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Ibrahim HM, Abdelrahman AE, Elwan A, Gharieb SA, Refaat M, Elmesallamy W, Salem AA. Clinicopathological Impact of FOXM1 and MMP-9 Immunohistochemical Expression in Different Grades of Intracranial Meningioma. Appl Immunohistochem Mol Morphol 2024; 32:292-304. [PMID: 38863278 DOI: 10.1097/pai.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/05/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES To find predictive biomarkers for recurrence and progression of meningioma. BACKGROUND Despite great advances in meningioma treatment, the prognosis remained unfavorable due to the high recurrence rate. METHODS In this study, we evaluated the immunohistochemical expression of FOXM1, MMP-9, and Ki67 in 50 cases of intracranial meningioma to detect its potential role in meningioma progression, recurrence, and patients' survival. RESULTS Strong FOXM1 expression was detected in 20% of the cases and was significantly associated with meningioma grade ( P = 0.002) and peritumoral brain edema (PTBE; P <0.001). Strong MMP-9 expression was noted in 32% of the cases and was significantly associated with meningioma grade and PTBE ( P <0.001, P <0.001, respectively). High Ki67 was noted in 50% and significantly associated with tumor grade and PTBE ( P <0.001, P = 0.002, respectively). The follow-up period revealed that meningiomas with strong FOXM1, strong MMP-9, and high Ki67 expression were associated with tumor recurrence, shorter OS, and recurrence-free survival. Furthermore, up-regulation of FOXM1 and MMP-9 expression had a significant relation with poor clinical response to the therapy ( P = 0.010, P = 0. 001, respectively). However, high Ki67 cases were more sensitive to clinical therapy ( P = 0.005). CONCLUSION Strong FOXM1, strong MMP-9, and high Ki67 in meningiomas indicate highly aggressive tumors with a shortened survival rate, dismal outcome, and high risk of recurrence after the standard protocol of therapy.
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Affiliation(s)
| | | | - Amira Elwan
- Department of Clinical Oncology and Nuclear Medicine
| | | | | | - Wael Elmesallamy
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
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Butta S, Gupta MK. HIF 1 α - a promising target for the treatment of meningiomas. Med Pharm Rep 2023; 96:170-174. [PMID: 37197281 PMCID: PMC10184527 DOI: 10.15386/mpr-2059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/03/2022] [Accepted: 12/29/2022] [Indexed: 05/19/2023] Open
Abstract
Background Meningiomas are the most frequent tumors of the brain and spinal cord with a potency to recur in around one third of the cases and and invade surrounding tissue. Hypoxia driven factors like HIFs (Hypoxia inducible factors) are implicated in tumor cell growth and proliferation. Aim This study aims at determining the association of HIF 1 α with different histopathological grades and types of meningiomas. Methods This prospective study was conducted on 35 patients. The patients presented with headache (65.71%), seizures (22.86%) and neurological deficits (11.43%). They underwent surgical excision and surgical tissue samples of these patients were histopathologically processed and microscopically graded and typed. Immunohistochemistry was performed using anti-HIF 1α monoclonal antibody. The nuclear expression of HIF 1 α was graded as <10%: negative, 11-50%: mild to moderate positive, >50%: strong positive. Results Of the 35 cases so examined 20% were recurrent; 74.29% were WHO grade I with meningothelial type (22.86%), being the commonest; 57.14 % revealed mild to moderate positivity for HIF 1α, while strong positivity was noted in 28.57%. Significant association was found between WHO grade and HIF 1α (p=0.0015) and between histopathological types and HIF 1α (p=0.0433). Furthermore, HIF 1α was also significantly associated with the recurrent cases (p=0.0172). Conclusion HIF 1α appears to be a marker and a promising target for effective therapeutics in meningiomas.
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Affiliation(s)
- Shristi Butta
- Department of Pathology, NRS Medical College, Kolkata, West Bengal, India
| | - Manoj Kumar Gupta
- Department of Tropical Medicine, Medical College, Kolkata, West Bengal, India
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Fiani B, Jarrah R, Bhandarkar AR, De Stefano F, Amare A, Aljameey UA, Reardon T. Peritumoral edema in meningiomas: pathophysiology, predictors, and principles for treatment. Clin Transl Oncol 2023; 25:866-872. [PMID: 36427121 DOI: 10.1007/s12094-022-03009-0] [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: 07/01/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Abstract
Meningiomas is a tumor of the meninges and is among the most common intracranial neoplasms in adults, accounting for over a third of all primary brain tumors in the United States. Meningiomas can be associated with peritumoral brain edema (PTBE) which if not managed appropriately can lead to poor clinical outcomes. In this review, we summarize the relevant pathophysiology, predictors, and principles for treatment of PTBE. The results of various case-reports and case-series have found that meningioma-associated PTBE have patterns in age, tumor size, and hormone receptor positivity. Our study describes how increased age, increased tumor size, tumor location in the middle fossa, and positive expression of hormone receptors, VEGF, and MMP-9 can all be predictors for worse clinical outcomes. We also characterize treatment options for PTBE such as glucocorticoids and VEGF inhibitors along with the ongoing clinical trials attempting to alleviate PTBE in meningioma cases. The trends summarized in this review can be used to better predict the behavior of meningioma-associated PTBE and establish prognosis models to identify at risk patients.
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Affiliation(s)
- Brian Fiani
- Department of Neurosurgery, Weill Cornell Medical Center/NewYork Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA.
| | - Ryan Jarrah
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Frank De Stefano
- Department of Neurosurgery, University of Kansas Medical Center, Kansas, MO, USA
| | - Abrham Amare
- Morehouse School of Medicine, Morehouse College, Atlanta, GA, USA
| | - Usama A Aljameey
- Lincoln Memorial DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN, USA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, USA
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4
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Janah R, Rujito L, Wahyono DJ. Correspondence of Meningioma Orbital Grading and Clinicopathological Features among Indonesian Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: Orbital meningiomas can cause visual disturbances, protrusion of the eyes, double vision, and optic nerve abnormalities that significantly decrease vision and eventually lead to blindness. To the best of our knowledge, data on the incidence and pathogenesis of orbital meningioma in Indonesia are non-existent.
AIM: This study aimed to analyze the clinicopathological relationship with orbital meningioma grading.
METHODS: It is a cross-sectional observational analysis on 44 orbital meningioma patients in Dr. Hasan Sadikin General Hospital and the National Eye Center, Cicendo Eye Hospital in 2017–2020. Chi-square analysis and logistic regression with statistical significance (p < 0.05) were engaged in the method.
RESULTS: Orbital meningioma mostly occurred in women aged 30–44 years. Meningioma Grade I was dominated by meningothelial meningioma found in 14 (31.8%) patients, Grade II was atypical meningioma in 9 (20.9%) patients, and Grade III was anaplastic meningioma in 3 patients (6.8%). Clinical symptoms in the form of papillary atrophy (p = 0.046), visual acuity (p = 0.026), proptosis (p = 0.029), and hyperostosis (p = 0.024) were statistically significant and there was a significant difference between Grade I, Grade II, and Grade III using the Chi-square test. Logistic regression results showed that hyperostosis is significantly related to grading the orbital meningioma (p = 0.044) with an odds ratio of 0.206 (IK95% 0.04–0.955).
CONCLUSION: Hyperostosis increases the grading of the orbital meningioma because it is related to the invasion of the tumor into the orbital bone and is a neoplastic process. The presence of hyperostosis which is more common in Grade III meningiomas can be used as one of the most important predictors of meningioma recurrence postoperatively. Nonetheless, our data add to the existing literature the potential points of anti-invasive adjuvant therapy attacks.
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Muacevic A, Adler JR, Mondragon-Soto M, Alvaro-Heredia J, Reyes-Moreno I, Montano-Tello H, Gutierrez-Aceves GA, Guerrero-Juarez V, Castro-Martinez E, Gonzalez-Aguilar A. Assessing the Malignancy Risk of a Meningioma by Its Location. Cureus 2022; 14:e31213. [PMID: 36505106 PMCID: PMC9729066 DOI: 10.7759/cureus.31213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Meningiomas represent 30% of primary intracranial tumors. The current incidence is up to 4.5 cases per 100,000 habitants worldwide. Although there is no prognostic difference among benign histopathological subtypes, atypical meningiomas and malignant meningiomas (WHO grade II and III respectively) may extend to the adjacent brain parenchyma, dura mater, and osseous tissue with a recurrence score (21-49%). This manuscript analyzes the malignancy risk according to neoplastic localization through a logistic retrospective analysis from a total sample of 452 patients with grade I, II, and III (WHO) meningiomas. METHODS Detailed data collection through a three-year retrospective analysis (January 2008 to December 2011) was applied at Mexico's National Neurology and Neurosurgery Institute including patients with intracranial or spinal-cord meningioma, preoperative imaging study availability and post-surgical histopathological diagnosis. Formal written consent was not required with a waiver by the appropriate national research ethics committee in accordance with the provisions of the regulations of the general health law of Mexico. RESULTS Convexity lesions displayed an increased risk of malignancy turning for non-benign meningiomas with an odds ratio of 3.1 (95% CI 1.6 to 5.7, p=0.0002) meanwhile skull-base meningiomas present an inverse risk with an odds ratio of 0.4 (95% CI 0.2 to 0.9, p=0.02), as well as spinal-cord meningiomas with an odds ratio of 0.3 (95% CI 0.1 to 0.9). CONCLUSION Skull base and spinal cord meningiomas usually have benign behavior, meanwhile grade II or III meningiomas within this location are rare. The present work provides an additional criterion for decision making, according to the meningioma's location.
