Clinicopathological characteristics and prognostic factors of atypical meningiomas with bone invasion: a retrospective analysis of nine cases and literature review

BACKGROUND

Meningiomas are the most common primary neoplasms of the central nervous system in adults, arising from the arachnoid cap cells. Thus, grade 2 meningiomas are situated on the border between benignity and malignancy. Among the many prognostic factors that have been investigated in these tumors, bone invasion is one of them.

OBJECTIVE

The aim of our study was to identify whether bone invasion influences tumor recurrence and progression-free survival (PFS) in patients with atypical meningiomas (AMs).

PATIENTS, MATERIALS AND METHODS

Out of 81 patients with AMs followed over a period of five years, we identified nine patients with bone invasion. We analyzed their demographic, clinical, imaging, and pathological characteristics, such as age, gender, radiological aspects, morphological features, extent of resection, recurrence rate, and PFS over a follow-up period of 60 months. Bone invasion was determined based on preoperative, surgical, and pathological reports.

RESULTS

Out of the nine patients with bone invasion, four had convexity meningiomas, four had parasagittal meningiomas and one had a falcine meningioma. Regarding tumor recurrence∕progression, most patients (n=6) recurred within the first 24 months after surgery. Our study showed that the early recurrence/progression of tumor (at 12 months) correlated with extensive presence of malignancy criteria, especially with the presence of 15-18 mitoses∕10 high-power fields, as well as with large foci of spontaneous necrosis, but also with tumor bone infiltration, extensive bone lamellae destruction, and tumor infiltration of adjacent muscle with its atrophy due to tumor compression. Patients with bone invasion had a PFS of 29.3 months, compared to patients without invasion who had a higher PFS (49.3 months). Significant statistical associations were observed between bone invasion and tumor recurrence (p=0.002) and PFS (p=0.004).

CONCLUSIONS

Our study emphasizes the importance of a thorough histopathological examination of the surgical specimen, which can provide significant data for the assessment of the progression of an AM [World Health Organization (WHO) grade 2] with bone invasion. AM infiltration in adjacent bone and muscle increases the rate of tumor recurrence and decreases PFS over a follow-up period of 60 months.

Predictor factors for recurrence in atypical meningiomas

BACKGROUND AND OBJECTIVES

Atypical meningiomas (AMs), World Health Organization (WHO) grade 2, are a group of tumors with uneven and unpredictable clinical behavior. Our aim was to analyze possible tumor recurrence predictors, and to identify factors that improve progression-free survival (PFS).

PATIENTS, MATERIALS AND METHODS

Our retrospective study included 81 patients followed up in the Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania, between 1 January 2010 and 31 December 2020. The histopathological specimens were reviewed according to the WHO 2021 criteria. Analyses included clinical, imaging, pathological and surgical factors.

RESULTS

The tumor recurred in 53.1% of the 81 cases within 60 months of surgery. Tumor location (p<0.000), tumor volume (p<0.010), extent of surgical resection (p<0.000) and dural sinus invasion (p<0.001) were predictive factors of recurrence. Gross total resection (Simpson grade I and II) was achieved in 59.2% of patients. Patients with the tumors located in the brain convexity and volume <26.4 cm³ had better survival rates up to recurrence. PFS showed a significant relationship between Simpson grade I-III and biopsy (p<0.000) and was statistically influenced by tumor volume and location, and dural sinus invasion.

CONCLUSIONS

AMs are a heterogeneous group of tumors, and we identified posterior fossa location, volume ≥26.4 cm³, Simpson grade III and IV resection and dural sinus invasion as predictive factors for relapse and a shorter PFS. Whereas certain characteristics provide some prognostic value, future molecular characterizations of AMs are necessary, which will support the clinical decision-making process.

Correlations between histological subtypes and neurocognitive assessment of language area tumors. Our 43 case series and review of the literature

BACKGROUND

Brain tumor location is related with specific, focal neurological impairment, but also with more diffuse, generalized and subtitle neurocognitive dysfunctions. For a better evaluation of these cases, we need a specific battery of tests. Beside the impact of preoperative status on surgical decision, the quantification of postoperative function alteration is essential in neurorehabilitation.

PATIENTS, MATERIALS AND METHODS

We proposed a battery of tests to assess the neurocognitive function, with an accent on language adapted to Romanian population. The 43 cases included in the study were tested preoperatively, seven days postoperatively and at one month, and correlated with the images and histological results.

