and accounting for less than 1% of all meningiomas. Demographically, younger patients are commonly affected without any remarkable gender preference. Moreover, CCM shows a unique anatomical site of involvement. It tends to occur in the cranium than the spine, whereas the basilar skull, posterior fossa, and lumbar spine have been the most frequently affected area. Although most cases present as typical the mass effect by the tumor, CCM exhibits characteristic imaging and histologic patterns. Even though surgical resection is the treatment of choice, recurrence-free survival is the biggest challenge and has been attempting to improve by adjuvant therapy. There is still debate about its management, outcome, and factors defining it. Herein, we aimed to summarize natural history, radiographic characteristics, histological features, treatment strategies to guide the best possible individualized care for the most favorable outcome.
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Affiliation(s)
- Masum Rahman
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Priyata Dutta
- Department of internal medicine, Mymensingh Medical College and Hospital, Mymensingh, Bangladesh
| | - Preeti Agarwala
- Department of internal medicine, Rajshahi Medical College and Hospital, Rajshahi, Bangladesh
| | - Samar Ikram
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eram Ahsan
- Stem Cell Therapy and Skeletal Regeneration laboratory, Mayo Clinic, Rochester, MN, USA
| | | | | | - Amro Abuleil
- Royal Medical Services, King Al Hussein Medical City Hospital, Jordan
| | | | | | - Abu Bakar Siddik
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
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10
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Gupta SK, Nayak N, Gandhoke CS, Gupta RK, Sharma AK, Singh P, Sharma R, Nehete LS. A Giant Nondural-Based Lumbosacral Clear Cell Meningioma Mimicking Schwannoma: A Case Report and Review of the Literature. Asian J Neurosurg 2021; 16:44-50. [PMID: 34211865 PMCID: PMC8202374 DOI: 10.4103/ajns.ajns_385_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/27/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022] Open
Abstract
Spinal clear cell meningiomas (CCMs) are rare and dural-based lesion usually affecting the younger population. We report the rare case of giant nondural-based spinal CCM mimicking schwannoma and review the literature. A literature search was performed at PubMed and Embase until January 1, 2020. A total of 19 cases of nondural-based spinal CCM was reported. The following relevant data were extracted: authors, publication year, patient and tumor characteristics, treatment, and outcome. The mean age of the presentation was 20.58 years. Twelve (63.16%) were female and seven patients (36.84%) were male. The most common location was lumbosacral region 15 (79%). Fifteen (79%) tumors had cranio-caudal dimension ≤2 vertebral level, and only four (21%) tumors had dimension ≥2 vertebral level. Gross total resection (GTR) was performed in 18 (95%) patients and subtotal resection (STR) in 1 patient. Recurrences were reported in five (26.14%) patients. Four of them showed recurrences within 6 months; earliest at 2.3 months in the patient had undergone STR. Our patient is 19-year-old male diagnosed with a lumbosacral intradural lesion. Craniocaudal dimension is ≥2 vertebral level shows the foraminal extension and vertebral scalloping. GTR is performed. Intraoperatively, the tumor has foraminal extension and shows attachment with right S1S2 nerve root. No dural attachment is found. Six-month follow-up magnetic resonance image shows no evidence of disease. Nondural-based spinal CCMs are extremely rare and should be kept as a differential diagnosis in young patients with giant intradural tumor, and whose radiological features suggesting of schwannoma. It affects young patients and usually involves more than one vertebral level. The chances of recurrences and metastasis are always high even after GTR; hence, close follow-up of the entire neuraxis is warranted.