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Abd Elhakeem AAE, Essa AA, Soliman RK, Hamdan ARK. Novel evaluation of the expression patterns CD44 and MMP9 proteins in intracranial meningiomas and their relationship to the overall survival. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
Meningiomas are common primary brain neoplasms. CD44 is a cell surface glycoprotein receptor that is involved in matrix-mediated cell signaling and cell–matrix adhesion. Matrix metalloproteinase-9 (MMP-9) plays important role in angiogenesis and tumor invasion. The expression of CD44 protein membranous and cytoplasmic (CD44M and CD44C) has been reported in several tumors (such as lobular carcinoma, renal cell carcinoma, sinonasal melanoma, and lymphoma) except CNS tumors.
Methods
This study addressed the expression of CD44M and CD44C and MMP9 proteins in intracranial meningiomas and their relationship to overall survival. The expression patterns of CD44M&C and MMP-9 proteins were examined in 32 cases of benign meningiomas, 12 cases of atypical meningiomas, and 6 cases of anaplastic meningiomas using immunohistochemical staining methods.
Results
There was more evidence of CD44M expression in atypical and anaplastic meningioma (p = < 0.001). Interestingly, Spearman correlation analyses revealed significant positive correlation between CD44M and MMP9 protein (r = 0.572, p = < 0.001) in spite of the negative correlation between MMP9 and CD44 score (r = − 0.035 p = 0.405). There was a significant association between Ki67 protein expression and the grade of meningiomas (p < 0.001) and gender (p = 0.026). There was a significant correlation between overall survival (OS) and age, gender, tumor grade, and Ki-67.
Conclusions
Extensive CD44M expression in high-grade meningioma may reflect a tendency toward more invasive power of meningioma cells into surrounding structures (dura, bone, and brain).CD44M/MMP-9 axis presented by this study is open for future investigations.
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Jung IH, Chang KW, Park SH, Jung HH, Chang JH, Chang JW, Chang WS. Pseudoprogression and peritumoral edema due to intratumoral necrosis after Gamma knife radiosurgery for meningioma. Sci Rep 2022; 12:13663. [PMID: 35953695 PMCID: PMC9372131 DOI: 10.1038/s41598-022-17813-9] [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: 03/04/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Peritumoral cerebral edema is reported to be a side effect that can occur after stereotactic radiosurgery. We aimed to determine whether intratumoral necrosis (ITN) is a risk factor for peritumoral edema (PTE) when gamma knife radiosurgery (GKRS) is performed in patients with meningioma. In addition, we propose the concept of pseudoprogression: a temporary volume expansion that can occur after GKRS in the natural course of meningioma with ITN. This retrospective study included 127 patients who underwent GKRS for convexity meningioma between January 2019 and December 2020. Risk factors for PTE and ITN were investigated using logistic regression analysis. Analysis of variance was used to determine whether changes in tumor volume were statistically significant. After GKRS, ITN was observed in 34 (26.8%) patients, and PTE was observed in 10 (7.9%) patients. When postoperative ITN occurred after GKRS, the incidence of postoperative PTE was 18.970-fold (p = 0.009) greater. When a 70% dose volume ≥ 1 cc was used, the possibility of ITN was 5.892-fold (p < 0.001) higher. On average, meningiomas with ITN increased in volume by 128.5% at 6 months after GKRS and then decreased to 94.6% at 12 months. When performing GKRS in meningioma, a 70% dose volume ≥ 1 cc is a risk factor for ITN. At 6 months after GKRS, meningiomas with ITN may experience a transient volume expansion and PTE, which are characteristics of pseudoprogression. These characteristics typically improve at 12 months following GKRS.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
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8
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Cui H, Yang Y, Feng M, Gao Y, Li L, Tu W, Chen X, Hao B, Li S, Li D, Chen L, Zhou C, Cao Y. Preoperative neutrophil-to-lymphocyte ratio (preNLR) for the assessment of tumor characteristics in lung adenocarcinoma patients with brain metastasis. Transl Oncol 2022; 22:101455. [PMID: 35598384 PMCID: PMC9126952 DOI: 10.1016/j.tranon.2022.101455] [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: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022] Open
Abstract
A relationship between preoperative Neutrophil-to-Lymphocyte ratio (preNLR) and brain metastasis characteristics such as tumor location and peritumoral brain edema is proposed. The corresponding spearman correlations of peritumoral brain edema and preoperative NLR between different tumor location was performed. A prognostic nomogram, that provide survival predictions for brain metastasis on lung adenocarcinoma (LUAD) patients has been established.
Objectives Brain metastases from lung adenocarcinoma cause significant patient mortality. This study aims to evaluate the role of preoperative Neutrophil-to-Lymphocyte ratio (preNLR) in predicting the survival and prognosis of Lung adenocarcinoma (LUAD) patients with brain metastasis (BM) and provide more references for predicting peritumoral edema. Methods We retrospectively reviewed 125 LUAD-BM patients who had undergone surgical resection from December 2015 to December 2020. The clinical characteristic, demographic, MRI data, and preNLR within 24–48 h before craniotomy were collected. Patients were divided into two groups based on preNLR (high NLR and low NLR), with cutoff values determined by receiver operating characteristic (ROC) analysis. Association between preoperative NLR and clinical features was determined by using Pearson chi-squared tests. Uni- and multivariate analyzes were performed to compare the overall survival (OS) of clinical features. Results The patients were divided into NLR-low (64 patients) and NLR-high (61 patients) groups based on receiver operating characteristic analysis of NLR area. According to correlation analysis, a high preNLR (NLR≥2.8) is associated with the both supra- and infratentorial location involved (P = 0.017) and a greater incidence of severe peritumoral edema (P = 0.038). By multivariable analysis, age ≥ 65 years (P = 0.011), KPS < 70 (P = 0.043), elevated preNLR (P = 0.013), extracerebral metastases (P = 0.003), EGFR/ALK+ (P = 0.037), postoperative radiotherapy (P = 0.017) and targeted therapy (P = 0.007) were independent prognostic factors. OS nomogram was constructed based on cox model and model performance was examined (AUC = 0.935). Conclusions PreNLR may serve as a prognosis indicator in LUAD patients with brain metastasis, and high preNLR tends to be positively associate with multiple locations and severe peritumoral edema.
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Behnam M, Motamedzadeh A, Aalinezhad M, Dadgostar E, Rashidi Noshabad FZ, Pourfridoni M, Raei M, Mirzaei H, Aschner M, Tamtaji OR. The role of aquaporin 4 in brain tumors: implications for pathophysiology, diagnosis and therapy. Mol Biol Rep 2022; 49:10609-10615. [PMID: 35715607 DOI: 10.1007/s11033-022-07656-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022]
Abstract
Primary brain tumors are a heterogeneous group of tumors that arise from cells intrinsic to the central nervous system (CNS). Aquaporin-4 (AQP4) has been implicated in the pathogenesis of brain tumors. Previous reports have documented a relationship between AQP4 and several molecular pathways associated with the etiology of brain tumors, such as apoptosis, invasion and cell migration. AQP4 affects apoptosis via cytochrome C, Bad and Bcl-2, as well as invasion and migration via IDO1/TDO-Kyn-AhR axis, lncRNA LINC00461, miR-216a, miRNA-320a and MMPs. In addition, inhibition of AQP4 mitigates the progression of brain tumors. This review summarizes current knowledge and evidence regarding the relationship between AQP4 and brain tumors, and the mechanisms involved.
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Affiliation(s)
- Mohammad Behnam
- Student Research Committee, Kashan University of Medical Sciences, Kashan, I.R. of Iran
| | - Alireza Motamedzadeh
- Department of Internal Medicine, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, I.R. of Iran
| | - Marzieh Aalinezhad
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, I.R. of Iran
| | - Ehsan Dadgostar
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, I.R. of Iran.,Student Research Committee, Isfahan University of Medical Sciences, Isfahan, I.R. of Iran
| | | | - Mohammad Pourfridoni
- Student Research Committee, Jiroft University of Medical Sciences, Jiroft, I.R. of Iran
| | - Maedeh Raei
- Faculty of Medicine, Sari Branch, Islamic Azad University, Sari, I.R. of Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, I.R. of Iran.
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, 10461, Bronx, NY, USA
| | - Omid Reza Tamtaji
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, I.R. of Iran. .,Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. of Iran.
