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Cui Y, Zhou X, Li N. A Single Hepatic Metastasis of Cranial Meningioma on [ 18F]FDG PET/CT 16 Years After Initial Surgery. J Nucl Med Technol 2024:jnmt.124.267905. [PMID: 39137986 DOI: 10.2967/jnmt.124.267905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/29/2024] [Indexed: 08/15/2024] Open
Abstract
Hepatic metastases of cranial meningiomas are rare, particularly when they present as a delayed, solitary metastasis, which poses a challenge for imaging-based diagnosis. [18F]FDG PET/CT facilitates diagnosis and posttreatment restaging, whereas somatostatin receptor-targeted PET demonstrates high sensitivity and specificity in the diagnosis of meningiomas and may potentially evaluate the viability of theranostics approaches, particularly for treatment-resistant meningiomas.
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Affiliation(s)
- Yan Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
| | - Xin Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
| | - Nan Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, China
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2
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Watanabe G, Young K, Rauber E, Khan MF, Suzuki R, Riestenberg R, Umana GE, Palmisciano P. A systematic review of extraneural meningioma metastasis: timing, evolution and outlook. J Neurooncol 2024; 168:187-196. [PMID: 38530549 DOI: 10.1007/s11060-024-04659-6] [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: 02/08/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE Extraneural meningioma metastasis is a rare occurrence and may pose a clinical challenge due to its unclear prognosis. In this systematic review, we analyze patient demographics, clinical characteristics, management strategies, and outcomes. METHODS PubMed, EMBASE, Scopus, Cochrane, and Web of Science databases were searched from inception to February 23, 2024 for cases of metastatic meningioma according to PRISMA guidelines. Descriptive statistics, Mann-Whitney U test, Fisher's exact tests, Kaplan-Meier curves, and log-rank tests were used for selected analyses. RESULTS A total of 288 patients (52% male) were included with an average age of 49 years at meningioma diagnosis. Tumors were distributed across WHO grade 1 (38%), 2 (36%), and 3 (26%). Most patients experienced intracranial recurrence (79%) and mean time to first metastasis was approximately 8 years. No change in WHO grade between primary and metastasis was observed for most cases (65%). Treatment of the initial metastasis was most often with surgery (43%), chemotherapy (20%), or no treatment (14%). Half of the patients were alive (50%) with an average follow-up of 3 years following metastasis. Overall median survival was 36 months for the entire cohort. This differed significantly between WHO grade 1 versus 2/3 meningioma primaries (168 vs. 15 months, p < 0.005). CONCLUSION Metastatic meningioma appears to be associated with more positive prognosis than other brain tumor types with extra-neural metastasis or metastasis in general. This is particularly true for cases arising from a WHO grade 1 meningioma.
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Affiliation(s)
- Gina Watanabe
- John A. Burns School of Medicine, University of Hawaii at Manoa, 5080 Likini St #417, Honolulu, HI, 96818, USA.
| | - Kurtis Young
- Department of Otolaryngology, University of Nevada, Las Vegas, NV, USA
| | - Erin Rauber
- School of Medicine, University of Kansas, Kansas City, KS, USA
| | | | - Reannon Suzuki
- John A. Burns School of Medicine, University of Hawaii at Manoa, 5080 Likini St #417, Honolulu, HI, 96818, USA
| | - Robert Riestenberg
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Paolo Palmisciano
- Department of Neurological Surgery, University of California Davis, Sacramento, CA, USA
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Trabzonlu L, Martinez-Lage M, Deschler D, Paly JJ, Faquin WC. FNA of Meningioma with Rhabdoid Features Presenting as a Lateral Neck Mass. Head Neck Pathol 2024; 18:32. [PMID: 38658429 PMCID: PMC11043294 DOI: 10.1007/s12105-024-01644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
Primary meningioma at extracranial head and neck sites is uncommon. Since fine needle aspiration (FNA) is often the first line diagnostic modality for the evaluation of masses in the head and neck, extracranial meningiomas can create a significant diagnostic pitfall for FNA. We report a case of meningioma with rhabdoid features and BAP1 loss in a 26-year-old woman, presenting as a large neck mass along the carotid sheath. FNA biopsy of the mass demonstrated a highly cellular specimen with clusters of uniform, epithelioid cells with round to ovoid nuclei and moderate nuclear to cytoplasmic ratio. An extensive immunohistochemical panel performed on cell block sections showed that the tumor cells were weakly EMA positive, progesterone receptor was focally positive, and SSTR2A was diffuse and strongly positive. BAP1 immunohistochemistry showed a diffuse loss of expression in the tumor cells. After the cytologic diagnosis of meningioma, a tissue biopsy was performed, and the diagnosis of meningioma with rhabdoid features and BAP1 loss was confirmed. We also perform a literature review of meningioma cases presenting as a neck mass and evaluated by FNA. Our case highlights the significant diagnostic challenges that can be caused by extracranial meningiomas on FNA and the importance of ancillary studies to avoid diagnostic pitfalls.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA
| | - Maria Martinez-Lage
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA
| | - Daniel Deschler
- Department of Otolaryngology, Massachusetts Eye and Ear, and Harvard Medical School, Boston, MA, USA
| | - Jonathan J Paly
- Department of Radiation Oncology, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, WRN 219, Boston, MA, 02114, USA.
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Lisowski D, Hartrampf PE, Hasenauer N, Nickl V, Monoranu CM, Tamihardja J. Complete loss of E-cadherin expression in a rare case of metastatic malignant meningioma: a case report. BMC Neurol 2023; 23:398. [PMID: 37925427 PMCID: PMC10625181 DOI: 10.1186/s12883-023-03450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/26/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Hematogenous tumor spread of malignant meningiomas occurs very rarely but is associated with very poor prognosis. CASE PRESENTATION We report an unusual case of a patient with a malignant meningioma who developed multiple metastases in bones, lungs and liver after initial complete resection of the primary tumor. After partial hepatic resection, specimens were histologically analyzed, and a complete loss of E-cadherin adhesion molecules was found. No oncogenic target mutations were found. The patient received a combination of conventional radiotherapy and peptide receptor radionuclide therapy (PRRT). Due to aggressive tumor behavior and rapid spread of metastases, the patient deceased after initiation of treatment. CONCLUSIONS E-cadherin downregulation is associated with a higher probability of tumor invasion and distant metastasis formation in malignant meningioma. Up to now, the efficacy of systemic therapy, including PRRT, is very limited in malignant meningioma patients.
