1
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Roukas D, Tsiambas E, Spyropoulou D, Adamopoulou M, Tsouvelas G, Mastronikoli S, Monastirioti AE, Kouzoupis A, Lazaris A, Kavantzas N. Caspase 3 Expression Profiles in Meningioma Subtypes Based on Tissue Microarray Analysis. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:586-591. [PMID: 39238614 PMCID: PMC11372700 DOI: 10.21873/cdp.10367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 09/07/2024]
Abstract
Background/Aim Concerning primary central nervous system neoplasms, meningiomas demonstrate the most common type in adults worldwide. Deregulation of apoptotic pathways in malignancies, including meningiomas, is correlated with chemoresistance and poor prognosis. Caspases represent crucial proteins that induce cell apoptosis. This study aimed to correlate caspase 3 protein expression levels to meningioma clinic-pathological features. Materials and Methods A set of fifty (n=50) meningioma lesions was included in the current analysis including a broad spectrum of histopathological subtypes (meningotheliomatous, psammomatus, transitional, fibrous, angiomatous, microcystic, atypical and anaplastic). Immunohistochemistry was implemented on tissue microarray cores of selected paraffin blocks by applying an anti-caspase 3 antibody. Additionally, an image analysis protocol was also performed in the corresponding immunostained slides. Results Caspase 3 protein over-expression was detected in 17/50 (34%) cases, whereas the remaining 33 cases (66%) were characterized by medium to low levels of the molecule. Caspase 3 expression was statistically significantly associated with the grade of the analyzed tumors and the mitotic index (p=0.002, p=0.001, respectively). Caspase 3 expression status was also correlated with the histotype of the selected meningiomas (p=0.016). Conclusion Caspase 3 demonstrated low expression levels in a significant subset of the examined meningiomas correlated with differentiation grade, mitotic activity, and partially with specific histotypes. Agents that could enhance caspase 3 expression - inducing its apoptotic activity - represent a very promising area in oncology for developing novel treatment regimens.
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Affiliation(s)
- Dimitrios Roukas
- Department of Psychiatry, 417 Veterans Army (NIMTS) Hospital, Athens, Greece
| | - Evangelos Tsiambas
- Department of Cytology, 417 Veterans Army (NIMTS) Hospital, Athens, Greece
- Department of Pathology, Medical School, University of Athens, Athens, Greece
| | - Despoina Spyropoulou
- Department of Radiation Oncology, Medical School, University of Patras, Patras, Greece
| | - Maria Adamopoulou
- Department of Biomedical Sciences, University of West Attica, Athens, Greece
| | - George Tsouvelas
- Department of Nursing, University of West Attica, Athens, Greece
| | | | | | | | - Andreas Lazaris
- Department of Pathology, Medical School, University of Athens, Athens, Greece
| | - Nikolaos Kavantzas
- Department of Pathology, Medical School, University of Athens, Athens, Greece
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2
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Ouyang ZQ, He SN, Zeng YZ, Zhu Y, Ling BB, Sun XJ, Gu HY, He B, Han D, Lu Y. Contrast enhanced magnetic resonance imaging-based radiomics nomogram for preoperatively predicting expression status of Ki-67 in meningioma: a two-center study. Quant Imaging Med Surg 2023; 13:1100-1114. [PMID: 36819280 PMCID: PMC9929424 DOI: 10.21037/qims-22-689] [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: 06/28/2022] [Accepted: 12/05/2022] [Indexed: 01/12/2023]
Abstract
Background The aim of this study was to develop and validate a radiomics nomogram for preoperative prediction of Ki-67 proliferative index (Ki-67 PI) expression in patients with meningioma. Methods A total of 280 patients from 2 independent hospital centers were enrolled. Patients from center I were randomly divided into a training cohort of 168 patients and a test cohort of 72 patients, and 40 patients from center II served as an external validation cohort. Interoperator reproducibility test, Z-score standardization, analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO) binary logistic regression were used to select radiomics features, which were extracted from contrast-enhanced T1-weighted imaging (CE-T1WI) imaging. The radiomics signature for predicting Ki-67 PI expression was developed and validated using 4 classifiers including logistic regression (LR), decision tree (DT), support vector machine (SVM), and adaptive boost (AdaBoost). Finally, combined radiological characteristics with radiomics signature were used to establish the nomogram to predict the risk of high Ki-67 PI expression in patients with meningioma. Results Fourteen radiomics features were used to construct the radiomics signature. The radiomics nomogram that incorporated the radiomics signature and radiological characteristics showed excellent discrimination in the training, test, and validation cohorts with areas under the curve of 0.817 (95% CI: 0.753-0.881), 0.822 (95% CI: 0.727-0.916), and 0.845 (95% CI: 0.708-0.982), respectively. In addition, the calibration curve for the nomogram demonstrated good agreement between prediction and actual observation. Conclusions The proposed contrast enhanced magnetic resonance imaging (MRI)-based radiomics nomogram could be an effective tool to predict the risk of Ki-67 high expression in patients with meningioma.