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Guadarrama-Ortíz P, Montes de Oca-Vargas I, Choreño-Parra JA, Gallegos-Garza C, Sánchez-Garibay C, Garibay-Gracián A, Salinas-Lara C, Guinto G. Expression of IL-6 and matrix metalloproteinases in a convexity meningiomas with hyperostosis: Case report. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Kumthekar P, Grimm SA, Aleman RT, Chamberlain MC, Schiff D, Wen PY, Iwamoto FM, Gursel DB, Reardon DA, Purow B, Kocherginski M, Helenowski I, Raizer JJ. A multi-institutional phase II trial of bevacizumab for recurrent and refractory meningioma. Neurooncol Adv 2022; 4:vdac123. [PMID: 36225651 PMCID: PMC9549880 DOI: 10.1093/noajnl/vdac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Systemic therapies for refractory meningiomas are limited with no FDA-approved therapeutics. Vascular endothelial growth factor (VEGF) is a signaling protein associated with neovascularization, peritumoral edema, and meningioma tumorigenesis. Methods This phase II study investigates the efficacy of bevacizumab (BEV), a VEGF binding monoclonal antibody, in patients with progressive Grade I (G1M), Grade II (G2M), Grade III (G3M) meningioma, and other non-parenchymal tumors including vestibular schwannoma (n = 4) and hemangiopericytoma (n = 4) with the primary endpoint of progression-free survival rate at 6-months (PFS-6). Non-meningiomas were included with the respective meningioma grade in the analysis. Secondary endpoints include median overall survival (mOS) and response rate. Results Fifty Patients (26 women; median age 54 years; range 23-81), 42 with progressive meningioma were treated: 10 G1M, 20 G2M, and 12 G3M. Prior treatments include surgical resection (41 patients), radiosurgery (24 patients), external beam radiotherapy (28 patients), and chemotherapy (14 patients). Median infusions administered were 16 (range, 2-68). Response was graded using the Macdonald's criteria. PFS-6, median PFS, and mOS were 87%, 22 months, 35 months for G1M; 77%, 23 months, 41 months for G2M; and 46%, 8 months, 12 months for G3M. Best radiographic responses include stable disease (G1M: 100%; G2M: 85%; G3M: 82%); partial response (G1M: 0%; G2M: 5%; G3M: 0%) and progressive disease (G1M: 0%; G2M: 10%; G3M:18%). The most common toxicities were hypertension (n = 19, 42.2%), proteinuria (n = 16, 35.6%), and fatigue (n = 14, 31.1%). Conclusion This study showed BEV is well tolerated and appears to be a promising systemic treatment option for patients with recurrent and refractory meningiomas.
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Affiliation(s)
- Priya Kumthekar
- The Lou and Jean Malnati Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University, Chicago, IL, USA
| | - Sean Aaron Grimm
- Department of Neurology, Rush University Medical Center, Chicago, IL, USA
| | - Roxanne T Aleman
- Department of Internal Medicine, Advocate Christ Medical Center, Oak Lawn, IL, USA
| | - Marc C Chamberlain
- University of Washington, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - David Schiff
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Patrick Y Wen
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard School of Medicine, Boston, MA, USA
| | | | - Demirkan Besim Gursel
- Northwestern University, Chicago, IL, USA
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - David A Reardon
- Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard School of Medicine, Boston, MA, USA
| | - Benjamin Purow
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Masha Kocherginski
- Department of Preventative Medicine, Feinberg College of Medicine at Northwestern University, Chicago, IL, USA
| | - Irene Helenowski
- Department of Preventative Medicine, Feinberg College of Medicine at Northwestern University, Chicago, IL, USA
| | - Jeffrey J Raizer
- The Lou and Jean Malnati Brain Tumor Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
- Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University, Chicago, IL, USA
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12
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Bai X, Liu X, Wen J. Efficacy of Bevacizumab in High-Grade Meningiomas: A Retrospective Clinical Study. Neuropsychiatr Dis Treat 2022; 18:1619-1627. [PMID: 35968510 PMCID: PMC9364983 DOI: 10.2147/ndt.s368740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE We investigated the role of bevacizumab (BV) in high-grade meningiomas (HGMs) by retrospective analysis. METHODS We retrospectively analyzed the clinical data of 139 patients with HGMs. The chi-square test was used to compare progression-free survival (PFS) and overall survival (OS) between patients who received BV and those who did not. According to whether they received BV treatment, we divided the patients into the BV group and non-BV group, and the effect of BV on PFS and OS was compared. In addition, we compared Karnofsky performance status (KPS) and steroid doses between the BV and non-BV groups. RESULTS There were statistically differences in PFS and OS between the BV and non-BV groups at 12 and 36 months after surgery (P<0.05). However, there was no significant difference in PFS and OS between the two groups at 60 months postoperatively (P>0.05). Using survival curves drawn by the Kaplan Meier method, we found that the PFS and OS of the BV group were greater than those of the non-BV group, and the difference was statistically significant (P<0.05). CONCLUSION BV could improve PFS and OS at 12 and 36 months after surgery in patients with HGMs. In addition, BV was associated with lower preoperative steroid use.
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Affiliation(s)
- Xuexue Bai
- Neurosurgery, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Xiaomin Liu
- Neurosurgery, Tianjin Huanhu Hospital, Tianjin, People's Republic of China
| | - Jun Wen
- Neurosurgery, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
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13
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Rezaee H, Abbasnia S, Alenabi A, Vakili R, Moheghi N, Tavakol Afshari J, Rezaee SA. Expression of Vascular Endothelial Growth Factor A and Its Type 1 Receptor in Supratentorial Neoplasm. Rep Biochem Mol Biol 2021; 10:354-361. [PMID: 34981011 PMCID: PMC8718773 DOI: 10.52547/rbmb.10.3.354] [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] [Received: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Vascular endothelial growth factor (VEGF) is one of the primary angiogenesis regulators in solid cancers. Brain solid tumors are life-threatening diseases in which angiogenesis is an important phase of tumor development and progression. In the present study, VEGF-A and VEGF receptor (VEGF-R1) gene expression was evaluated in CNS brain tumors. METHODS VEGF-A and VEGF-R1 expression was quantified using real-time PCR on fresh biopsies of 38 supratentorial brain tumors compared to 30 non-tumoral tissues. Then, the correlations were investigated with clinic-pathological and demographic factors of the patients. RESULTS PCR product sequencing confirmed the validity of qRT-PCR. Although VEGF-A and VEGF-R1 expression showed increasing trends with the progression of cell proliferation in different stages of astrocytoma, VEGF-R1 did not meet the 95% confidence interval in other brain tumors. An increasing trend in VEGF-A expression and a declining trend in VEGF-R1 expression from Stage I to II were observed in meningioma. VEGF-A and VEGF-R1 expression had no significant correlation with age and gender. Although peritumoral brain edema (PTBE) in astrocytoma was significantly associated with tumor stages, VEGF-A and VEGF-R1 were not correlated with PTBE in meningioma and metastasis. CONCLUSION VEGF-A is a valuable factor for the prognosis of PTBE and malignancy in astrocytoma and is helpful in monitoring treatment approaches.
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Affiliation(s)
- Hamid Rezaee
- Neurosurgery Department, Mashhad University of Medical Sciences, Mashhad, Iran.
- The first and the second authors contributed equally to this work.
| | - Shadi Abbasnia
- Immunology Research Centre, Inflammation and inflammatory Diseases division, Mashhad University of Medical Sciences, Mashhad, Iran.
- The first and the second authors contributed equally to this work.
| | - Anita Alenabi
- Shariati Hospital, Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Rosita Vakili
- Immunology Research Centre, Inflammation and inflammatory Diseases division, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Nasrin Moheghi
- Genetic Laboratory, Qaem Hosp. Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Seyed Abdolrahim Rezaee
- Immunology Research Centre, Inflammation and inflammatory Diseases division, Mashhad University of Medical Sciences, Mashhad, Iran.
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14
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Mariani CL, Niman ZE, Boozer LB, Ruterbories LK, Early PJ, Muñana KR, Olby NJ. Vascular endothelial growth factor concentrations in the cerebrospinal fluid of dogs with neoplastic or inflammatory central nervous system disorders. J Vet Intern Med 2021; 35:1873-1883. [PMID: 34105831 PMCID: PMC8295675 DOI: 10.1111/jvim.16181] [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: 02/27/2021] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
Background Vascular endothelial growth factor (VEGF) is a key molecular driver of angiogenesis and vascular permeability and is expressed by a wide variety of neoplasms. Although blood VEGF concentrations have been quantified in intracranial tumors of dogs, cerebrospinal fluid (CSF) VEGF concentration might be a more sensitive biomarker of disease. Objective Concentrations of VEGF in CSF are higher in dogs with central nervous system (CNS) neoplasia compared to those with meningoencephalomyelitis and other neurologic disorders. Animals One hundred and twenty‐six client‐owned dogs presented to a veterinary teaching hospital. Methods Case‐control study. Cerebrospinal fluid was archived from dogs diagnosed with CNS neoplasia and meningoencephalomyelitis. Control dogs had other neurological disorders or diseases outside of the CNS. A commercially available kit was used to determine VEGF concentrations. Results Detectable CSF VEGF concentrations were present in 49/63 (77.8%) neoplastic samples, 22/24 (91.7%) inflammatory samples, and 8/39 (20.5%) control samples. The VEGF concentrations were significantly different between groups (P < .0001), and multiple comparison testing showed that both neoplastic and inflammatory groups had significantly higher concentrations than did controls (P < .05), but did not differ from each other. Gliomas and choroid plexus tumors had significantly higher VEGF concentrations than did the control group (P < .05). Conclusions and Clinical Importance Cerebrospinal fluid VEGF concentrations may serve as a marker of neoplastic and inflammatory CNS disorders relative to other conditions.
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Affiliation(s)
- Christopher L Mariani
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Zachary E Niman
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Lindsay B Boozer
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA
| | - Laura K Ruterbories
- Comparative Neuroimmunology and Neuro-oncology Laboratory, North Carolina State University, Raleigh, North Carolina, USA.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Peter J Early
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Karen R Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Natasha J Olby
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
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15
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Regression of Intracranial Meningiomas Following Treatment with Cabozantinib. ACTA ACUST UNITED AC 2021; 28:1537-1543. [PMID: 33919580 PMCID: PMC8167720 DOI: 10.3390/curroncol28020145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022]
Abstract
Recurrent meningiomas remain a substantial treatment challenge given the lack of effective therapeutic options aside from surgery and radiation therapy, which yield limited results in the retreatment situation. Systemic therapies have little effect, and responses are rare; the search for effective systemic therapeutics remains elusive. In this case report, we provide data regarding significant responses in two radiographically diagnosed intracranial meningiomas in a patient with concurrent thyroid carcinoma treated with cabozantinib, an oral multitarget tyrosine kinase inhibitor with potent activity against MET and VEGF receptor 2. Given the clinical experience supporting the role of VEGF agents as experimental therapeutics in meningioma and the current understanding of the biological pathways underlying meningioma growth, this may represent a new oral therapeutic alternative, warranting prospective evaluation.