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Affiliation(s)
- Dominik Lisowski
- Department of Radiation Oncology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany, Germany.
| | - Philipp E Hartrampf
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Natalie Hasenauer
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Vera Nickl
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Camelia-Maria Monoranu
- Department of Neuropathology, Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Jörg Tamihardja
- Department of Radiation Oncology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany, Germany
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Cao X, He Q, Ding M, Kong W, Yin C, Zhao W, Wang Y. Hemorrhagic meningioma with pulmonary metastasis: Case report and literature review. Open Life Sci 2023; 18:20220745. [PMID: 37941787 PMCID: PMC10628577 DOI: 10.1515/biol-2022-0745] [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: 07/04/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 11/10/2023] Open
Abstract
Meningiomas are extra-axial neoplasms that originate from the arachnoid cap cells located on the inner surface of the meninges. Approximately 36% of central nervous system tumors are meningiomas. Based on earlier findings to be benign in most cases, they are categorized as slow-growing tumors that form gradually over time. Meningiomas are usually asymptomatic and discovered inadvertently. They rarely present with immediate clinical symptoms or abrupt hemorrhagic strokes. However, tumor hemorrhage can be fatal in high-grade meningiomas, particularly those with vascularization. We describe a 58-year-old man who was hospitalized after experiencing an unexpectedly acute headache. The right cerebellar hemisphere and vermis cerebellar hemorrhage were detected on computed tomography (CT), and the cerebellar hemorrhage was explained by a diagnosis of hypertension. When additional analysis of the patient's chest CT indicated lung mass lesions, we assumed that the lung cancer had spread to the brain. However, the pathological outcomes of a guided definite pulmonary aspiration biopsy, in conjunction with resection of the cerebellar tumor, suggested a subtentorial meningioma with ruptured hemorrhage and pulmonary meningioma metastasis. The patient was transferred to a hospital closer to home for ongoing follow-up and, after 2 months, he had recovered well.
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Affiliation(s)
- Xuan Cao
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
- Department of Neurosurgery, People’s Hospital of Rongcheng, The Middle Section of Chengshan Avenue 298, Rongcheng, 264300, Shandong, China
| | - Qiaowei He
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Mingzeng Ding
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Wei Kong
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Changyou Yin
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Wei Zhao
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
| | - Yanbin Wang
- Department of Neurosurgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, China
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Himič V, Burman RJ, Fountain DM, Hofer M, Livermore LJ, Jeyaretna DS. Metastatic meningioma: a case series and systematic review. Acta Neurochir (Wien) 2023; 165:2873-2883. [PMID: 37491650 PMCID: PMC10542723 DOI: 10.1007/s00701-023-05687-3] [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: 05/09/2023] [Accepted: 06/15/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Meningiomas are the most common primary intracranial tumor. While the majority of meningiomas are benign, rarely they can metastasize extracranially. There is a need for a more comprehensive review of these patients to improve our understanding of this rare phenomenon and its prevalence globally. Here we describe our institution's experience of patients presenting with metastatic meningiomas. We further perform a systematic review of the existing literature to explore common features of this rare manifestation of meningioma and review the efficacy of current treatments. METHODS We performed a retrospective clinical review of all adult patients with metastatic meningioma managed at our institution over the past 20 years, identifying 6 patients. We then performed a systematic review of cases of metastatic meningioma in the literature ranging from the years 1886 to 2022. A descriptive analysis was then conducted on the available data from 1979 onward, focusing on the grade and location of the primary tumor as well as the latency period to, and location of, the metastasis. RESULTS In total, we analyzed 155 cases. Fifty-four percent of patients initially presented with a primary meningioma located in the convexity. The most common site of metastasis was the lung. Risk factors associated with a shorter time to metastasis were male sex and a high initial grade of the tumor. Regarding treatment, the addition of chemotherapy was the most common adjunct to the standard management of surgery and radiotherapy. Despite an exhaustive review we were unable to identify effective treatments. The majority of published cases came from centers situated in high-income countries (84%) while only 16% came from lower- and middle-income countries. CONCLUSIONS Metastatic meningiomas pose a pertinent, and likely underestimated, clinical challenge within modern neurosurgery. To optimize management, timely identification of these patients is important. More research is needed to explore the mechanisms underlying these tumors to better guide the development of effective screening and management protocols. However, screening of each meningioma patient is not feasible, and at the heart of this challenge is the inability to control the primary disease. Ultimately, a consensus is needed as to how to correctly screen for and manage these patients; genomic and epigenomic approaches could hold the answer to finding druggable targets.
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Affiliation(s)
- Vratko Himič
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Richard J Burman
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Daniel M Fountain
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Monika Hofer
- Department of Neuropathology, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Laurent J Livermore
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - D Sanjeeva Jeyaretna
- Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
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Trakolis L, Petridis AK. Interdisciplinary Therapeutic Approaches to Atypical and Malignant Meningiomas. Cancers (Basel) 2023; 15:4251. [PMID: 37686527 PMCID: PMC10486693 DOI: 10.3390/cancers15174251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Meningiomas have the highest incidence among brain tumors. In contrast to benign tumors that constitute the majority of this tumor entity, the treatment of aggressive meningiomas (WHO Grade 2 and 3) is more challenging, requiring gross total removal of the tumor and the affected dura and adjuvant radiotherapy. Sometimes the location and/or the configuration of the tumor do not favor radical surgical resection without endangering the patient's clinical condition after surgery and pharmacological therapy has, until now, not been proven to be a reliable alternative. Discussion: In this narrative review, we discuss the current literature with respect to the management of meningiomas, discussing the importance of the grade of resection in the overall prognosis of the patient and in the planning of adjuvant therapy. Conclusions: According to the location and size of the tumor, radical resection should be taken into consideration. In patients with aggressive meningiomas, adjuvant radiotherapy should be performed after surgery. In cases of skull base meningiomas, a maximal, though safe, resection should take place before adjuvant therapy. An interdisciplinary approach is beneficial for patients with primary or recurrent meningioma.