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Affiliation(s)
- Zhi-Qiang Ouyang
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Radiology, Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shao-Nan He
- Department of Medical Imaging, First People's Hospital of Yunnan Province, Kunming, China
| | - Yi-Zhen Zeng
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yun Zhu
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bing-Bing Ling
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xue-Jin Sun
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - He-Yi Gu
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Bo He
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dan Han
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yi Lu
- Department of Medical Imaging, Laboratory of Brain Function, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Biczok A, Thorsteinsdottir J, Karschnia P, Ruf VC, Tonn JC, Herms J, Schichor C, Dorostkar MM. Mutational signature of extracranial meningioma metastases and their respective primary tumors. Acta Neuropathol Commun 2023; 11:12. [PMID: 36641486 PMCID: PMC9840245 DOI: 10.1186/s40478-023-01505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/27/2022] [Indexed: 01/15/2023] Open
Abstract
Extracranial metastases of intracranial meningiomas are rare. Little is known about the mutational pattern of these tumors and their metastatic seeding. Here, we retrospectively explored the molecular alterations of these metastatic lesions and their respective intracranial tumor manifestations.Histology and genome sequencing were performed in intracranial meningiomas and their extracranial metastatic lesions operated upon between 2002 and 2021. Next-generation DNA/RNA sequencing (NGS) and methylome analysis were performed to determine molecular alterations.We analyzed the tumors of five patients with clinically suspected metastases of a meningioma using methylome analysis and next generation panel sequencing of the primary tumors as well as the metastatic lesions. Metastases were found in the spinal cord and one in the lung. In four of these patients, molecular analyses confirmed metastatic disease, while the fifth patient was found to harbor two molecularly distinct meningiomas. On pathological assessment, the primary lesions ranged from CNS WHO grades 1 to 3 (integrated molecular-morphologic meningioma classification scores 2 to 6). Of the four true metastatic cases, three out of the four metastasizing tumors harbored alterations in the BAP1 gene, comprising a stop-mutation combined with copy-number loss (WHO grade 1), copy number loss (WHO grade 3) and a frameshift mutation (WHO grade 2). Furthermore, the latter was confirmed to harbor a BAP1 tumor predisposition syndrome. The fourth metastasizing tumor had copy-number losses in NF2 and PTEN. Only one of four showed CDKN2A homozygous deletion; none showed TERT promotor mutation.Our results molecularly confirm true metastatic disease in four meningioma patients. BAP1 gene alterations were the most frequent. Larger cohorts, most likely from multicenter studies are necessary to evaluate the role of BAP-1 alterations to further understand the metastatic spread in meningiomas. for metastatic spread and might indicate patients at risk for metastatic spread. Further explorations within larger cohorts are necessary to validate these findings which might influence the clinical management in the future.