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16
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Buonfiglioli A, Hambardzumyan D. Macrophages and microglia: the cerberus of glioblastoma. Acta Neuropathol Commun 2021; 9:54. [PMID: 33766119 PMCID: PMC7992800 DOI: 10.1186/s40478-021-01156-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/14/2021] [Indexed: 12/13/2022] Open
Abstract
Glioblastoma (GBM) is the most aggressive and deadliest of the primary brain tumors, characterized by malignant growth, invasion into the brain parenchyma, and resistance to therapy. GBM is a heterogeneous disease characterized by high degrees of both inter- and intra-tumor heterogeneity. Another layer of complexity arises from the unique brain microenvironment in which GBM develops and grows. The GBM microenvironment consists of neoplastic and non-neoplastic cells. The most abundant non-neoplastic cells are those of the innate immune system, called tumor-associated macrophages (TAMs). TAMs constitute up to 40% of the tumor mass and consist of both brain-resident microglia and bone marrow-derived myeloid cells from the periphery. Although genetically stable, TAMs can change their expression profiles based upon the signals that they receive from tumor cells; therefore, heterogeneity in GBM creates heterogeneity in TAMs. By interacting with tumor cells and with the other non-neoplastic cells in the tumor microenvironment, TAMs promote tumor progression. Here, we review the origin, heterogeneity, and functional roles of TAMs. In addition, we discuss the prospects of therapeutically targeting TAMs alone or in combination with standard or newly-emerging GBM targeting therapies.
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17
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Bernatz S, Monden D, Gessler F, Radic T, Hattingen E, Senft C, Seifert V, Ronellenfitsch MW, Plate KH, Harter PN, Baumgarten P. Influence of VEGF-A, VEGFR-1-3, and neuropilin 1-2 on progression-free: and overall survival in WHO grade II and III meningioma patients. J Mol Histol 2021; 52:233-243. [PMID: 33528717 PMCID: PMC8012320 DOI: 10.1007/s10735-020-09940-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022]
Abstract
Higher grade meningiomas tend to recur. We aimed to evaluate protein levels of vascular endothelial growth factor (VEGF)-A with the VEGF-receptors 1-3 and the co-receptors Neuropilin (NRP)-1 and -2 in WHO grade II and III meningiomas to elucidate the rationale for targeted treatments. We investigated 232 specimens of 147 patients suffering from cranial meningioma, including recurrent tumors. Immunohistochemistry for VEGF-A, VEGFR-1-3, and NRP-1/-2 was performed on tissue micro arrays. We applied a semiquantitative score (staining intensity x frequency). VEGF-A, VEGFR-1-3, and NRP-1 were heterogeneously expressed. NRP-2 was mainly absent. We demonstrated a significant increase of VEGF-A levels on tumor cells in WHO grade III meningiomas (p = 0.0098). We found a positive correlation between expression levels of VEGF-A and VEGFR-1 on tumor cells and vessels (p < 0.0001). In addition, there was a positive correlation of VEGF-A and VEGFR-3 expression on tumor vessels (p = 0.0034). VEGFR-2 expression was positively associated with progression-free survival (p = 0.0340). VEGF-A on tumor cells was negatively correlated with overall survival (p = 0.0084). The VEGF-A-driven system of tumor angiogenesis might still present a suitable target for adjuvant therapy in malignant meningioma disease. However, its role in malignant tumor progression may not be as crucial as expected. The value of comprehensive testing of the ligand and all receptors prior to administration of anti-angiogenic therapy needs to be evaluated in clinical trials.
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Affiliation(s)
- Simon Bernatz
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Daniel Monden
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Tijana Radic
- Institute of Clinical Neuroanatomy, Goethe-University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Michael W Ronellenfitsch
- Department of Neuro-Oncology, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Karl H Plate
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI), Goethe-University, Frankfurt, Germany.,German Cancer Consortium (DKTK), Partner site Frankfurt/Mainz, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
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18
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A clinico-pathological and neuro-radiological study of angiomatous meningioma: Aggressive look with benign behaviour. J Clin Neurosci 2020; 83:43-48. [PMID: 33342627 DOI: 10.1016/j.jocn.2020.11.032] [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: 06/10/2020] [Revised: 09/28/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022]
Abstract
Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts for about 2.1% of all meningioma. Their clinical presentation, surgical management, and prognosis are almost similar to the classical meningioma. Despite of benign nature and being comparatively small in size, they look aggressive on radiology images like massive peritumoral edema and intense contrast enhancement. Being a unique subtype of meningioma, the studies on angiomatous meningioma are very limited. In this cross sectional retrospective study, we described the clinical presentation, radiology, histopathological features and differential diagnosis of 30 cases of angiomatous meningioma from a single centre. The clinical parameters include demographic profile, symptoms and radiological findings including location, extent, pattern, histopathology with World Health Organization (WHO) grade-2016, extent of tumour excision, recurrence and surgical outcome. Incidence of angiomatous meningioma in our study was 2.46% with male predominance. The most common location in our study was convexity. 27 out of 30 had histopathology reports of angiomatous meningioma and 3 had lipoangiomatous meningioma. The high vascularity and disproportionate peri-tumoral edema makes it a surgical challenge for excision. The complications and surgical outcome were analysed. The radiological anticipation of tumour subtype, meticulous pre-operative planning and intraoperative precautions remains a key for success.
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19
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Hajimohammadebrahim-Ketabforoush M, Shahmohammadi M, Vahdat Shariatpanahi Z, Zali A. Preoperative Serum Level of Vitamin D is a Possible Protective Factor for Peritumoral Brain Edema of Meningioma: A Cross Sectional Study. Nutr Cancer 2020; 73:2842-2848. [PMID: 33331170 DOI: 10.1080/01635581.2020.1861311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Meningioma is associated with the development of vasogenic edema defined as disrupted blood brain barrier. Vitamin D3 through its own nuclear receptor can regulate the expression of many effective agents on the integrity of the blood brain barrier. This study aimed to investigate the association between preoperative serum levels of 25(OH)D and peritumoral brain edema in patients with meningioma. One hundred and twelve patients with meningioma completed the study. Serum 25(OH)D levels assessment and magnetic resonance imaging (MRI) were done for all patients at the beginning of the study. The percentage of edema index (EI) was used to estimate the extent of peritumoral brain edema through preoperative MRI. The median serum level of 25(OH)D in the patients with the percentage of EI < 100% was significantly higher than those with > 100% (65.58 vs. 37.33, P < 0.001). The median percentage of EI was 24.9. Preoperative serum levels of 25(OH)D had an inverse and significant correlation with the percentage of EI as by increasing each 1 ng/mL of serum 25(OH)D, EI was decreased approximately 4% (95% CI; -5.984 to -1.952, P < 0.001). Vitamin D may be a protective factor for peritumoral brain edema of meningioma.
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Affiliation(s)
- Melika Hajimohammadebrahim-Ketabforoush
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shahmohammadi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Vahdat Shariatpanahi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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20
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Abstract
PURPOSE OF REVIEW Meningioma is a common intracranial neoplasm currently classified in 15 histologic subtypes across 3 grades of malignancy. First-choice therapy for meningioma is maximum safe resection for grade I tumors, and surgery plus optional and mandatory adjuvant radiotherapy for grade II and III, respectively, given the increased rate of recurrence even in the event of complete resection. The WHO 2016 histopathologic grading of meningioma has been questioned due to subjectivity and its controversial predictive power for recurrence. RECENT FINDINGS Novel DNA methylation profiling has simplified classification into six classes that seem to improve prognostic accuracy. We review five main topics of molecular biology research regarding tumorigenesis and natural history of meningioma from the clinician's perspective: the histopathologic diagnostic features and pitfalls of the current tumor classification; the molecular integrated diagnosis supported by identification of genetic alterations and DNA methylation profiling; the general landscape of the various signaling pathways involved in meningioma formation; the pathogenic theories of the peri-tumoral edema present in meningioma and its therapy implications; and a summarized review on the current treatments and plausible targeted therapies directed to meningioma. It seems likely that molecular assessment will be introduced within the next update of the WHO classification of meningiomas, acknowledging the promising value of DNA methylation profiling. This integrated diagnostic protocol will simplify tumor subtype categorization and provide improved accuracy in predicting recurrence and outcome. Although much effort is being done in identifying key gene mutations, and elucidating specific intracellular signaling pathways involved in meningioma tumorigenesis, effective targeted therapies for recurrent meningiomas are still lacking.