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Affiliation(s)
- Leonidas Trakolis
- Department of Neurosurgery, Agios Loukas Clinic Thessaloniki, 55236 Thessaloniki, Greece;
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Zhou J, Du Z. Case Report: Recurrent meningioma with multiple metastases. Front Oncol 2023; 13:1192575. [PMID: 37529695 PMCID: PMC10388547 DOI: 10.3389/fonc.2023.1192575] [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: 03/23/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Post-surgery recurrence of meningiomas with multiple extracranial metastases is rare. Currently, information on extracranial metastases is limited, and no clear predictors and standardized treatment protocols can be applied clinically. Herein, we report a case of meningioma that recurred after two surgeries and had multiple distant metastases. Computed tomography revealed multiple enlarged lymph nodes in the para-aortic arch, left lower lung region, retroperitoneum, and abdominopelvic region, as well as soft tissue mass-like lesions under the liver capsule in the right lobe of the liver. Magnetic resonance imaging showed space-occupying lesions under the cranial plate of the left parietal lobe. Tissue biopsy confirmed the diagnosis of recurrent meningioma with extracranial metastases. Immune checkpoint inhibitors and anti-angiogenic drugs were administered. After two treatment cycles, the patient's clinical symptoms were significantly relieved, and the imaging assessment confirmed a stable disease. Although it did not meet our expectations, this combination therapy still demonstrated a possible benefit in improving meningioma patients' survival and quality of life. In this report, along with the case, we also review the relevant literature on the subject and discuss the associated risk factors and treatment options.
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Affiliation(s)
- Juyue Zhou
- Graduate Institute, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
| | - Zhonghai Du
- Department of Oncology, Weifang Hospital of Traditional Chinese Medicine, Weifang, Shandong, China
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9
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Ajler P, Davila EZG, Plou P, Casto F, Christiansen S, Boccalatte LA, Larrañaga J. Multidisciplinary approach to anaplastic and metastatic meningioma: A case report and review of the literature. Surg Neurol Int 2023; 14:230. [PMID: 37560559 PMCID: PMC10408638 DOI: 10.25259/sni_222_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/14/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Meningiomas are slow-growing neoplasms, accounting for 20% of all primary intracranial neoplasms and 25% of all intraspinal tumors. Atypical and anaplastic meningiomas are infrequent, representing fewer than 5% of all meningiomas. Unusually, they can show aggressive behavior, and extracranial metastases are extremely rare, representing approximately 0.1% of all reported cases. CASE DESCRIPTION Fifty-six-year-old male patient diagnosed with atypical basal frontal meningioma with multiple resections, both endoscopic endonasal and transcranial. After hypofractionated radiosurgery, the patient showed new tumor recurrence associated to right cervical level II ganglionic metastasis. We opted for complete resection of the meningioma and reconstruction with anterior rectus abdominis muscle flap, as well as selective cervical ganglionectomy. Anatomical pathology showed neoplastic proliferation of meningothelial cells in syncytial cytoplasm, oval or spherical nuclei with slight anisocariosis and hyperchromasia, and intranuclear vacuoles, all compatible with anaplastic meningioma. CONCLUSION Due to a lack of consensus on how to treat a metastatic malignant meningioma, this pathology requires a multidisciplinary approach, and treatment needs to be adapted to each particular case. Complete resection of the lesion is the primary goal, and this requires complex procedures involving endocranial as well as extracranial surgeries, which result in composite defects difficult to resolve. Microvascular free flaps are considered the gold standard in reconstructions of large skull base defects, with high success rates and few complications.
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Affiliation(s)
- Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | | | - Pedro Plou
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Florencia Casto
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Silvia Christiansen
- Department of Pathological Anatomy, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Luis Alejandro Boccalatte
- Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - Juan Larrañaga
- Reconstructive Surgery, Hospital Italiano de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
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Gousias K, Trakolis L, Simon M. Meningiomas with CNS invasion. Front Neurosci 2023; 17:1189606. [PMID: 37456997 PMCID: PMC10339387 DOI: 10.3389/fnins.2023.1189606] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
CNS invasion has been included as an independent criterion for the diagnosis of a high-grade (WHO and CNS grade 2 and 3) meningioma in the 2016 and more recently in the 2021 WHO classification. However, the prognostic role of brain invasion has recently been questioned. Also, surgical treatment for brain invasive meningiomas may pose specific challenges. We conducted a systematic review of the 2016-2022 literature on brain invasive meningiomas in Pubmed, Scopus, Web of Science and the Cochrane Library. The prognostic relevance of brain invasion as a stand-alone criterion is still unclear. Additional and larger studies using robust definitions of histological brain invasion and addressing the issue of sampling errors are clearly warranted. Although the necessity of molecular profiling in meningioma grading, prognostication and decision making in the future is obvious, specific markers for brain invasion are lacking for the time being. Advanced neuroimaging may predict CNS invasion preoperatively. The extent of resection (e.g., the Simpson grading) is an important predictor of tumor recurrence especially in higher grade meningiomas, but also - although likely to a lesser degree - in benign tumors, and therefore also in brain invasive meningiomas with and without other histological features of atypia or malignancy. Hence, surgery for brain invasive meningiomas should follow the principles of maximal but safe resections. There are some data to suggest that safety and functional outcomes in such cases may benefit from the armamentarium of surgical adjuncts commonly used for surgery of eloquent gliomas such as intraoperative monitoring, awake craniotomy, DTI tractography and further advanced intraoperative brain tumor visualization.
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Affiliation(s)
- Konstantinos Gousias
- Department of Neurosurgery, St. Marien Academic Hospital Lünen, KLW St. Paulus Corporation, Luenen, Germany
- Medical School, Westfaelische Wilhelms University of Muenster, Muenster, Germany
- Medical School, University of Nicosia, Nicosia, Cyprus
| | - Leonidas Trakolis
- Department of Neurosurgery, St. Marien Academic Hospital Lünen, KLW St. Paulus Corporation, Luenen, Germany
| | - Matthias Simon
- Department of Neurosurgery, Bethel Clinic, Medical School, Bielefeld University, Bielefeld, Germany
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Abstract
Meningiomas comprise a histologically and clinically diverse set of tumors arising from the meningothelial lining of the central nervous system. In the past decade, remarkable progress has been made in deciphering the biology of these common neoplasms. Nevertheless, effective systemic or molecular therapies for meningiomas remain elusive and are active areas of preclinical and clinical investigation. Thus, standard treatment modalities for meningiomas are limited to maximal safe resection, radiotherapy, or radiosurgery. This review examines the history, clinical rationale, and future directions of radiotherapy and radiosurgery as integral and effective treatments for meningiomas.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Calixto-Hope G Lucas
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL 60611, USA
| | - C Leland Rogers
- Radiation Oncology, GammaWest Cancer Services, Salt Lake City, UT, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA 94143, USA
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12
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Feltracco H, Matar AJ, Smith SA, Blair C, Sarmiento JM. Surgical management of a giant hepatic metastasis from a cranial meningioma 10 years after resection. J Surg Case Rep 2023; 2023:rjad238. [PMID: 37153828 PMCID: PMC10156433 DOI: 10.1093/jscr/rjad238] [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: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
Meningiomas are the most common type of primary brain tumor; they have a low risk for extracranial metastases, which are primarily associated with increased tumor grade. Hepatic metastases from cranial meningiomas are extremely rare, with only a paucity of cases reported in the literature and no standardized approach to management. Herein, we report a case of an incidentally discovered giant (>20 cm) metastatic meningioma to the liver treated with surgical resection 10 years following resection of a low-grade cranial meningioma. This report also highlights the use of (68Ga) DOTATATE PET/CT as the diagnostic imaging modality of choice when evaluating for meningioma metastases. To our knowledge, this report describes the largest hepatic metastasis from a cranial meningioma to undergo surgical resection in the literature.