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Affiliation(s)
- A. Biczok
- grid.5252.00000 0004 1936 973XDepartment of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany
| | - J. Thorsteinsdottir
- grid.5252.00000 0004 1936 973XDepartment of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany
| | - P. Karschnia
- grid.5252.00000 0004 1936 973XDepartment of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany
| | - V. C. Ruf
- grid.5252.00000 0004 1936 973XCenter for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany
| | - J. C. Tonn
- grid.5252.00000 0004 1936 973XDepartment of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany
| | - J. Herms
- grid.5252.00000 0004 1936 973XCenter for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany
| | - C. Schichor
- grid.5252.00000 0004 1936 973XDepartment of Neurosurgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377 Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany
| | - M. M. Dorostkar
- grid.5252.00000 0004 1936 973XCenter for Neuropathology and Prion Research, Ludwig-Maximilians-University Munich, Munich, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Munich, Heidelberg, Germany ,grid.459693.4Present Address: Department of Pathology, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
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4
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Wang Q, Wei W, Cao M. Rare pulmonary metastases of atypical meningioma diagnosed on total-body 18F-FDG PET/CT. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2022; 12:163-165. [PMID: 36419587 PMCID: PMC9677137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Here we reported a 59-year-old male who had undergone brain surgery three times and the pathological results showed atypical meningioma (2015, WHO grade I; 2018, WHO grade II; 2019, WHO grade II-III), with multiple pulmonary nodules, which arose during follow-up. A total-body 18F-FDG PET/CT showed multiple solid nodules with increased 18F-FDG metabolism (SUVmax = 8.6). The patient underwent a CT-guided lung biopsy and the histopathological study showed positive staining of epithelial membrane antigen (EMA), vimentin (VIM), SSTR2, Ki67 (20%), and negative staining of CK, TTF-1, CD34, SY, PR, P40, respectively. Based on the history and immunohistology results, multiple pulmonary metastases from atypical meningioma were finally diagnosed, since double positive staining of EMA and VIM supported the diagnosis of meningioma and negative staining excluded primary lung cancers. The patient has given up any treatment because of personal reasons. Pulmonary metastasis from meningioma is rare, accurate diagnosis should be based on medical history, imaging characteristics, and histopathological findings.
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Affiliation(s)
- Qing Wang
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200217, China
| | - Weijun Wei
- Department of Nuclear Medicine, Institute of Clinical Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai 200217, China
| | - Min Cao
- Department of Thoracic Surgery, Renji Hospital, Shanghai Jiao Tong University School of MedicineShanghai 200217, China
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Barresi V, Lawlor RT, Mafficini A, Gilioli E, Scarpa A. Metastatic grade 1 meningioma lacking genetic abnormalities commonly associated with bad prognosis. Pathol Res Pract 2022; 238:154089. [PMID: 36067609 DOI: 10.1016/j.prp.2022.154089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/20/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
AIMS Meningioma metastasis is a rare event, observed primarily in World Health Organization (WHO) grade 3 tumors, although it has also been reported in WHO grade 1 meningiomas. This study aims at clarifying whether the metastasis of a WHO grade 1 meningioma was associated with genetic abnormalities commonly found in cases that are more aggressive. METHODS Using next generation sequencing of a panel of 174 genes, we analyzed the genetic alterations of a WHO grade 1 skull-base meningioma and its paired lung metastases detected 22 years after craniotomy. RESULTS Similar to the primary tumor, lung metastases did not show mitoses or histological signs of malignancy. Consistent with their origin from intracranial tumor, they harbored the same genetic alterations as this one. These consisted of the pathogenic mutation p. E17K of AKT1 and variants of unknown significance in NOTCH1 (p. P2133T), SERPINB8 (p. H359Y) and SMARCA4 (p. P277S). CONCLUSIONS The E17K AKT1 mutation is frequently found in skull base meningiomas and without prognostic significance. Our findings suggest that metastasis of grade 1 meningiomas is independent of genetic alterations (CDKN2A homozygous deletion, pTERT mutation, or 1p, 9p, 14q and 18q loss of heterozygosity) commonly found in more aggressive tumors.