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21
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Occurrence of Fibrotic Tumor Vessels in Grade I Meningiomas Is Strongly Associated with Vessel Density, Expression of VEGF, PlGF, IGFBP-3 and Tumor Recurrence. Cancers (Basel) 2020; 12:cancers12103075. [PMID: 33096816 PMCID: PMC7593950 DOI: 10.3390/cancers12103075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022] Open
Abstract
Angiogenesis is a key feature during oncogenesis and remains a potential target of antiangiogenic therapy. While commonly described in high-grade lesions, vascularization and its correlation with prognosis in grade I meningiomas is largely unexplored. In the histological classification, not only the number but also the composition of blood vessels seems to be important. Therefore, tumor vessel density and fibrosis were correlated with clinical and imaging variables and prognosis in 295 patients with intracranial grade I meningioma. Expression of pro-angiogenic proteins within the meningiomas was investigated by proteome analyses and further validated by immunohistochemical staining. Fibrotic tumor vessels (FTV) were detected in 48% of all tumors and strongly correlated with vessel density, but not with the histopathological tumor subtype. Occurrence of FTV was correlated with a 2-fold increased risk of recurrence in both univariate and multivariate analyses. Explorative proteome analyses revealed upregulation of VEGF (vascular endothelial growth factor), PlGF (placental growth factor), and IGFBP-3 (insulin-like growth factor-binding protein-3) in tumors displaying FTV. Immunohistochemical analyses confirmed strong correlations between tumor vessel fibrosis and expression of VEGF, PlGF, and IGFBP-3. Presence of FTV was strongly associated with disruption of the arachnoid layer on preoperative MRI in univariate and multivariate analyses. In summary, the occurrence of fibrotic tumor vessels in grade I meningiomas is strongly associated with vessel density, disruption of the arachnoid layer, expression of VEGF, PlGF, IGFBP-3 and tumor recurrence.
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22
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Winter RC, Antunes ACM, de Oliveira FH. The relationship between vascular endothelial growth factor and histological grade in intracranial meningioma. Surg Neurol Int 2020; 11:328. [PMID: 33194262 PMCID: PMC7655995 DOI: 10.25259/sni_528_2020] [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: 08/13/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background Meningioma is the most common benign intracranial neoplasm, accounting for 30% of all primary brain tumors. In 90% of cases, meningiomas are benign. Several aspects of molecular biology, including potential biomarkers, have been studied in attempts to better understand the natural history of meningiomas. Vascular endothelial growth factor (VEGF) is a biomarker responsible for inducing physiological and pathological angiogenesis. VEGF expression has been investigated as a potential predictor of several tumor aspects, including growth rate, recurrence rate, brain tissue invasion, peritumoral edema and surgical prognosis, and also as a marker of histological grade. However, there is no consensus in the literature with respect to the association between this biological factor and meningioma. We digitally analyzed immunohistochemical images using ImageJ software with the aim of correlating VEGF expression with tumor histology. Methods Tissue samples from patients presenting with meningioma who had undergone surgical removal between 2007 and 2016 at the Hospital de Clínicas de Porto Alegre (HCPA), in Southern Brazil, were analyzed to identify possible immunohistochemical associations between VEGF and histological grade and subtype. Results Seventy-six patients were included; 82% were female, mean age was 59.9 years (range: 18-91). No statistically significant associations were found between VEGF expression and histological grade or subtype (P = 0.310). Conclusion Our findings suggest that VEGF is frequently present in meningiomas regardless of histological grade and should not be used as a marker of severity or histological grade.
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Affiliation(s)
- Rafael Contage Winter
- Departments of Neurosurgery Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Francine Hehn de Oliveira
- Departments of Neuropathology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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23
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Shao Z, Liu L, Zheng Y, Tu S, Pan Y, Yan S, Wei Q, Shao A, Zhang J. Molecular Mechanism and Approach in Progression of Meningioma. Front Oncol 2020; 10:538845. [PMID: 33042832 PMCID: PMC7518150 DOI: 10.3389/fonc.2020.538845] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/17/2020] [Indexed: 12/20/2022] Open
Abstract
Meningioma is the most common tumor of the central nervous system, most of which is benign. Even after complete resection, a high rate of recurrence of meningioma is observed. From in-depth study of its pathogenesis, it has been found that a number of chromosomal variations and abnormal molecular signals are closely related to the occurrence and development of malignancy in meningioma, which may provide the theoretical basis and potential direction for accurate and targeted treatment. We have reviewed advances in chromosomal variations and molecular mechanisms involved in the progression of meningioma, and have highlighted the association with malignant biological behavior including cell proliferation, angiogenesis, increased invasiveness, and inhibition of apoptosis. In addition, the chemotherapy of meningioma is summarized and discussed.
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Affiliation(s)
- Zhiwei Shao
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lihong Liu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanghao Zheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Sheng Tu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yuanbo Pan
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sheng Yan
- Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qichun Wei
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Brain Research Institute, Zhejiang University, Hangzhou, China.,Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, China
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24
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Effects of carboxymethyl chitosan oligosaccharide on regulating immunologic function and inhibiting tumor growth. Carbohydr Polym 2020; 250:116994. [PMID: 33049904 DOI: 10.1016/j.carbpol.2020.116994] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/15/2020] [Accepted: 08/23/2020] [Indexed: 02/07/2023]
Abstract
Herein, the effects of carboxymethyl chitosan oligosaccharide (CM-COS) on regulating immunologic function and inhibiting hepatocellular tumor growth were evaluated. Results showed that CM-COS caused dramatic viability loss of hepatocellular carcinoma BEL-7402 with non-toxicity towards normal liver L-02 cells. CM-COS repressed tumor growth of hepatoma-22, and elevated the spleen index and thymus index of tumor-bearing mice. Contents of VEGF and MMP-9 were significantly down-regulated by CM-COS. Histological analyses revealed that CM-COS promoted tumor cell necrosis and produced no significant toxicity to spleen tissues. Moreover, expressions of Caspase-3 in tumor tissues and IL-2 in spleen tissues were significantly activated by CM-COS. Additionally, in vitro cell viability, phagocytic capability and NO production of mouse peritoneal macrophages exposed to CM-COS were significantly higher. CM-COS remarkably increased the in vivo phagocytosing capacity of peritoneal macrophages of Kunming mice. Taken together, our findings suggested that CM-COS might be potentially effective and non-toxic candidate as anti-hepatoma agents.
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25
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Peripheral Blood Occludin Level as a Biomarker for Perioperative Cerebral Edema in Patients with Brain Tumors. DISEASE MARKERS 2020; 2020:8813535. [PMID: 32884584 PMCID: PMC7455817 DOI: 10.1155/2020/8813535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/02/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022]
Abstract
Objective Cerebral edema is a common complication of brain tumors in the perioperative period. However, there is currently no reliable and convenient method to evaluate the extent of brain edema. The objective is to explore the effectiveness of serum occludin on predicting the extent of perioperative brain edema and outcome in patients with brain tumors. Methods This prospective study enrolled 55 patients with brain tumors and 24 healthy controls in Sanbo Brain Hospital from June 2019 through November 2019. Serum occludin levels were measured preoperatively and on postoperative day 1. Peritumoral edema was assessed preoperatively using MRI. Pericavity brain edema on postoperative day 1 was evaluated using CT. Results Compared with healthy controls, the serum occludin level was higher in patients with brain tumors both preoperatively and postoperatively (P < 0.001). The serum occludin level correlated positively with the degree of brain edema preoperatively (r = 0.78, P < 0.001) and postoperatively (r = 0.59, P < 0.001). At an optimal cutoff of 3.015 ng/mL, the preoperative serum occludin level discriminated between mild and severe preoperative brain edema with a sensitivity of 90.48% and specificity of 84.62%. At an optimal cutoff value of 3.033 ng/mL, the postoperative serum occludin level distinguished between mild and severe postoperative brain edema with a sensitivity of 97.30% and specificity of 55.56%. Conclusions The serum occludin level is associated with cerebral edema and could potentially be used as a biomarker for perioperative cerebral edema. This trial is registered with ChiCTR1900023742.
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26
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Gill CM, Loewenstern J, Rutland JW, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Shrivastava RK. Peritumoral edema correlates with mutational burden in meningiomas. Neuroradiology 2020; 63:73-80. [PMID: 32789536 DOI: 10.1007/s00234-020-02515-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/04/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Meningiomas are the most common primary central nervous system tumor. Emerging data supports that higher mutational burden portends worse clinical outcomes in meningiomas. However, there is a lack of imaging biomarkers that are associated with tumor genomics in meningiomas. METHODS We performed next-generation targeted sequencing in a cohort of 75 primary meningiomas and assessed preoperative imaging for tumor volume and peritumoral brain edema (PTBE). An Edema Index was calculated. RESULTS Meningiomas that were high grade (WHO grade II or grade III) had significantly larger tumor volume and were more likely to present with PTBE. Moreover, PTBE was associated with brain invasion on histopathology and reduced overall survival. There was a direct association between Edema Index and mutational burden. For every one increase in Edema Index, the number of single nucleotide variants increased by 1.09-fold (95% CI: 1.02, 1.2) (P = 0.01). CONCLUSION These data support that Edema Index may serve as a novel imaging biomarker that can inform underlying mutational burden in patients with meningiomas.