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Affiliation(s)
| | - Nitish Nayak
- Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India
| | | | - Rakesh Kumar Gupta
- Department of Pathology and Laboratory Medicine, AIIMS, Raipur, Chhattisgarh, India
| | | | - Prashant Singh
- Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India
| | | | - Lokesh S Nehete
- Department of Neurosurgery, AIIMS, Raipur, Chhattisgarh, India
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11
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Wang Y, Qin X, Liu M, Liu X, Yu Y, Zhao G, Xu Y. Clear Cell Meningioma in the Central Nervous System: Analysis of Surveillance, Epidemiology, and End Results Database. Front Oncol 2021; 10:592800. [PMID: 33552966 PMCID: PMC7862755 DOI: 10.3389/fonc.2020.592800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Clear cell meningioma (CCM) is a rare subtype of meningioma, accounting for approximately 0.2% of all meningiomas. The present study aimed to analyze the epidemiology and outcome of CCMs using the Surveillance, Epidemiology, and End Results (SEER) database. Methods Patients diagnosed with central nervous system CCM between 2004 and 2016 were identified from the SEER database. Descriptive analyses were performed to evaluate the distribution of patients and tumor-related characteristics. The survival analysis was performed using Kaplan-Meier curves. The Cox proportional hazards model was used for the univariate and multivariate analyses. Results The age-adjusted incidence rate was 0.032 per 1,000,000 person-years. The median age was 52 years. Most of the CCMs were intracranial CCMs that were larger than 3 cm. The overall cumulative survival rates at 1, 3, and 5 years were 97.6, 93.2, and 86.9%, respectively. The log-rank test and Cox proportional hazards regression analysis revealed that age at diagnosis and primary site of the tumor were independent prognostic factors. Conclusion CCM is an extremely rare entity with a favorable survival rate. CCMs usually affect patients during the fourth to fifth decades of life. Patients diagnosed at 21-60 years old and patients with spinal CCMs have a better prognosis.
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Affiliation(s)
- Yubo Wang
- Department of Neurosurgery, First Affiliated Hospital of Jilin University, Changchun, China
| | - Xiaowei Qin
- Department of Neurosurgery, First Affiliated Hospital of Jilin University, Changchun, China
| | - Mingyang Liu
- College of Instrument Science and Electrical Engineering, Jilin University, Changchun, China
| | - Xinrui Liu
- Department of Neurosurgery, First Affiliated Hospital of Jilin University, Changchun, China
| | - Ying Yu
- Department of Neurosurgery, First Affiliated Hospital of Jilin University, Changchun, China
| | - Gang Zhao
- Department of Neurosurgery, First Affiliated Hospital of Jilin University, Changchun, China
| | - Ying Xu
- Computational Systems Biology Lab, Department of Biochemistry and Molecular Biology, University of Georgia, Athens, GA, United States
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Clear cell histology portends a worse prognosis than other WHO grade II histologies. J Neurooncol 2021; 151:307-312. [PMID: 33398533 DOI: 10.1007/s11060-020-03668-5] [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: 10/24/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Clear cell meningioma (CCM) is a rare WHO grade II meningioma variant, characterized by aggressive features and a high tumor recurrence rate. In this study, we compared overall and progression-free survivals between CCMs and other WHO grade II meningiomas. METHODS A retrospective institutional database review was performed to identify all patients who underwent surgical resection of a WHO grade II meningioma between 1997 and 2019. Overall survival and progression-free survival were compared between patients with clear cell meningiomas and patients with other WHO grade II meningiomas. Multivariable Cox proportional-hazards analysis was used to identify independent predictors of tumor recurrence and survival. RESULTS We included a total of 214 patients in this study (43 CCMs, 171 other WHO grade II meningiomas). Patients with CCMs had significantly shorter progression-free (p = 0.001) and overall (p = 0.026) survivals than patients with other grade II meningiomas. In multivariable analysis, clear cell histology was a significant and powerful independent predictor of tumor recurrence (HR 1.93; 95% CI 1.14-3.26) when controlling for tumor location, extent of resection, and adjuvant radiation. In multivariable analysis, clear cell histology correlated with increased mortality (HR 1.96, 95% CI 0.97-3.94), though this was not statistically significant. CONCLUSION This is the first study to compare overall and progression-free survivals between CCMs and other WHO grade II meningiomas. Clear cell histology predicts a higher risk of tumor recurrence and mortality than other grade II histologies. Future studies may help to understand the impact of these findings and the treatment implications.