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Affiliation(s)
- Valeria Barresi
- Department of Diagnostics and Public Health, Section of Anatomic Pathology, University of Verona, Verona, Italy.
| | - Rita T Lawlor
- ARC-NET Research Centre, University and Hospital Trust of Verona, Verona, Italy
| | - Andrea Mafficini
- Department of Diagnostics and Public Health, Section of Anatomic Pathology, University of Verona, Verona, Italy; ARC-NET Research Centre, University and Hospital Trust of Verona, Verona, Italy
| | - Eliana Gilioli
- Department of Pathology and Diagnostics, Unit of Anatomic Pathology, Hospital Trust of Verona, Verona, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Anatomic Pathology, University of Verona, Verona, Italy; ARC-NET Research Centre, University and Hospital Trust of Verona, Verona, Italy
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6
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Roukas D, Kouzoupis A, Spyropoulou D, Tsiambas E, Mastronikolis S, Falidas E, Tsouvelas G, Ragos V, Lazaris AC, Kavantzas N. Caspase 8 Expression Patterns in Meningiomas: A Tissue Microarray Digital Image Analysis. Cureus 2022; 14:e26182. [PMID: 35891812 PMCID: PMC9304793 DOI: 10.7759/cureus.26182] [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] [Accepted: 03/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background: Caspases (cysteine-aspartic proteases) represent a family of enzymes that critically influence cell homeostasis by being involved in inflammation and apoptosis mechanisms. Meningiomas demonstrate the most common intracranial primary central nervous system tumors in adults worldwide. Aim: Our purpose was to explore the role of caspase 8 expression in meningiomas’ pathological features. Materials and methods: A total of 50 meningioma cases were included in the study, comprising a broad spectrum of histopathological sub-types. An immunohistochemistry assay was applied on tissue microarray cores followed by digital image analysis. Results: Overexpression of caspase 8 protein was observed in 21/50 (42%) cases, whereas the rest of them (29/50, 58%) demonstrated moderate to low levels of the molecule. Caspase 8 overall expression was statistically significantly correlated to grade of the examined tumors and to mitotic index (p=0.001,p=0.002, respectively). Conclusions: Caspase 8 aberrant expression is observed in meningiomas associated with their differentiation grade and mitotic activity. Targeted therapeutic strategies focused on enhancing caspase 8 expression and also inducing the overall apoptotic activity should be a very promising approach in rationally handling sub-groups of meningioma patients.
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7
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Huntoon K, Yilmaz AS, Pietrzak M, Chen X, Yan P, Toland AE, Elder JB. Genetic analysis of a malignant meningioma and associated metastases. Acta Neurochir (Wien) 2022; 164:1401-1405. [PMID: 34981192 DOI: 10.1007/s00701-021-05101-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/26/2021] [Indexed: 12/21/2022]
Abstract
To identify genes altered in a highly aggressive metastatic meningioma primary as well as its metastases. Exome sequencing of a primary anaplastic meningioma and metastatic lesions in which DNA could be extracted and compared to germline DNA. Genetic analysis of the metastatic sites found 31 common mutations among the primary tumor and two metastatic sites. Additionally, genetic mutations were identified which were either infrequently (MUC3A, ALDH1A3, HOXA1) or not at all previously described in meningiomas (CASS4, CMKLR1). Exome sequencing of a metastatic meningioma and its distant metastases outside the CNS identified mutations that were not previously well described.
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Affiliation(s)
- Kristin Huntoon
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Ohio State University, Columbus, OH, USA.
- Department of Neurological Surgery, MD Anderson Cancer Center, Houston, TX, USA.