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Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai venture, Stamford, CT, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
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Gestational Parasellar Mass as a Cause of Painful Third Nerve Palsy Followed by Spontaneous Improvement During the Puerperium. J Neuroophthalmol 2020; 39:502-505. [PMID: 31453914 DOI: 10.1097/wno.0000000000000811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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28
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Liyanage UA, Mathangasinghe Y, Wijerathne PK, Vithoosan S, Pallewatte A. Location and Diameter of Intracranial Meningioma as Predictors of Peritumoral Brain Oedema and Mass Effect. J Med Imaging Radiat Sci 2020; 51:411-416. [PMID: 32423785 DOI: 10.1016/j.jmir.2020.04.004] [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: 10/15/2019] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The presence of peritumoral oedema or mass effect with intracranial meningiomas is associated with poor clinical outcomes. This study aimed to investigate magnetic resonance (MR) morphologic features of meningioma, which can predict peritumoral oedema and mass effect. METHODS Data of 100 consecutive patients diagnosed with meningioma on MRI brain at the neurosurgical MRI unit, National Hospital of Sri Lanka, reported by a Consultant Radiologist were analysed in a retrospective study. Binary logistic regression models were fitted to identify predictors of perilesional oedema and mass effect. RESULTS Female-to-male ratio was 5.8:1. Patients were aged 18-80 years. Majority (n = 78) were in supratentorial compartment with 16 at parasagittal location. Cerebellopontine angle was the commonest infratentorial site (n = 9). Size of meningiomas ranged from 1.1 to 9.1 cm (largest dimension). Mass effect (n = 68), perilesional oedema (n = 37), and midline deviation (n = 31) were the most commonly reported complications. Maximum diameter of meningioma and its location significantly predicted the presence of perilesional oedema [χ2(2,47) = 6.03, P = .049, Nagelkerke R2 = 18.2%] and mass effect [χ2(2,71) = 16.73, P = .000, Nagelkerke R2 = 39.4%] in two logistic regression models. CONCLUSION The probability of mass effect and perilesional oedema increased with the maximum diameter. Meningioma extending to both supratentorial and infratentorial compartments had the highest risk of having concomitant perilesional oedema and mass effect.
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Affiliation(s)
| | | | | | | | - Aruna Pallewatte
- Neuroradiology and MRI Section, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Al-Rashed M, Foshay K, Abedalthagafi M. Recent Advances in Meningioma Immunogenetics. Front Oncol 2020; 9:1472. [PMID: 31970090 PMCID: PMC6960175 DOI: 10.3389/fonc.2019.01472] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/09/2019] [Indexed: 12/26/2022] Open
Abstract
Meningiomas are relatively common, and typically benign intracranial tumors, which in many cases can be cured by surgical resection. However, less prevalent, high grade meningiomas, grow quickly, and recur frequently despite treatment, leading to poor patient outcomes. Across tumor grades, subjective guidelines for histological analysis can preclude accurate diagnosis, and an insufficient understanding of recurrence risk can cloud the choice of optimal treatment. Improved diagnostic and prognostic markers capable of discerning between the 15 heterogeneous WHO recognized meningioma subtypes are necessary to improve disease management and identify new targeted drug treatments. In this review, we show the advances in molecular profiling and immunophenotyping of meningiomas, which may lead to the development of new personalized therapeutic strategies.
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Affiliation(s)
- May Al-Rashed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Kara Foshay
- Inova Neuroscience and Spine Institute, Inova Health Systems, Falls Church, VA, United States
- Virginia Commonwealth University School of Medicine, Inova Campus, Richmond, VA, United States
| | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City, King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
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Shamsdin SA, Mehrafshan A, Rakei SM, Mehrabani D. Evaluation of VEGF, FGF and PDGF and Serum Levels of Inflammatory Cytokines in Patients with Glioma and Meningioma in Southern Iran. Asian Pac J Cancer Prev 2019; 20:2883-2890. [PMID: 31653130 PMCID: PMC6982662 DOI: 10.31557/apjcp.2019.20.10.2883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Meningioma and glioma are common central nervous system tumors. Hypoxic tumor cells secrete angiogenic cytokines, such as vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF) and basic fibroblast growth factor (bFGF) that stimulate neovascular formation and inflammatory cytokine, such as TNF-α and IL-1β. We measured these serum levels in patients with glial cell tumors and meningioma. MATERIALS AND METHODS This was a case-control study in 2014-2015 on patients diagnosed with meningioma/glioma. All demographic and clinical data were registered. The tumor volume and intraoperative bleeding were recorded. Serum levels of VEGF, PDGF, FGF, TNF-α and IL-1β were measured by ELISA methods. RESULTS Ninety-six patients were enrolled in this study, 32 in each group. Patients VEGF level with cranial tumor, glioma/meningioma had increased. VEGF level was highest among grade IV tumors, larger tumors, and in glioblastoma multiform. There was an upsurge in VEGF serum level as glioma grade increased. The highest VEGF levels were seen in parasagittal meningioma. In contrast to VEGF, PDGF was slightly elevated in glial cell tumors, which was significantly elevated in meningioma. Higher PDGF correlated with increased intraoperative bleeding, especially in meningioma cases. Oligodendroglial tumors expressed higher PDGF levels in contrast to other glial tumors. FGF level was not statistically significant. TNF-α and IL-1β expressions were significantly higher in the meningioma and glioma group in comparison to control group. CONCLUSION We found increased VEGF and PDGF serum levels in CNS patient's tumor. A different role for PDGF was found in the pathogenesis of neovascularization of meningioma, as well as oligodendroglioma. No significant result was found for FGF. TNF-α and IL-1β can serve as key prognostic biomarker in high-grade glioma and meningioma patients.
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Affiliation(s)
- Seyedeh Azra Shamsdin
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Mehrafshan
- Department of Neurosurgery, Qom University of Medical Sciences, Qom, Iran
| | | | - Davood Mehrabani
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Shenqi Fuzheng Injection (SFI) Enhances IFN- α Inhibitory Effect on Hepatocellular Carcinoma Cells by Reducing VEGF Expression: Validation by Gene Silencing Technique. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8084109. [PMID: 31179333 PMCID: PMC6507437 DOI: 10.1155/2019/8084109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 11/22/2022]
Abstract
Shenqi Fuzheng Injection (SFI) is a traditional Chinese medicine injection with anticancer properties and is mainly composed of ginseng and astragalus. Its efficacy has been confirmed in clinical trials, but the mechanism remains unclear. We investigated the effect of SFI on vascular endothelial growth factor (VEGF) gene expression in hepatocellular carcinoma (HCC) cells and identified its possible mechanism of synergistic effects when combined with the chemotherapeutic drug interferon (IFN-) α. An MTT assay was used to measure the inhibition effects of low-dose IFN-α (6000 IU) with or without SFI (0.5 g/L) on the HCC cell line MHCC97. VEGF-silenced MHCC97L-mir200 cell lines were prepared using lentiviral vectors and evaluated by real-time PCR to determine the inhibition effect. We examined MHCC97L-mir200 and MHCC97L cells by MTT assay, using IFN-α alone or in combination with SFI. The inhibition ratio of IFN-α (6000 IU) was -29.5%, while that for IFN-α (6000 IU) + SFI (0.5 g/L) was 17.0%, which was significantly higher than that for the IFN-α group (P < 0.01). The VEGF gene was silenced successfully in MHCC97-L cells. After interference of VEGF, the inhibition by SFI and IFN-α in MHCC97L-mir200 did not differ from that in MHCC97-L cells (P > 0.05). SFI can reduce the expression of VEGF in HCC, which can increase the efficacy of IFN-α, providing a theoretical basis for clinical application.
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Maier AD, Bartek J, Eriksson F, Ugleholdt H, Juhler M, Broholm H, Mathiesen TI. Clinical and histopathological predictors of outcome in malignant meningioma. Neurosurg Rev 2019; 43:643-653. [DOI: 10.1007/s10143-019-01093-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/10/2019] [Accepted: 03/03/2019] [Indexed: 02/01/2023]
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Mathew Thomas V, Bindal P, Vredenburgh JJ. Everolimus and Bevacizumab in the Management of Recurrent, Progressive Intracranial NF2 Mutated Meningioma. Case Rep Oncol 2019; 12:126-130. [PMID: 31043950 PMCID: PMC6477501 DOI: 10.1159/000496984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 01/18/2023] Open
Abstract
Meningiomas are primary CNS tumors that arise from the arachnoid layer of the meninges. Genomic sequencing has revealed that NF2 mutations are the most common genetic alteration seen in meningiomas. Meningiomas although usually low grade, can sometimes progress to high grade. A patient who had several recurrences of meningiomas since childhood presented with recurrent headaches. Imaging showed that he had another recurrence of a meningioma. He underwent surgery for resection of the meningioma and histopathology showed NF2 mutation. He was started on everolimus and bevacizumab with good effect. Studies have shown that NF-2 mutated meningiomas have a good response to everolimus and bevacizumab with increased progression-free survival time and progression-free survival time at 6 months.
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Affiliation(s)
- Vinay Mathew Thomas
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Poorva Bindal
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - James J Vredenburgh
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Hematology-Oncology, Smilow Cancer Center Yale-New Haven at Saint Francis, Hartford, Connecticut, USA
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Pereira BJA, Oba-Shinjo SM, de Almeida AN, Marie SKN. Molecular alterations in meningiomas: Literature review. Clin Neurol Neurosurg 2018; 176:89-96. [PMID: 30553171 DOI: 10.1016/j.clineuro.2018.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/16/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Abstract
Meningiomas, tumors that originate from meningothelial cells, account for approximately 30% of all new diagnoses of central nervous system neoplasms. According to the 2016 WHO classification of central nervous system tumors meningiomas are classified into three grades: I, II, and III. Past studies have shown that the risk of meningiomas recurrence is strongly correlated with the molecular profile of the tumor. Extensive whole-exome or whole-genome sequencing has provided a large body of information about the mutational landscape of meningiomas. However, such a stratification of meningiomas based on mutational analysis alone has been proven not to satisfy the clinical need for distinction between patients who need (or do not need) an adjuvant treatment. Combined analysis of exome, transcriptome, methylome and future approaches for epigenetic aspects in meningiomas may allow researchers to unveil a more comprehensive understanding of tumor progression mechanisms and, consequently, a more personalized clinical approach for patients with meningioma. A better understanding of the genetics and clinical behavior of high-grade meningiomas is mandatory in order to better design future clinical trials. By studying the mechanisms underlying these new tumorigenesis pathways, we should be able to offer personalized chemotherapy to patients with surgery and radiation-refractory meningiomas in the near future. The purpose of this article is to accurately bring the compilation of this information, for a greater understanding of the subject.