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TSUCHIYA T, IKEDA S, ISOO A, SAKAKIBARA H, KUMADA S, KOMORI T, TAKAI K. Intraoperative Anatomical Findings in Pediatric Clear Cell Meningioma of the Lumbar Spine: Case Report and Literature Review. NMC Case Rep J 2021; 8:519-527. [PMID: 35079512 PMCID: PMC8769484 DOI: 10.2176/nmccrj.cr.2020-0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Clear cell meningioma (CCM) is a WHO classification Grade II meningioma. It is a very rare disease, of which only 41 cases of spinal cord CCM in children have been reported to date. CCMs sometimes do not have the “dural attachment” that is usually found in meningiomas, and our understanding of the origin of CCMs is therefore controversial. We hereby present a case of pediatric CCM of the lumbar spine, in which we examined intraoperatively, the detailed anatomical location of the tumor. The case is a 10-year-old boy, who presented to our hospital with a 2-month history of lower back and bilateral lower extremity pain upon waking, which gradually worsened. Lumbar spine CT and MRI revealed an intradural extramedullary tumor at the L3 vertebral level, and surgery was performed to remove it. The tumor was in close contact with the dura mater, and also in contact with the cauda equina via the arachnoid. The tumor was likely located primarily between the dura mater and arachnoid. The pathological diagnosis was CCM, with an MIB-1 index of less than 1%. His back pain and bilateral lower extremity pain improved after surgery, and he was discharged from our hospital. Postoperative radiation therapy was not performed. Based on this case, we suggest that intraoperative examination of the anatomical location of these tumors and accumulation of relevant experience are important to elucidate the embryological mechanisms of this rare disease.
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Affiliation(s)
- Takahiro TSUCHIYA
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Syunsuke IKEDA
- Department of Neurosurgery, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Ayako ISOO
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Hiroshi SAKAKIBARA
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Satoko KUMADA
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Takashi KOMORI
- Laboratory Medicine and Pathology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Keisuke TAKAI
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
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14
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DNA repair and cell synthesis proteins: immunohistochemical expression and correlation with recurrence-regrowth in meningiomas. J Mol Histol 2020; 51:411-420. [PMID: 32617895 DOI: 10.1007/s10735-020-09892-7] [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: 01/20/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
Meningiomas are considered the second most common neoplasm of the central nervous system in adults. Most of them are benign with slow growth, frequent in women and with a high recurrence rate. In tumors, DNA error repair processes lose efficacy, providing mutagenesis and genomic instability. This work evaluated the expression of proteins involved in cell synthesis (cyclin D1) and DNA errors repair (MUTYH, XPF, XPG) in meningiomas, relating them to clinical, tumor and survival variables. The study included 85 patients, with a mean age of 52 ± 13.3 years and most of them women (2:1 ratio). Sixty-seven cases were grade I (79%). Grade II tumors were independent predictors of recurrence-regrowth (HR: 2.8; p = 0.038). The high expression of cyclin D1 was associated with grade II (p = 0.001) and low MUTYH expression with grade I (p = 0.04). Strong expression of XPF and XPG was associated with grade II (p = 0.002; p < 0.001) and with recurrence-regrowth (p = 0.04; p = 0.003). Strong XPF expression was significantly related to large tumors (p = 0.03). An association of cyclin D1, MUTYH and XPF were found. Survival was not associated with the expression of any of the proteins studied. To know the role of DNA repair proteins and cell synthesis is important for understanding the processes of origin and tumor development. Grade II meningiomas and strong expression of XPF and XPG were predictors of recurrence or regrowth and may assist in clinical management, considering the high recurrence of meningiomas and the absence of consensus regarding treatment.