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Affiliation(s)
- Haley Feltracco
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Abraham J Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Savannah A Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Catherine Blair
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Juan M Sarmiento
- Correspondence address. Clinic Building—A, Suite A5039, 1365 Clifton Rd, Atlanta, GA 30322, USA. E-mail:
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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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14
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Mair MJ, Berghoff AS, Brastianos PK, Preusser M. Emerging systemic treatment options in meningioma. J Neurooncol 2023; 161:245-258. [PMID: 36181606 PMCID: PMC9989003 DOI: 10.1007/s11060-022-04148-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/25/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Meningiomas are the most frequently diagnosed intracranial neoplasms. Usually, they are treated by surgical resection in curative intent. Radiotherapy and stereotactic radiosurgery are commonly applied in the adjuvant setting in newly diagnosed atypical (CNS WHO grade 2), and anaplastic (CNS WHO grade 3) meningioma, especially if gross total resection is not feasible, and in recurrent cases. Conversely, the evidence for pharmacotherapy in meningioma is scarce. METHODS The available literature of systemic treatment in meningioma was screened using PubMed, and ongoing clinical trials were explored using ClinicalTrials.gov. RESULTS Classical cytotoxic agents, somatostatin analogs, and antihormone treatments have shown only limited efficacy. In contrast, tyrosine kinase inhibitors and monoclonal antibodies, especially those targeting angiogenic signaling such as sunitinib and bevacizumab, have shown promising antitumoral activity in small phase 2 trials. Moreover, results of recent landmark studies on (epi-)genetic alterations in meningioma revealed potential therapeutic targets which are currently under investigation. These include inhibitors of mammalian target of rapamycin (mTOR), focal adhesion kinase (FAK), cyclin-dependent kinases (CDK), phosphoinositide-3-kinase (PI3K), sonic hedgehog signaling, and histone deacetylases. In addition, clinical trials evaluating immune checkpoint inhibitors such as ipilimumab, nivolumab, pembrolizumab and avelumab are currently being conducted and early results suggest clinically meaningful responses in a subset of patients. CONCLUSIONS There is a paucity of high-level evidence on systemic treatment options in meningioma. However, interesting novel treatment targets have been identified in the last decade. Positive signals of anti-angiogenic agents, genomically targeted agents and immunotherapy in early phase trials should be confirmed in large prospective controlled trials.
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Affiliation(s)
- Maximilian J Mair
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria
| | - Priscilla K Brastianos
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Christian Doppler Laboratory for Personalized Immunotherapy, Medical University of Vienna, Vienna, Austria.
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15
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Muacevic A, Adler JR, Vyas PA. Asymptomatic Intraosseous Meningioma of the Humerus: A Case Report and Review of the Literature. Cureus 2022; 14:e32590. [PMID: 36654535 PMCID: PMC9840848 DOI: 10.7759/cureus.32590] [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] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
Meningiomas are the most common central nervous system tumor. They are typically benign neoplasms but may produce neurological symptoms due to mass effect. Meningiomas may also extend to extradural locations; however, these account for only a small percentage of all meningiomas. Most extradural meningiomas arise in intraosseous locations, usually within the cranial bones or vertebrae. However, this is a rare case of extradural extension of an asymptomatic intracranial meningioma to the proximal humerus in the absence of any musculoskeletal symptoms. To the best of our knowledge, this presentation of an extradural intraosseous meningioma has not previously been reported in the literature. We present a case of an incidental intraosseous meningioma in a 66-year-old man. This patient was initially being screened for metastasis of stage IA1 adenocarcinoma of the lung, and a positron emission tomography (PET) scan revealed a focus of activity in the proximal diaphysis of the right humerus suspicious for malignancy. The upper extremity magnetic resonance imaging (MRI) demonstrated an indeterminate lesion. Curettage of the humeral lesion revealed an intraosseous psammomatous meningioma without evidence of metastatic lung carcinoma. Our case report aims to illustrate the importance of considering alternative metastatic sources, such as intracranial meningioma, during the investigation of an indeterminate bony lesion. This is the first case to illustrate asymptomatic intraosseous meningioma in an appendicular skeletal location, highlighting the need for thorough source investigation.