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Affiliation(s)
- Benedito Jamilson Araújo Pereira
- Departament of Neurology, Laboratory of Molecular and Cellular Biology, LIM15, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
| | - Sueli Mieko Oba-Shinjo
- Departament of Neurology, Laboratory of Molecular and Cellular Biology, LIM15, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Suely Kazue Nagahashi Marie
- Departament of Neurology, Laboratory of Molecular and Cellular Biology, LIM15, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Rohilla S, Garg HK, Singh I, Yadav RK, Dhaulakhandi DB. rCBV- and ADC-based Grading of Meningiomas With Glimpse Into Emerging Molecular Diagnostics. Basic Clin Neurosci 2018; 9:417-428. [PMID: 30719256 PMCID: PMC6359681 DOI: 10.32598/bcn.9.6.417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/25/2017] [Accepted: 05/05/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction This study was conducted to grade meningiomas based on relative Cerebral Blood Volume (rCBV) and Apparent Diffusion Coefficient (ADC) to help surgeons plan the approach and extent of operation as well as decide on the need of any adjuvant radio/chemo therapy. The current and evolving genomic, proteomic, and spectroscopic technologies are also discussed which can supplement the current radiologic methods and procedures in grading meningiomas. Methods A total of 35 patients with meningioma prospectively underwent basic MR sequences (T1W, T2W, T2W/FLAIR) in axial, sagittal and coronal planes followed by Diffusion Weighted (DW) imaging having b value of 1000 (minimum ADC values used for analysis). Then, gadobenate dimeglumine/meglumine gadoterate was administered (0.1 mmol/kg at a rate of 4 mL/s) followed by saline flush (20 mL at a rate of 4 mL/s). Next, T2*W/FFE dynamic images were acquired; dynamics showing maximum fall in intensity was used for creating rCBV and relative Cerebral Blood Flow (rCBF) maps and calculating rCBV. Results Both maximum rCBV and minimum ADC within the tumor were not significant for differentiating benign from malignant meningiomas. A cut-off maximum rCBV of 2.5 mL/100 g in peritumoral edema was 75% sensitive, 84.6% specific, and 83.3% accurate in differentiating benign from malignant meningiomas. Conclusion Benign and malignant meningiomas can be differentiated based on maximum rCBV in peritumoral edema but ADC values within the tumor are insignificant in differentiating benign and malignant tumors. rCBV values within tumor, however, may be helpful in subtyping meningiomas, especially transitional and meningothelial meningiomas.
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Affiliation(s)
- Seema Rohilla
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Sciences, Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Harender K Garg
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Sciences, Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Ishwar Singh
- Department of Neurosurgery, Post Graduate Institute of Medical Sciences, Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Rohtas K Yadav
- Department of Radiodiagnosis & Imaging, Post Graduate Institute of Medical Sciences, Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Dhara B Dhaulakhandi
- Department of Biotechnology & Molecular Medicine, Post Graduate Institute of Medical Sciences, Regional Cancer Centre, Sharma University of Health Sciences, Rohtak, Haryana, India
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Rezaei S, Faeghi F, Samadian M, Shekarchi B. Preoperative Evaluation of Tumor Adhesion to Adjacent Brain Tissue in Patients with Meningioma with BSMI Method and Its Comparison with the Width of Edema Around Tumor. Asian Pac J Cancer Prev 2018; 19:2007-2012. [PMID: 30051700 PMCID: PMC6165639 DOI: 10.22034/apjcp.2018.19.7.2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background This study aims to investigate the ability of BSMI, to preoperative evaluation of tumor adhesion to adjacent brain tissue in patients with meningioma and comparing this method to the width of edema around tumor, using surgery findings as the reference standard. Methods Thirty patients with meningioma brain tumor who underwent surgery at Loghman hospital were selected for the study between November 2016 and January 2018. The level of edema according to the classification of Ide et al., (u1995) was compared with the surgical findings with blinded results, and neurosurgeons made a qualitative assessment of tumor adhesion at the time of resection. The ability of BSMI and level of edema to predict the surgical assessment of adhesion was tested using the Fisher Exact Test. Results BSMI method was conducted on patients with meningioma brain tumor, which judged 22 (73.3%) patients as adhesion (+) and 8 (26.66%) patients as adhesion (-). In this case, there was a significant relationship between BSMI judgment and surgical findings (p-value<0.0001). The sensitivity, specificity, precision and accuracy was high, at 91.30%, 85.71%, 95.45% and 90%, respectively. Using T2-Weighted SPACE sequence, of the 30 patients, 13 (43.3%) were judged as adhesion (+) and 17 (56.7%) as adhesion (-) from edema, whereas surgical findings evaluated 23 (76.7%) as adhesion (+) and 7 (23.3%) as adhesion (-).The sensitivity was moderate but the specificity was high, at 52.17% and 85.71%, respectively. Other criteria such as precision and accuracy were 62.31% and 60%, respectively. Conclusions BSMI evaluated adhesion of the tumor to the adjacent brain tissue with high-accuracy prior to surgery. This method was more effective than Edema method in evaluating adhesion between meningioma and the brain.
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Affiliation(s)
- Sonia Rezaei
- Department of Radiology, School of Allied Medical Science, Shahid Beheshti University of Medical Science,Tehran, Iran.
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Administration of ghrelin associated with decreased expression of matrix metalloproteinase-9 following normobaric systemic hypoxia in the brain. Endocr Regul 2018; 52:152-158. [PMID: 31517605 DOI: 10.2478/enr-2018-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE According to our previous studies, ghrelin protects blood brain barrier (BBB) integrity and it attenuates hypoxia-induced brain edema in the hypoxic conditions. However, the underlying mechanisms remain poorly understood. Several studies suggest a role for matrix metal-loproteinase-9 (MMP9) in the BBB disruption and cerebral edema formation. The present study was conducted to determine the effect of ghrelin on MMP9 protein expression in the model of acute and chronic systemic hypoxia. METHODS Adult male Wistar rats were divided into acute or chronic controls, acute or chronic hypoxia and ghrelin-treated acute or chronic hypoxia groups. The hypoxic groups were kept in the hypoxic chamber (10-11% O2) for two (acute) or ten days (chronic). Effect of ghrelin on MMP9 protein expression was assessed using immunoblotting. RESULTS Our results showed that acute and chronic systemic hypoxia increased the MMP9 protein expression in the brain (p<0.001). Treatment with ghrelin significantly attenuated this expression in the cerebral hypoxia (p<0.05). CONCLUSION Our results demonstrate that the neuroprotective effects of ghrelin may be mediated, in part, by decreasing in MMP9 production in the hypoxic brain.
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Gilard V, Goia A, Ferracci FX, Marguet F, Magne N, Langlois O, Perez A, Derrey S. Spinal meningioma and factors predictive of post-operative deterioration. J Neurooncol 2018; 140:49-54. [PMID: 29926318 DOI: 10.1007/s11060-018-2929-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 06/07/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Spinal meningiomas are slow-growing intradural-extramedullary tumors. They are usually associated with good outcomes. However, there are few descriptions of factors predictive of impaired evolution. Our objective was to identify predictive factors of post-operative deterioration as well as outcomes at follow-up. METHODS Between 2009 and 2016, 87 patients had surgery for spinal meningioma in our referral center. Clinical presentation, management and outcomes were reported during the post-operative period and at 3-month follow-up. Evaluation was based on post-operative neurological deterioration defined as an increase of at least one point in the McCormick score compared to the status at admission. RESULTS During the study period, post-operative deterioration occurred in 17 patients (19.5%). Risk factors associated with this deterioration were the absence of pre-operative neurological signs (Relative Risk; RR = 2.38, p = 0.04), an anterior location of the meningioma and a grade 2 meningioma on WHO classification score (RR = 6, p ≤ 0.01). At 3-month follow-up, in patients who initially presented with a motor deficit, partial recovery was found in 75%, stability in 20% and a deterioration of their clinical status in 5%. After a mean follow-up of 92.4 ± 51.9 months, the recurrence rate was 8%. CONCLUSIONS Spinal meningiomas are usually benign tumors whose treatment is based on complete surgical resection. Progress in surgical techniques has resulted in lower morbidity rates and improvement in post-operative recovery. In this study, we observed several factors associated with clinical deterioration. Before surgery, patients should be fully informed of these predictive factors of post-operative deterioration and their association with surgical morbidity.