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Soni P, Li S, Sagar S, Prayson RA, Angelov L, Mohammadi AM, Barnett GH, Recinos PF, Kshettry VR. Clear Cell Meningioma: A Clinicopathologic Study of a Rare Meningioma Subtype in 35 Patients. World Neurosurg 2020; 141:e334-e340. [PMID: 32445901 DOI: 10.1016/j.wneu.2020.05.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clear cell meningioma (CCM) is a rare histologic variant, accounting for only 0.2%-0.8% of all meningiomas. Given their relative infrequency, few cases have been reported. We have presented one of the largest series of patients with intracranial CCM and reported the treatments and outcomes of these patients. METHODS Patients with histologically proven CCM from 2003 to 2018 were identified for inclusion in the present study. Relevant clinical and radiographic data were obtained via retrospective review and analyzed. Kaplan-Meier and Cox proportional hazards analyses were used to compare overall and progression-free survival. RESULTS A total of 35 patients had undergone surgical resection for CCM, including 18 women and 17 men, with a mean age of 59.3 years. Gross total resection was achieved in 22 patients (62.9%), and 11 patients (31.4%) had received adjuvant postoperative radiotherapy. Tumors recurred in 17 patients (48.6%), with a mean time to recurrence of 31.3 months. The mean postoperative follow-up was 66.3 months. On multivariable analysis, adjuvant radiotherapy and gross total tumor resection were both independently associated with prolonged progression-free survival (P < 0.033), although not with overall survival (P >0.274). CONCLUSIONS The data from the present series of 35 patients with CCM have shown distinct contrasts to previous series, with an older mean age and a nearly 1:1 male/female ratio. Although gross total resection and adjuvant postoperative radiotherapy were both independently associated with longer progression-free survival for patients with CCM, tumor recurrence has remained a challenge in the treatment of these patients.
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Affiliation(s)
- Pranay Soni
- Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA
| | - Samuel Li
- Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA
| | - Soumya Sagar
- Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA
| | - Richard A Prayson
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Lilyana Angelov
- Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alireza M Mohammadi
- Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gene H Barnett
- Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Pablo F Recinos
- Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Varun R Kshettry
- Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
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Tsurubuchi T, Matsuda M, Muroi A, Sakamoto N, Ishikawa E, Matsumura A. An Aggressive Extension of Dumbbell-Type Pediatric Skull Base Meningioma: A Case Report with Review of the Literature. World Neurosurg 2020; 139:535-547. [PMID: 32371076 DOI: 10.1016/j.wneu.2020.04.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric meningiomas account for less than 2% of pediatric brain tumors. Pediatric clear cell meningiomas (CCMs) occurring in the posterior fossa are particularly rare. Therapeutic strategies differ among the previous pediatric CCM case reports. Therefore, to clarify the clinical features of pediatric CCMs, we report a rare case of dumbbell-type pediatric CCM and a corresponding literature review. CASE DESCRIPTION A 7-year-old boy with complaints of headache, left facial palsy, dysarthria, and left-sided ataxic gait was emergently admitted to our hospital. His consciousness level was slight stupor, with Glasgow Coma Scale score 3-5-6, and he showed left ptosis, dysarthria, and ataxias of the left trunk and extremities. Magnetic resonance imaging (MRI) scan showed acute obstructive hydrocephalus because of the tumor's compression of the brainstem. The dumbbell-shaped tumor extended from the lateral wall of the cavernous sinus, through the left Meckel's cave, to the cerebellopontine angle. Physical examination and perioperative MRI scan showed no evidence regarding neurofibromatosis type I or II. The tumor was removed in a 2-staged operation. Postoperative proton therapy was done to treat some residual tumors. One year after postoperative proton therapy, there is no recurrence, and apart from left corneal and facial hypesthesia, he is healthy. CONCLUSIONS We reported a rare case of pediatric skull base-type CCM with huge extension originating from the anteromedial wall of Meckel's cave firmly adhered to the cavernous sinus wall to the posterior fossa that was successfully treated with surgery and postoperative proton therapy. CCM has a high recurrence rate; therefore, careful prolonged follow-up is needed.