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16
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Zeng J, Sun L, Huang J, Yang X, Hu W. Enhancer of zeste homolog 2 is a negative prognostic biomarker and correlated with immune infiltrates in meningioma. Front Neurosci 2022; 16:1076530. [PMID: 36532284 PMCID: PMC9748184 DOI: 10.3389/fnins.2022.1076530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Enhancer of zeste homolog 2 (EZH2), an important epigenetic regulator, that mainly regulates histone H3 lysine 27 trimethylation (H3K27me3) through histone methyltransferase, and participates in promoting the development of tumors. At present, the loss of H3K27me3 expression in meningioma is a poor prognostic factor, but the research of EZH2 in meningioma is rare. Therefore, we aim to explore the expression of EZH2 in the meningioma and its correlation with the prognosis and immune microenvironment and lay the foundation for the subsequently potential targeted therapy and immunotherapy for meningioma. METHODS Tissue microarray immunohistochemistry staining was performed on 276 meningioma samples from Sun Yat-sen University Cancer Center. Expression levels of EZH2, H3K27me3, Ki67, programmed cell death protein 1 (PD-1), programmed cell death 1 ligand 1 (PD-L1), CD4, CD8, CD20, FOXP3, CD68, and CD163 were evaluated. Cox regression analyses were performed, and the Kaplan-Meier (KM) method was used to construct survival curves. In addition, we use biological information methods to analyze the mRNA expression of EZH2 and its relationship with the prognosis and immune microenvironment in the gene expression omnibus (GEO) database. RESULTS Enhancer of zeste homolog 2 expression is concentrated in World Health Organization (WHO) grades 2 and 3 meningiomas (8.3+ and 33.3%+). We found that EZH2 expression was associated with a worse prognosis in meningioma (P < 0.001), the same results were confirmed in the GEO database (P < 0.001). Both EZH2 expression and H3K27me3 deletion (P = 0.035) predicted a worse prognosis, but EZH2 has no correlation with H3K27me3 expression. EZH2 expression was closely associated with increased Ki67 index (P < 0.001). In addition, EZH2 was associated with the immune microenvironment and positively correlated with PD-L1 expression (P < 0.001). CONCLUSION Enhancer of zeste homolog 2 is a new prognostic biomarker in meningioma. It correlates with PD-L1 expression and closely related to tumor immunosuppression. Our research can provide a reference for the potential targeted therapy and immunotherapy of meningioma in the future.
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Affiliation(s)
- Jing Zeng
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lu Sun
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jiaming Huang
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xia Yang
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wanming Hu
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, China
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17
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Gambacciani C, Grimod G, Sameshima T, Santonocito OS. Surgical management of skull base meningiomas and vestibular schwannomas. Curr Opin Oncol 2022; 34:713-722. [PMID: 36093884 DOI: 10.1097/cco.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to discuss surgical management of meningiomas and schwannomas of skull base. RECENT FINDINGS Meningiomas and schwannomas are typically benign neoplasm with a good prognosis after surgery. Patients should be treated individually related to several features: size and localization of tumor and its proximity with deep critical neurovascular structures, neurological status, age and comorbidity. Also, the widespread use of neuroimaging and the progressive and constant aging of the populations inevitably result in the increase of detection rate of incidental (asymptomatic) neoplasm.Nowadays, there are still controversies about the correct management strategy. SUMMARY Surgery represents the gold standard treatment, with the objective of gross total resection; however, it is not always feasible due to localization, encasement of neuro-vascular structure, invasion of cranial nerve and brain parenchyma. Stereotactic radiosurgery and radiation therapy are important to achieve a satisfactory functional outcome and tumor control in case of residue or recurrence. A multidisciplinary approach is pivotal.
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Affiliation(s)
| | | | - Tetsuro Sameshima
- Department of Neurosurgery. Hamamatsu University School of Medicine, University Hospital, Hamamatsu, Japan
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18
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Chen WC, Perlow HK, Choudhury A, Nguyen MP, Mirchia K, Youngblood MW, Lucas CHG, Palmer JD, Magill ST, Raleigh DR. Radiotherapy for meningiomas. J Neurooncol 2022; 160:505-515. [PMID: 36315366 PMCID: PMC9722800 DOI: 10.1007/s11060-022-04171-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022]
Abstract
Meningiomas are the most common primary central nervous system neoplasm. Despite promising recent progress in elucidating the genomic landscape and underlying biology of these histologically, molecularly, and clinically diverse tumors, the mainstays of meningioma treatment remain maximal safe resection and radiation therapy. The aim of this review of meningioma radiotherapy is to provide a concise summary of the history, current evidence, and future for application of radiotherapy in meningioma treatment.
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Affiliation(s)
- William C Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA.
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA.
| | - Haley K Perlow
- Department of Radiation Oncology, Ohio State University, Columbus, OH, 43210, USA
| | - Abrar Choudhury
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Minh P Nguyen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Kanish Mirchia
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Mark W Youngblood
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60611, USA
| | | | - Joshua D Palmer
- Department of Radiation Oncology, Ohio State University, Columbus, OH, 43210, USA
| | - Stephen T Magill
- Department of Neurological Surgery, Northwestern University, Chicago, IL, 60611, USA
| | - David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, USA.
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA.
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19
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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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20
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Brastianos PK, Kim AE, Giobbie-Hurder A, Lee EQ, Wang N, Eichler AF, Chukwueke U, Forst DA, Arrillaga-Romany IC, Dietrich J, Corbin Z, Moliterno J, Baehring J, White M, Lou KW, Larson J, de Sauvage MA, Evancic K, Mora J, Nayyar N, Loeffler J, Oh K, Shih HA, Curry WT, Cahill DP, Barker FG, Gerstner ER, Santagata S. Phase 2 study of pembrolizumab in patients with recurrent and residual high-grade meningiomas. Nat Commun 2022; 13:1325. [PMID: 35289329 PMCID: PMC8921328 DOI: 10.1038/s41467-022-29052-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/16/2022] [Indexed: 01/16/2023] Open
Abstract
High-grade meningiomas are associated with neuro-cognitive morbidity and have limited treatments. High-grade meningiomas harbor an immunosuppressive tumor microenvironment (TME) and programmed death-ligand 1 (PD-L1) expression may contribute to their aggressive phenotype. Here, we present the results of a single-arm, open-label phase 2 trial (NCT03279692) evaluating the efficacy of pembrolizumab, a PD-1 inhibitor, in a cohort of 25 evaluable patients with recurrent and progressive grade 2 and 3 meningiomas. The primary endpoint is the proportion of patients alive and progression-free at 6 months (PFS-6). Secondary endpoints include progression-free and overall survival, best intracranial response, and toxicity. Our study has met its primary endpoint and achieved a PFS-6 rate of 0.48 (90% exact CI: 0.31-0.66) and a median PFS of 7.6 months (90% CI: 3.4-12.9 months). Twenty percent of patients have experienced one (or more) grade-3 or higher treatment-related adverse events. These results suggest that pembrolizumab exerts promising efficacy on a subset of these tumors. Further studies are needed to identify the biological facets within the meningioma TME that may drive response to immune-based therapies.