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Affiliation(s)
- Vianney Gilard
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
- Normandie Univ, UNIROUEN, INSERM U1245, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, 76000, Rouen, France.
| | - Alice Goia
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | | | - Florent Marguet
- Normandie Univ, UNIROUEN, INSERM U1245, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, 76000, Rouen, France
- Department of Neuropathology, Rouen University Hospital, 76000, Rouen, France
| | - Nicolas Magne
- Department of Radiology, Rouen University Hospital, 76000, Rouen, France
| | - Olivier Langlois
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Alexis Perez
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
| | - Stéphane Derrey
- Department of Neurosurgery, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France
- Normandie Univ, UNIROUEN, INSERM UMR 1073, Laboratory Nutrition, Gut and Brain, 76000, Rouen, France
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Teramoto S, Tsunoda A, Kawamura K, Sugiyama N, Saito R, Maruki C. Malignant Subdural Hematoma Associated with High-Grade Meningioma. Surg J (N Y) 2018; 4:e91-e95. [PMID: 29896565 PMCID: PMC5995683 DOI: 10.1055/s-0038-1660511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/01/2018] [Indexed: 11/16/2022] Open
Abstract
A 70-year-old man, who had previously undergone surgical resection of left parasagittal meningioma involving the middle third of the superior sagittal sinus (SSS) two times, presented with recurrence of the tumor. We performed removal of the tumor combined with SSS resection as Simpson grade II. After tumor removal, since a left dominant bilateral chronic subdural hematoma (CSDH) appeared, it was treated by burr hole surgery. However, because the CSDH rapidly and repeatedly recurred and eventually changed to acute subdural hematoma, elimination of the hematoma with craniotomy was accomplished. The patient unfortunately died of worsening of general condition despite aggressive treatment. Histopathology of brain autopsy showed invasion of anaplastic meningioma cells spreading to the whole outer membrane of the subdural hematoma. Subdural hematoma is less commonly associated with meningioma. Our case indicates the possibility that subdural hematoma associated with meningioma is formed by a different mechanism from those reported previously.
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Affiliation(s)
| | - Akira Tsunoda
- Department of Neurosurgery, Koshigaya Municipal Hospital, Saitama, Japan
| | - Kaito Kawamura
- Department of Neurosurgery, Koshigaya Municipal Hospital, Saitama, Japan
| | - Natsuki Sugiyama
- Department of Neurosurgery, Koshigaya Municipal Hospital, Saitama, Japan
| | - Rikizo Saito
- Department of Neurosurgery, Koshigaya Municipal Hospital, Saitama, Japan
| | - Chikashi Maruki
- Department of Neurosurgery, Koshigaya Municipal Hospital, Saitama, Japan
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Hua L, Luan S, Li H, Zhu H, Tang H, Liu H, Chen X, Bozinov O, Xie Q, Gong Y. Angiomatous Meningiomas Have a Very Benign Outcome Despite Frequent Peritumoral Edema at Onset. World Neurosurg 2017; 108:465-473. [PMID: 28844928 DOI: 10.1016/j.wneu.2017.08.096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/13/2017] [Accepted: 08/14/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Angiomatous meningioma (AM) is a rare subtype of meningioma characterized by highly vascular tumor tissue comprising predominantly variable sized hyalinized blood vessels. The aim of this study is to evaluate the clinical radiologic features of AM and the long-term prognosis in a single neurosurgical center. METHODS A total of 93 patients who underwent surgical resection of AMs between 2003 and 2008 were enrolled for analysis. Clinical information, treatment, and radiologic images were collected and analyzed; follow-up was carried out as well. Expression of estrogen receptor, progesterone receptor, and vascular endothelial growth factor was analyzed by immunohistochemistry. RESULTS Forty-eight females and 45 males were identified. Forty-four patients (47.31%) manifested as hypersignal in T1-weighted imaging sequences and 68 (73.12%) as hypersignal in T2-weighted imaging, and a characteristic ringlike signal was observed in 28 patients (30.11%). Eighty-one cases (87.10%) showed different degrees of peritumor brain edema and it was significantly correlated with the vascular endothelial growth factor expression (P < 0.001). Simpson I resection was achieved in 63 patients (67.74%), grade II in 27 patients (29.03%), and grade III in 3 patients (3.23%). The extent of resection was not associated with the postoperative neurologic function (P = 0.546). Only 4 patients experienced recurrences during the follow-up and these 4 patients were stable until the last follow-up. CONCLUSIONS AMs were a special subtype of meningioma with distinctive radiologic features. AMs manifest benign behavior with a satisfying outcome, which makes Simpson grade II resection an option.
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Affiliation(s)
- Lingyang Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shihai Luan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Haixia Li
- Department of Pathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongda Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hailiang Tang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hanqiu Liu
- Department of Radiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiancheng Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Critical Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
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41
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Pathogenesis of peri-tumoral edema in intracranial meningiomas. Neurosurg Rev 2017; 42:59-71. [DOI: 10.1007/s10143-017-0897-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/23/2017] [Accepted: 08/18/2017] [Indexed: 12/21/2022]
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42
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Piazza M, Munasinghe J, Murayi R, Edwards N, Montgomery B, Walbridge S, Merrill M, Chittiboina P. Simulating vasogenic brain edema using chronic VEGF infusion. J Neurosurg 2017; 127:905-916. [PMID: 28059647 DOI: 10.3171/2016.9.jns1627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To study peritumoral brain edema (PTBE), it is necessary to create a model that accurately simulates vasogenic brain edema (VBE) without introducing a complicated tumor environment. PTBE associated with brain tumors is predominantly a result of vascular endothelial growth factor (VEGF) secreted by brain tumors, and VEGF infusion alone can lead to histological blood-brain barrier (BBB) breakdown in the absence of tumor. VBE is intimately linked to BBB breakdown. The authors sought to establish a model for VBE with chronic infusion of VEGF that can be validated by serial in-vivo MRI and histological findings. METHODS Male Fischer rats (n = 182) underwent stereotactic striatal implantation of MRI-safe brain cannulas for chronic infusion of VEGF (2-20 µg/ml). Following a preinfusion phase (4-6 days), the rats were exposed to VEGF or control rat serum albumin (1.5 µl/hr) for as long as 144 hours. Serial MRI was performed during infusion on a high-field (9.4-T) machine at 12-24, 24-36, 48-72, and 120-144 hours. Rat brains were then collected and histological analysis was performed. RESULTS Control animals and animals infused with 2 µg/ml of VEGF experienced no neurological deficits, seizure activity, or abnormal behavior. Animals treated with VEGF demonstrated a significantly larger volume (42.90 ± 3.842 mm3) of T2 hyper-attenuation at 144 hours when compared with the volume (8.585 ± 1.664 mm3) in control animals (mean difference 34.31 ± 4.187 mm3, p < 0.0001, 95% CI 25.74-42.89 mm3). Postcontrast T1 enhancement in the juxtacanalicular region indicating BBB breakdown was observed in rats undergoing infusion with VEGF. At the later time periods (120-144 hrs) the volume of T1 enhancement (34.97 ± 8.99 mm3) was significantly less compared with the region of edema (p < 0.0001). Histologically, no evidence of necrosis or inflammation was observed with VEGF or control infusion. Immunohistochemical analysis demonstrated astrocyte activation, vascular remodeling, and increased claudin-5 expression in juxtacanalicular regions. Aquaporin-4 expression was increased in both control and VEGF animals in the juxtacanalicular regions. CONCLUSIONS The results of this study show that chronic brain infusion of VEGF creates a reliable model of VBE. This model lacks necrosis and inflammation that are characteristic of previous models of VBE. The model allows for a precise investigation into the mechanism of VBE formation. The authors also anticipate that this model will allow for investigation into the mechanism of glucocorticoid action in abrogating VBE, and to test novel therapeutic strategies targeting PTBE.
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Affiliation(s)
- Martin Piazza
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | | | - Roger Murayi
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Nancy Edwards
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Blake Montgomery
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Stuart Walbridge
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Marsha Merrill
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
| | - Prashant Chittiboina
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, and
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Gawlitza M, Fiedler E, Schob S, Hoffmann KT, Surov A. Peritumoral Brain Edema in Meningiomas Depends on Aquaporin-4 Expression and Not on Tumor Grade, Tumor Volume, Cell Count, or Ki-67 Labeling Index. Mol Imaging Biol 2016; 19:298-304. [DOI: 10.1007/s11307-016-1000-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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A phase II trial of bevacizumab and everolimus as treatment for patients with refractory, progressive intracranial meningioma. J Neurooncol 2016; 129:281-8. [PMID: 27311730 DOI: 10.1007/s11060-016-2172-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 06/01/2016] [Indexed: 02/05/2023]
Abstract
Meningiomas that progress after standard therapies are challenging with limited effective chemotherapy options. This phase II trial evaluated the efficacy of everolimus plus bevacizumab in patients with recurrent, progressive meningioma after treatment with surgical resection and local radiotherapy when appropriate. Patients with recurrent meningioma (WHO grade I, II, or III) following standard treatments with surgical resection and radiotherapy received bevacizumab (10 mg/kg IV days 1 and 15) and everolimus (10 mg PO daily) each 28 day cycle. Evaluation of response occurred every 2 cycles. The primary endpoint was progression-free survival (PFS). Secondary endpoints included response rate, overall survival and safety. Seventeen patients with a median age of 59 years (29-84) received study treatment. WHO grades at study entry included: I, 5 (29 %); II, 7 (41 %); III, 4 (24 %); unknown, 1 (6 %). Patients received a median of 8 cycles (1-37); all patients are off study treatment. A best response of SD was observed in 15 patients (88 %), and 6 patients had SD for >12 months. Overall median PFS was 22 months (95 % CI 4.5-26.8) and was greater for patients with WHO grade II and III compared to grade I tumors (22.0 months vs 17.5 months). Four patients discontinued treatment due to toxicity (proteinuria, 2; colitis, 1, thrombocytopenia, 1). However, other grade 3 toxicity was uncommon, and no patient had grade 4 toxicity. The combination of everolimus and bevacizumab was well-tolerated, and produced stable disease in 88 % of patients; the median duration of disease stabilization of 10 months (2-29). The median PFS from this prospective trial was similar to previous retrospective reports of bevacizumab in the treatment of recurrent meningioma.
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