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Affiliation(s)
- Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriaki Sakamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Libert DM, Prayson RA. Pediatric clear cell meningioma involving the middle cranial fossa in the context of NF2 and SMARCE1 mutations. Ann Diagn Pathol 2020; 46:151516. [PMID: 32311644 DOI: 10.1016/j.anndiagpath.2020.151516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/24/2020] [Indexed: 11/25/2022]
Abstract
Meningiomas are an uncommon entity in children and adolescents. <30 cases of pediatric clear cell meningioma (CCM), a World Health Organization (WHO) Grade II tumor, have been reported in the literature. These tumors are more likely to recur than the more common WHO Grade I meningiomas, especially with incomplete surgical resection. CCMs are most commonly found in the spine and posterior cranial fossa. Recently, SMARCE1 mutations have been linked to the development of CCM. To evaluate the progression of pediatric CCM in the context of emerging genetic knowledge, we reviewed all 45 cases of CCM at our institution for a 23 year period (1997-2019) to identify pediatric cases. Forty-four of the tumors arose in adults from age 34-81 years. The one pediatric case originally presented at age 4 years; the patient was found to have a CCM in the left cavernous sinus projecting into the posterior fossa, associated with a novel germline SMARCE1 mutation and somatic NF1 and DMD mutations. After two years, the patient had a recurrence of the tumor and underwent a second resection. This is the 5th reported case of CCM in the middle cranial fossa, and the only recurrent case, as well as the only reported case of recurrent pediatric CCM associated with a germline SMARCE1 mutation. Further study of the natural history of tumors associated with germline SMARCE1 loss could potentially inform prognosis.
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Affiliation(s)
- Diane M Libert
- Cleveland Clinic Lerner College of Medicine and Cleveland Clinic Department of Anatomic Pathology, Cleveland, OH, United States of America
| | - Richard A Prayson
- Cleveland Clinic Lerner College of Medicine and Cleveland Clinic Department of Anatomic Pathology, Cleveland, OH, United States of America.
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18
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Graillon T, Regis J, Barlier A, Brue T, Dufour H, Buchfelder M. Parasellar Meningiomas. Neuroendocrinology 2020; 110:780-796. [PMID: 32492684 DOI: 10.1159/000509090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Abstract
Parasellar spaces remain particularly singular, comprising the most important neurovascular structures such as the internal carotid artery and optic, oculomotor, and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and a meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategies. In the case of benign nonsymptomatic tumors, observation should be proposed. Tumor growth will lead to the proposition of surgery or radiosurgery. In the case of an uncertain diagnosis and an aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel's cave lesions, complete removal is rarely considered, leading to the proposition of an endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these approaches. A case-by-case discussion about the best approach is recommended. A transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. Cerebrospinal fluid leakage, meningitis, venous sacrifice, visual impairment, and cranial nerve palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment and in postoperative follow-up but should be assessed in the case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-cavernous sinus postoperative residue, whereas radiation therapy and proton beam therapy are indicated for large, extended, nonoperable meningiomas. The place of the peptide receptor radionuclide therapyneeds to be defined. Targeted therapy should be considered in rare, recurrent, and aggressive parasellar meningiomas.