| | - Ayse Selen Yilmaz
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Maciej Pietrzak
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Ohio State University, Columbus, OH, USA
| | - Xi Chen
- Division of Hematology, Department of Internal Medicine, College of Medicine, OSUCCC Genomics Shared Resource, Columbus, OH, USA
| | - Pearlly Yan
- Division of Hematology, Department of Internal Medicine, College of Medicine, OSUCCC Genomics Shared Resource, Columbus, OH, USA
| | - Amanda Ewart Toland
- Department of Cancer Biology & Genetics, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Ohio State University, Columbus, OH, USA
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8
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Vasudevan HN, Castro MRH, Lee JC, Villanueva-Meyer JE, Bush NAO, McDermott MW, Solomon DA, Perry A, Magill ST, Raleigh DR. DNA methylation profiling demonstrates superior diagnostic classification to RNA-sequencing in a case of metastatic meningioma. Acta Neuropathol Commun 2020; 8:82. [PMID: 32517746 PMCID: PMC7285578 DOI: 10.1186/s40478-020-00952-3] [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: 04/30/2020] [Accepted: 05/19/2020] [Indexed: 02/04/2023] Open
Abstract
Meningiomas are the most common primary intracranial tumors, but meningioma metastases are rare. Accordingly, the clinical workup, diagnostic testing, and molecular classification of metastatic meningioma is incompletely understood. Here, we present a case report of multiply recurrent meningioma complicated by liver metastasis. We discuss the patient presentation, imaging findings, and conventional histopathologic characterization of both the intracranial lesion and the metastatic focus. Further, we perform multiplatform molecular profiling, comprised of DNA methylation arrays and RNA-sequencing, of six stereotactically-guided samples from the intracranial meningioma and a single ultrasound-guided liver metastasis biopsy. Our results show that DNA methylation clusters distinguish the liver metastasis from the intracranial meningioma samples, and identify a small focus of hepatocyte contamination with the liver biopsy. Nonetheless, DNA methylation-based classification accurately identifies the liver metastasis as a meningioma with high confidence. We also find that clustering of RNA-sequencing results distinguishes the liver metastasis from the intracranial meningiomas samples, but that differential gene expression classification is confounded by hepatocyte-specific gene expression programs in the liver metastasis. In sum, this case report sheds light on the comparative biology of intracranial and metastatic meningioma. Furthermore, our results support methylation-based classification as a robust method of diagnosing metastatic lesions, underscore the broad utility of DNA methylation array profiling in diagnostic pathology, and caution against the routine use of bulk RNA-sequencing for identifying tumor signatures in heterogeneous metastatic lesions.
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Attuati L, Zaed I, Morselli C, Pecchioli G, Fornari M, Picozzi P. Multimodal Management of Metastatic Malignant Meningiomas: The Role of Radiosurgery in Long-Term Local Control. World Neurosurg 2019; 128:562-572. [PMID: 31102770 DOI: 10.1016/j.wneu.2019.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/04/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Metastatic meningiomas (MMs) are rare (0.1 of 100 cases). Their treatment requires a multimodal approach, with surgery, radiotherapy, chemotherapy, and radiosurgery, which allows a long-term local control (LC) and an extension of free survival. In this study, the authors performed a review of the literature and reported 2 cases of patients affected by extracranial MMs, with long-term follow-up. CASE DESCRIPTION Case 1: A 48-year-old woman was admitted for resection of an extra-axial falx lesion (meningioma G1). After 2 years, the lesion got a local recurrence, resected with a histologic diagnosis of meningioma G3. During the next 9 years, the patient underwent 5 Gamma Knife radiosurgery (GKRS) procedures for local recurrence. At 56 years, she was readmitted for a surgical local recurrence (histologic definition: anaplastic meningioma G3). At the age of 62, the patient underwent a right lobectomy for a lung mass (histologic diagnosis: anaplastic meningioma G3). After that, multiple lesions at soma L5 and adrenal gland were discovered and then monitored. Case 2: A 48-year-old woman was operated for a lesion involving torcular herophili (meningioma G2). After 3 years, a local recurrence requires GKRS combined with tamoxifen. In the next 7 years, she underwent 5 GKRS procedures for local recurrence. The patient also underwent chemotherapy with octreotide. At the age of 61, she discovered multiple lesions in both lungs, liver, and kidney. A hepatic biopsy showed anaplastic meningioma G3. Also this patient does not suffer from any neurologic or clinical deficits. CONCLUSIONS LC in malignant meningioma is achievable through a multimodal approach; GKRS makes possible LC, but a novel aspect of these lesions is opened to discussion: the metastases. These reports show that multimodal treatment for MMs is an effective approach with good LC and improvement of overall survival. However, a long survival may allow systemic diffusion of the disease, in particular, when sagittal sinus is involved.
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Affiliation(s)
- Luca Attuati
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.
| | - Carlotta Morselli
- Department of Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Guido Pecchioli
- Department of Neurosurgery, Azienda Ospedaliera Careggi, Florence, Italy
| | - Maurizio Fornari
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Piero Picozzi
- Department of Neurosurgery, Functional Radiosurgery and Gamma Knife Unit-IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
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