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Affiliation(s)
| | - Albert E Kim
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Eudocia Quant Lee
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Nancy Wang
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - April F Eichler
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Ugonma Chukwueke
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Deborah A Forst
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Jorg Dietrich
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Zachary Corbin
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer Moliterno
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Joachim Baehring
- The Chenevert Family Brain Tumor Center, Smilow Cancer Hospital and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Michael White
- Wilmot Cancer Center, University of Rochester, Division of Neuro-Oncology, Rochester, NY, USA
| | - Kevin W Lou
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Juliana Larson
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Magali A de Sauvage
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Kathryn Evancic
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Joana Mora
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Naema Nayyar
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Jay Loeffler
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Kevin Oh
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Helen A Shih
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - William T Curry
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Daniel P Cahill
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Fred G Barker
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Elizabeth R Gerstner
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Sandro Santagata
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Department of Pathology, Harvard Medical School, Boston, MA, USA
- Ludwig Center at Harvard, Boston, MA, USA
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21
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Galldiks N, Angenstein F, Werner JM, Bauer EK, Gutsche R, Fink GR, Langen KJ, Lohmann P. Use of advanced neuroimaging and artificial intelligence in meningiomas. Brain Pathol 2022; 32:e13015. [PMID: 35213083 PMCID: PMC8877736 DOI: 10.1111/bpa.13015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/09/2021] [Accepted: 08/02/2021] [Indexed: 01/04/2023] Open
Abstract
Anatomical cross‐sectional imaging methods such as contrast‐enhanced MRI and CT are the standard for the delineation, treatment planning, and follow‐up of patients with meningioma. Besides, advanced neuroimaging is increasingly used to non‐invasively provide detailed insights into the molecular and metabolic features of meningiomas. These techniques are usually based on MRI, e.g., perfusion‐weighted imaging, diffusion‐weighted imaging, MR spectroscopy, and positron emission tomography. Furthermore, artificial intelligence methods such as radiomics offer the potential to extract quantitative imaging features from routinely acquired anatomical MRI and CT scans and advanced imaging techniques. This allows the linking of imaging phenotypes to meningioma characteristics, e.g., the molecular‐genetic profile. Here, we review several diagnostic applications and future directions of these advanced neuroimaging techniques, including radiomics in preclinical models and patients with meningioma.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Cologne, Germany
| | - Frank Angenstein
- Functional Neuroimaging Group, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany.,Leibniz Institute for Neurobiology (LIN), Magdeburg, Germany.,Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | - Jan-Michael Werner
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elena K Bauer
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robin Gutsche
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Cologne, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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22
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Indolent enhancing spinal lesions mimicking spinal metastasis in pediatric patients with malignant primary brain tumors. Sci Rep 2022; 12:1728. [PMID: 35110660 PMCID: PMC8811062 DOI: 10.1038/s41598-022-05831-6] [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: 10/25/2021] [Accepted: 01/13/2022] [Indexed: 12/01/2022] Open
Abstract
Spinal metastasis from malignant primary brain tumors (MPBTs) in pediatric patients is rare and often appears as enhancing lesions on MRI. However, some indolent enhancing spinal lesions (IESLs) resulting from previous treatment mimic metastasis on MRI, leading to unnecessary investigation and treatment. In 2005–2020, we retrospectively enrolled 12 pediatric/young patients with clinical impression of spinal metastasis and pathological diagnosis of their spinal lesions. Three patients had MPBT with IESL, and 9 patients had malignant tumors with metastases. The histopathologic diagnosis of IESL was unremarkable marrow change. We evaluated their MRI, CT, and bone scan findings. The following imaging findings of IESL vs. spinal metastasis were noted: (1) IESLs appeared round/ovoid (3/3, 100%), whereas spinal metastasis appeared irregular (9/9, 100%) (P = 0.005); (2) target-shaped enhancement was noted in (3/3, 100%) vs. (0/9, 0%) of cases, respectively (P = 0.005); (3) pathologic fracture of the vertebral body was noted in (1/3, 33.3%) vs. (9/9, 100%) of cases, respectively (P = 0.045); (4) expansile vertebral shape was noted in (0/3, 0%) vs. (9/9, 100%) of cases, respectively (P = 0.005); (5) obliteration of the basivertebral vein was noted in (0/3, 0%) vs. (9/9, 100%) of cases, respectively (P = 0.005); and (6) osteoblastic change on CT was noted in (3/3, 100%) vs. (2/9, 22.2%) of cases, respectively (P = 0.034). IESL in pediatric patients with MPBT can be differentiated from metastasis based on their imaging characteristics. We suggest close follow-up rather than aggressive investigation and treatment for IESL.
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Mardani P, Safarian A, Ashari A, Pourjafar S, Anbardar MH, Azarpira N, Vafabin M, Yousefi S. Low-grade intracranial meningioma with bilateral pulmonary metastases incidentally detected postpartum: a case report and review of the literature. J Med Case Rep 2021; 15:509. [PMID: 34645501 PMCID: PMC8515739 DOI: 10.1186/s13256-021-03093-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Meningiomas are the most commonly encountered intracranial tumors, usually showing indolent behavior. Extra-axial spreading and distant metastases are seldom detected in these tumors, and lung metastasis from a low-grade meningioma is a rare event. Case presentation This case report aimed to present the clinical, imaging, and pathological features of a 37-year-old Caucasian pregnant woman with bilateral lung metastases incidentally detected during preoperative workup ahead of surgery for a primary intracranial meningioma. The possible metastatic routes and risk factors of dissemination to the pulmonary circulation were discussed as well. Conclusion Metastasis must be considered in patients with intracranial meningiomas accompanied by venous sinus invasion and extension through the calvarium. Thorough paraclinical investigations are suggested in such cases.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Safarian
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anita Ashari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sarina Pourjafar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Masoud Vafabin
- General Surgery Resident, Shiraz University of Medical Sciences, Shiraz, Iran
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Neurosurgical follow-up and treatment of a series of 26 WHO grade III meningiomas. J Clin Neurosci 2021; 91:219-225. [PMID: 34373031 DOI: 10.1016/j.jocn.2021.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 12/22/2022]
Abstract
Meningiomas are the most common primary intracranial tumors. They have three pathologic grades. Surgical resection aiming Simpson I resection is the standard treatment for meningiomas. Radiotherapy and Gamma Knife radiosurgery are the main adjuvant and salvage treatments. Chemotherapy has limited use. Grade II, and III meningiomas have a higher recurrence rate, and adjuvant radiotherapy is usually the standard treatment for grade III meningiomas. In this paper, we analyzed our meningioma series of 1401 patients and presented the treatment and follow-up results of 26 grade III meningioma cases. Median follow-up of grade III meningiomas was 40.5 (range, 1-154) months. The mean age of patients was 51.7 ± 15.7 years; 12 of them were female and 14 were male (female/male ratio = 0.9). The median progression-free survival (PFS) of them was 22 months, and overall survival (OS) was 62 months. Meningiomas with gross total resection (GTR), non-skull base meningiomas, and primary grade III meningiomas had longer PFS, while meningiomas with GTR, non-skull base meningiomas, and primary meningiomas had longer OS with a statistical significance.