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Affiliation(s)
- Thomas Graillon
- Neurosurgery Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France,
- Aix-Marseille University, INSERM, MMG, Marseille, France,
| | - Jean Regis
- Gamma Knife Unit, Functional and Stereotactic Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France
| | - Anne Barlier
- Aix-Marseille University, INSERM, MMG, Marseille, France
- Molecular Biology Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France
| | - Thierry Brue
- Aix-Marseille University, INSERM, MMG, Marseille, France
- Endocrinology Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Conception, Marseille, France
| | - Henry Dufour
- Neurosurgery Department, Aix-Marseille University, Assistance Publique-Hôpitaux de Marseille, CHU Timone, Marseille, France
- Aix-Marseille University, INSERM, MMG, Marseille, France
| | - Michael Buchfelder
- Department of Neurosurgery, University Hospital of Erlangen, Erlangen, Germany
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Zhang H, Ma L, Shu C, Dong LQ, Ma YQ, Zhou Y. Spinal Clear Cell Meningiomas: Clinical Features and Factors Predicting Recurrence. World Neurosurg 2019; 134:e1062-e1076. [PMID: 31765868 DOI: 10.1016/j.wneu.2019.11.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVE As a World Health Organization grade II tumor of the nervous system, clear cell meningioma (CCM) is an uncommon histologic variant of meningioma. Spinal CCMs are even rarer, with <100 spinal CCMs reported in the English literature. We present this study to characterize clinical manifestations of spinal CCMs and determine the factors predicting recurrence. METHODS A literature search was performed for relevant case reports and series in PubMed and Embase until September 1, 2019. These articles were reviewed to identify clinical features, treatment modalities, and prognosis of patients with spinal CCMs. RESULTS Eighty-four spinal CCMs were analyzed. Of these patients, 36 (42.9%) were young (age ≤18 years), and the mean age at resection was 24 years. Fifty-three patients (63.1%) were female and 31 (36.9%) were male. Most of the tumors (56/84, 66.7%) were located in the lumbar region. In 31 patients (36.9%) >2 segments in the craniocaudal direction were involved (number of involved segments ≥3 levels). Gross tumor resection was performed in 77 patients (91.7%). Twenty patients (23.8%) showed radiographic evidence of recurrence during follow-up. Recurrence-free survival at 1, 5, and 10 years after resection of spinal CCM was 87%, 71%, and 47%, respectively. Multivariate analysis showed that age ≤18 years (hazard ratio [HR], 3.64; P = 0.024), subtotal resection (HR, 3.43; P = 0.031), and segments involving ≥3 levels (HR, 5.66; P = 0.002) were associated with increased recurrence. CONCLUSIONS Spinal CCMs have their own unique clinical features compared with conventional spinal meningiomas and intracranial CCMs. Spinal CCMs have a predilection to affect younger patients, are prone to appear in the lumbar region, and have a high recurrence rate. Age ≤18 years, subtotal resection, and involvement of long segments (≥3 levels) are positive predictors of recurrence.
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Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, Air Force Medical Center of the Chinese PLA, Beijing, China
| | - Li Ma
- Department of Anesthesiology, 7th Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Cheng Shu
- Department of Neurosurgery, Air Force Medical Center of the Chinese PLA, Beijing, China
| | - Lian-Qiang Dong
- Department of Neurosurgery, Air Force Medical Center of the Chinese PLA, Beijing, China
| | - Ya-Qun Ma
- Department of Anesthesiology, 7th Medical Center of the Chinese PLA General Hospital, Beijing, China.
| | - Yan Zhou
- Department of Neurosurgery, Air Force Medical Center of the Chinese PLA, Beijing, China
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Wei HL, Lu S, Chang YM. [Persistent chest pain for 4 months and progressive lower limb weakness for 2 months in a boy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:820-823. [PMID: 31416509 PMCID: PMC7389903 DOI: 10.7499/j.issn.1008-8830.2019.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/30/2019] [Indexed: 06/10/2023]
Abstract
A boy, aged 5 years, was admitted due to chest pain for 4 months, right lower limb weakness for 2 months, and weakness of both lower limbs for 10 days. There were no symptoms of defecation/urination disorders or disturbance of consciousness, and the boy had upper motor neuron paralysis in both lower limbs, without cranial nerve involvement or sensory disorder. Spine magnetic resonance imaging revealed tumor in the spinal canal between cervical vertebra 6 and thoracic vertebra 2, which put pressure on the spinal cord. He was transferred to the department of neurosurgery for surgical treatment and fully recovered after tumor resection, and no recurrence was observed after 6 years of follow-up. The pathological diagnosis was clear cell meningioma (WHO grade II). For children with chest pain and dyskinesia, spinal meningioma should be considered.
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Affiliation(s)
- Hong-Ling Wei
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
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Li J, Deng X, Zhang S, Wang Q, Cheng J, Li X, Ke D, Hui X. Intracranial clear cell meningioma: Clinical study with long-term follow-up in 24 patients. Clin Neurol Neurosurg 2018; 175:74-83. [DOI: 10.1016/j.clineuro.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/17/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
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Li J, Meng J, Wang Q, Wang Y, Liu W, Hui X. A case report on cystic meningioma in cerebellopontine angle and recommendations for management. Medicine (Baltimore) 2018; 97:e13179. [PMID: 30431593 PMCID: PMC6257460 DOI: 10.1097/md.0000000000013179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Cystic meningioma located at the cerebellopontine angle (CPA) is an extremely rare occurrence. It is frequently misdiagnosed preoperatively. Little is known about the clinical features and outcome of this rare disease. PATIENT CONCERNS A 70-year-old male presenting with progressive headache and gait disturbance. DIAGNOSIS According to the symptoms, signs, and Gd-enhanced magnetic resonance images (MRI), a preoperative diagnosis of hemangioblastoma located in left CPA was made. Finally, the histological examination revealed a meningioma. INTERVENTIONS A complete resection, including the part of the solid mass together with cyst, was performed. OUTCOMES The postoperative course of the patient was uneventful, and no residual or recurrent tumor was found during the 24-month follow-up period. LESSONS Cystic meningioma should be included in the differential diagnosis of a CPA mass with atypical radiologic features, such as a large cyst and enhanced mural nodule. By summarizing the related literature, we found that the most common pathological subtype of CPA cystic meningioma is the clear cell subtype, which belongs to WHO grade II. Gross total resection including the enhanced cyst wall is extremely important. A close follow-up is necessary because of the high recurrence rate in this subset of meningioma.
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Affiliation(s)
- Jiuhong Li
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Jinli Meng
- Department of Radiology, Hospital of Chengdu office of People's Government of Tibetan Autonomous Region (Hospital C.T), Chengdu, China
| | - Qiguang Wang
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Yanchao Wang
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Wenke Liu
- Department of Neurosurgery, West China Hospital, Sichuan University
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University
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Li J, Zhang S, Wang Q, Cheng J, Deng X, Wang Y, Hui X. Spinal Clear Cell Meningioma: Clinical Study with Long-Term Follow-Up in 12 Patients. World Neurosurg 2018; 122:e415-e426. [PMID: 30342264 DOI: 10.1016/j.wneu.2018.10.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clear cell meningioma (CCM) is a rare histologic subtype of meningioma. The features of CCMs have commonly been based on intracranial cases. However, CCMs in the spinal cord are even rarer, and their natural history, management, and prognosis remain ill-defined. METHODS From January 2006 to January 2018, 12 patients with spinal CCM were treated in our hospital. The clinical features, radiologic findings, diagnosis, treatment, and outcome of these patients were analyzed retrospectively. Additionally, we performed a review of the reported data on spinal CCMs. RESULTS CCMs accounted for 2.8% of all the spinal meningiomas treated in our hospital. The most common localization of this disease was the lumbar region (7 of 12). The mean age at diagnosis was significantly younger than that of patients with spinal meningiomas (28.8 ± 13.4 years vs. 54.0 ± 14.4 years). During the follow-up period, 5 patients (41.7%) experienced tumor recurrence. Kaplan-Meier analysis showed that younger patients had a significantly shorter progression-free survival time than older patients. The review of the reported data showed that 55 cases of spinal CCMs had been reported. Nineteen patients (38.0%) had developed local recurrence, with a 5-year progression-free survival rate of 33.3%. CONCLUSIONS Spinal CCMs are extremely rare tumors with a predilection to affect younger patients and have a high recurrence rate. Although gross total resection is considered to be the optimal treatment, radiotherapy could be considered for patients who had undergone subtotal resection or for younger patients, regardless of the extent of removal. Close follow-up of the entire neuraxis for years is crucial.
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Affiliation(s)
- Jiuhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Qiguang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Jian Cheng
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Xueyun Deng
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Yanchao Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China.
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