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25
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Vuong HG, Ngo TNM, Dunn IF. Incidence, risk factors, and prognosis of meningiomas with distant metastases at presentation. Neurooncol Adv 2021; 3:vdab084. [PMID: 34345819 DOI: 10.1093/noajnl/vdab084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Distant metastases (DM) at presentation in meningiomas is a very rare event, and the incidence and factors predicting this are uncertain. This population-based study also aimed to investigate the prognostic implication of DM at presentation and clinical parameters to prognosticate the overall survival (OS) of meningiomas presenting with DM (M1). Methods We accessed the Surveillance, Epidemiology, and End Results program to search for patients who were diagnosed with meningioma between 2004 and 2016. The log-rank test was used to compare Kaplan-Meier survival curves and multivariate Cox regression model was utilized to evaluate the prognostic parameters of meningiomas with DM at presentation. Results The incidence of DM at presentation among all meningiomas was 0.18%. Clinical variables associated with this event were male gender, large tumor size, and WHO grade III. The presence of DM at diagnosis conferred a shorter survival in comparison to those without DM (HR = 2.015; 95% CI = 1.600-2.536). Older patient age, male gender, malignant histology, and the lesser extent of resection were independent prognostic factors that could negatively impact OS of M1 meningiomas. Radiotherapy and chemotherapy were not associated with an improved outcome for these patients. Conclusion Our study highlighted the clinical and prognostic factors of M1 meningiomas. These data suggest that a greater extent of resection is associated with increased OS across a nationwide analysis and emphasize the need to establish the standards of care in these patients.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Tam N M Ngo
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
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26
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Hanna R, Feldman AM, Keller CE, Siddiqui MS. A Grade I Intracranial Meningioma with Metastasis to Multiple Vertebral Bodies: A Case Report and Literature Review. Cureus 2020; 12:e11477. [PMID: 33329973 PMCID: PMC7734695 DOI: 10.7759/cureus.11477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
World Health Organization (WHO) grade I meningiomas are slow-growing and typically benign brain tumors that can often be easily removed by surgery and rarely become malignant. We report the case of a WHO grade I meningioma in a 67-year-old man with multiple extracranial metastases.
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Affiliation(s)
- Renee Hanna
- Radiation Oncology, Henry Ford Health System, Detroit, USA
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Williams EA, Santagata S, Wakimoto H, Shankar GM, Barker FG, Sharaf R, Reddy A, Spear P, Alexander BM, Ross JS, Brastianos PK, Cahill DP, Ramkissoon SH, Juratli TA. Distinct genomic subclasses of high-grade/progressive meningiomas: NF2-associated, NF2-exclusive, and NF2-agnostic. Acta Neuropathol Commun 2020; 8:171. [PMID: 33087175 PMCID: PMC7580027 DOI: 10.1186/s40478-020-01040-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Genomic studies of high-grade/progressive meningiomas have reported a heterogeneous mutation spectrum, identifying few recurrently mutated genes. Most studies have been underpowered to detect genomic subclasses of aggressive meningiomas due to relatively small number of available samples. Here, we present a genomic survey of one of the largest multi-institutional cohorts of high-grade/progressive meningiomas to date. METHODS 850 high-grade/progressive meningiomas, including 441 WHO grade 2 and 176 WHO grade 3 meningiomas and 220 progressive WHO grade 1 meningiomas, were tested as part of a clinical testing program by hybridization capture of 406 cancer-related genes to detect base substitutions, indels, amplifications, deletions, and rearrangements. Information from pathology reports, histopathology review, and patient clinical data was assessed. RESULTS Genomic analyses converged to identify at least three distinct patterns of biologically-aggressive meningiomas. The first and most common contained NF2-mutant tumors (n = 426, 50%), was associated with male sex (64.4% %, p = 0.0001) and often harbored additional mutations in CDKN2A/B (24%), and the chromatin regulators ARID1A (9%), and KDM6A (6%). A second group (NF2-agnostic) featured TERT promoter (TERTp; n = 56) or TP53 mutations (n = 25) and were either NF2-mutant or wild-type, and displayed no association with either sex (p = 0.39). The remaining group generally lacked NF2 mutations, and accounted for 40% of the cases-with three subgroups. One consistent primarily of grade 3 lesions harboring alterations in chromatin regulators BAP1 (n = 22) or PBRM1 (n = 16). A second subgroup contained AKT1 (n = 26), PIK3CA (n = 14) and SMO (n = 7) mutant skull-based meningiomas, and a third mixed subgroup included 237 meningiomas with a heterogeneous spectrum of low frequency and non-recurrent alterations. CONCLUSIONS Our findings indicate that the patterns of genomic alterations in high-grade/progressive meningiomas commonly group into three different categories. The most common NF2-associated canonical group frequently harbored CDKN2A/B alterations, which is potentially amenable to targeted therapies. An NF2-agnostic group harbored frequent TERTp and TP53 mutations. The final subclass, distinct from the canonical NF2 mutant associated pathway, was partly characterized by BAP1/PBRM1 alterations (rhabdoid/papillary histology) or skull-base disease. Overall, these data increase our understanding of the pathobiology of high-grade/progressive meningiomas and can guide the design of clinical trials. IRB APPROVAL STATUS Reviewed and approved by Western IRB; Protocol No. 20152817.
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Affiliation(s)
- Erik A Williams
- Foundation Medicine Inc, 150 Second Street, Cambridge, MA, 02141, USA.
- Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Hiroaki Wakimoto
- Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Radwa Sharaf
- Foundation Medicine Inc, 150 Second Street, Cambridge, MA, 02141, USA
| | - Abhinav Reddy
- Foundation Medicine Inc, 150 Second Street, Cambridge, MA, 02141, USA
| | - Phoebe Spear
- Foundation Medicine Inc, 150 Second Street, Cambridge, MA, 02141, USA
| | - Brian M Alexander
- Foundation Medicine Inc, 150 Second Street, Cambridge, MA, 02141, USA
| | - Jeffrey S Ross
- Foundation Medicine Inc, 150 Second Street, Cambridge, MA, 02141, USA
- Department of Pathology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Priscilla K Brastianos
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel P Cahill
- Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Shakti H Ramkissoon
- Foundation Medicine Inc, 150 Second Street, Cambridge, MA, 02141, USA
- Department of Pathology, Wake Forest School of Medicine, Wake Forest Comprehensive Cancer Center, Winston-Salem, NC, USA
| | - Tareq A Juratli
- Translational Neuro-Oncology Laboratory, Department of Neurosurgery, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, Dresden, Germany.
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Jenson M, Haymes D, Patel J. Grade III Solitary Fibrous Tumor/Hemangiopericytoma: A Rare Case of a World Health Organization Grade III Anaplastic Hemangiopericytoma. Cureus 2020; 12:e10926. [PMID: 33194492 PMCID: PMC7657444 DOI: 10.7759/cureus.10926] [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] [Indexed: 11/05/2022] Open
Abstract
Solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs) have been combined into a single designation in the most recent World Health Organization (WHO) guidelines as solitary fibrous tumor/hemangiopericytoma (SFT/HPC). These rare intracranial tumors can present as WHO grade I, II, or III tumors, with the risk of recurrence, metastasis, and mortality worsening with higher-grade tumors. We present a case of a patient with a WHO grade III SFT/HPC with an emphasis on the imaging features that help differentiate this type of tumor from meningiomas, which are much more common and can appear similar. Being able to help differentiate these tumors by their imaging appearance is important to help triage and risk-stratify patient management decisions.
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Affiliation(s)
- Matthew Jenson
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Dalys Haymes
- Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Jeet Patel
- Radiology, University of Florida College of Medicine, Jacksonville, USA
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29
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Lin D, Yu Y, Wang H, Fang Y, Yin J, Shen Y, Tan L. Radiological manifestations, histological features and surgical outcomes of pulmonary meningothelial proliferation: a case series and rethinking. Transl Lung Cancer Res 2020; 9:1159-1168. [PMID: 32953494 PMCID: PMC7481605 DOI: 10.21037/tlcr-19-699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Lung cancer screening with computed tomography (CT) has been adopted worldwide. Consequently, there is an increase of some previously rarely reported lesions, like pleuropulmonary meningothelial proliferation (PMP), which included metastatic pulmonary meningiomas (MPMs), primary pulmonary meningiomas (PPMs) and minute pulmonary meningothelial-like nodules (MPMNs). To date, the understanding of the clinical management of PMP is limited. Methods We retrospectively searched PMP (MPMs, PPMs, and MPMNs) on the medical database (May 2005 to April 2019) of our department, and extracted the demographic and perioperative information. The last follow-up was in May 2019. Results A total of 78 patients, including 16 (20.5%) males and 62 (79.5%) females, were enrolled, with the median age as 61 (range, 27–78) years. There was 1 case with multiple MPMs, 4 cases with PPMs and 73 cases with MPMNs. On CT, MPMs manifested as round nodules with solid or part-solid components. PPM mainly presented as an isolated, round, solid, and well-circumscribed nodule, with or without lobulation. While MPMNs often showed as multiple, round, randomly-distributed, solid or partly-solid nodules, most of which were in tiny size. Histologically, MPM, PPM, and MPMN had similar morphological and immunohistochemical (IHC) features. As to the surgical outcomes, the case with multiple MPMs had undergone a progression after wedge resection and was in an active monitoring. And the four cases with PPMs and the five cases with MPMNs were all in regular surveillance. Conclusions PPM has variable radiological manifestations. But it can be histologically identified by the characteristic features. Although surgery is able to achieve satisfying prognosis, active observation is an alternative in selected cases due to the surgical invasiveness and the indolent nature of the disease.
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Affiliation(s)
- Dong Lin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yangli Yu
- Department of Radiology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Hao Wang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yong Fang
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jun Yin
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yaxing Shen
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Lijie Tan
- Department of Thoracic Surgery, Zhongshan Hospital Fudan University, Shanghai, China
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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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Minami Y, Sato S, Koyanagi H, Kinowaki Y. Malignant primary pulmonary meningioma with bone metastasis. Oxf Med Case Reports 2020; 2020:omaa005. [PMID: 32128218 PMCID: PMC7048065 DOI: 10.1093/omcr/omaa005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 12/27/2022] Open
Abstract
Primary pulmonary meningioma is extremely rare and only <45 cases have been reported since its first report by Kemnitz and Heinrich (Meningioma of lung: first report with light and electronmicroscopic findings. Ultrastruct. Pathol. 1982;3:359-65). Among these cases, only five cases were malignant or atypical. A 67-year-old female with primary pulmonary meningioma underwent thoracoscopic pulmonary wedge resection of the left lower lobe a year before. She had been aware of left thigh pain for 9 months, then she was referred to our division. Positron emission tomography-computed tomography suspected multiple bone metastasis including frontal bone, mandible, left scapula, rib, vertebra, pubis, left femur and sternum. We performed a needle biopsy of the sternum. Histopathological diagnosis was metastasis of primary pulmonary meningioma, World Health Organization grade III. We treated her with denosumab and radiation therapy targeting the left femur. Two months after the treatment, the pain had decreased and she could walk with no cane. No case of malignant extracranial meningioma with bone metastasis have been reported.
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Affiliation(s)
- Yusuke Minami
- Division of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shingo Sato
- Division of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirotaka Koyanagi
- Division of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Kinowaki
- Division of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
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Vakil H, Tran L, Lewis GD, Cykowski MD, Butler EB, Teh BS. Biopsy proven metastatic meningioma: A case report and review of the literature. Rep Pract Oncol Radiother 2019; 24:528-532. [PMID: 31516399 DOI: 10.1016/j.rpor.2019.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/21/2019] [Accepted: 08/11/2019] [Indexed: 11/18/2022] Open
Abstract
Meningiomas are the most common type of benign tumor found in the brain and are typically benign, slow-growing lesions. The current standard of care consists of surgical resection and subsequent postoperative radiotherapy to prevent local recurrence. Because of their indolent nature, meningiomas are rarely found to spread extracranially and develop distant metastases. We present the clinical, imaging, and pathologic features of a patient who had meningioma with multiple local recurrences, who was incidentally found to have metastatic disease in the lungs. In addition, we discuss details of this case in the context of the previously reported literature.
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Affiliation(s)
- Haris Vakil
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Lena Tran
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Gary D Lewis
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Edward Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
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