RESULTS

At admission, from all participants, 11.6% were affected across all measured items and 6.9% on none of them. A rate of impairment significantly higher, four or more items, was observed in glioblastoma (GB) cases (23.3%) in contrast with low-grade glioma (LGG) (0%), meningioma (0%) and metastases (6.9%). From all cases, we performed seven awake craniotomies. At one-month evaluation, general decrease in neurocognitive function was observed in 20.93% cases, among them 88.88% being GB and favorable outcome in 32.55% patients with dominance of LGG and meningioma cases.

CONCLUSIONS

A neurocognitive assessment of brain tumor patients is important for preoperative and postoperative evaluation and secondary adjustment of the surgical resection in order to improve or, at list, meantime the initial status. The role and the link between the histological type and tests alteration were observed. The results can be used for a better understanding and management of language area tumors.

Salmonella serotype typhimurium phage typing. A critical evaluation

Of 12,930 Salmonella serotype typhimurium strains, phage typed during 1985-1988, 45.68% were "nontypable" by Anderson's set; the percent of typable strains decreased from 54.17 in 1986 to 30.54 in 1988. Of 90 phage patterns of sensitivity, 22 were currently encountered. Phage types 1, 18 and 104 were most frequent to strain of both human and non-human origin. In food generating S. typhimurium outbreaks, phage types 1 and 36 were prevalent. Except lysotypes 198 and 95, isolated from "single cases" in man only, all other phage types were common in man and animals, too. Introducing other typing methods to serotype typhimurium "nontypable" strains (by Anderson's set) was considered necessary for epidemiological purposes.

[Evaluation of the effectiveness of serological typing in subdifferentiation of strains of Klebsiella of extraenteral origin]

The present study reports on the results of capsular serotyping of Klebsiella strains isolated between 1971 and 1972, carried out in view of the subdivision of the genus. Serologic typing was performed with K1--K80 sera on 156 Klebsiella strains, isolated from in-hospital cases of extraenteral klebsiella infections. The 140 (90%) strains typed were listed in 34 capsular serotypes. Another 16 strains (10%) could not be typed because of their insufficient capsular coating. The following 13 serotypes were predominant: K4 (13.57%), K2 (7.85%), K16 (6.42%), K18 (6.42%), K27 (5%), K20 (4.28%), K24 (4.28%), K55 (4.28%), K68 (4.28%), K48 (3.55%), K15 (2.85%), K17 (2.85%), representing 70.71%. In the feces samples from the healthy controls serotypes K7, K14, K30, K1, K2, K24, K27, K47 etc. may be considered omnipresent. It has been demonstrated that in periods of minimal epidemiological survey, these serotypes from healthy carriers may initiate nosocomial infections. The present findings emphasize the accessibility and value of serologic typing of klebsiellas according to clinical and epidemiologic indications. The serologic type is a marker that can be included on the programme of systematic typing of in-hospital strains.

[Sensitivity to antibiotics and chemotherapeutic agents in some strains of Salmonella typhi isolated in Romania during the period 1974-1976]

Investigations were carried out on 781 S. typhi strains isolated from patients and carriers. Testing of the sensitivity to chemotherapeutical agents by diffusiometry and the incorporation technique led to the detection of four resistant strains: 1 strain isolated by coproculture from a carrier since 1958, resistant to A, K, N, Ca and Cf and 3 strains isolated by coproculture, biliculture and uroculture from a carrier since 1974, resistant to A and Ca. The R factors of these strains were transferred in their totality. The resistant strains did not manifest any particular pathogenicity for the laboratory animal, and their immunogenic potential was below that of the current typhoid vaccine. None of the 781S typhi were resistant to Cmx, C, G, T, Co and Po. Consequently, in Romania Chloramphenicol may be used in continuation in the treatment of typhoid fever, and Cotrimoxazol, Gentamycin, Tetracyclin and Ampicillin are and remain reserve substitutes. The possible unexpected appearance of resistant S. typhi strains demand, however, further control of the sensitivity to chemotherapeutics of all the isolated strains.

[Additional anti-Klebsiella phages used in lysotyping of Klebsiella strains]

In order to increase the efficiency of lysotyping as a method for differentiating Klebsiella strains the authors tested the activity of 10 additional phages isolated, prepared and studied in the laboratory and compared to the Slopek-Milch set. A number of 734 Klebsiella strains were isolated in different clinical and epidemiological conditions and lysotyped. The phage type was determined in 64.60% of the strains examined, using 15 phages of the Slopek-Milch set. By using additional autochtonous phages the proportion of lysotypable strains reached 77.80%; therefore, 13.20% were sensitive only to the additional phages.

Restriction and modification of typing phages by an R factor in S. typhi

We have investigated the qualities of one R factor 552 discovered on a strain of S. typhi resistant to A, C, S, T, nontypable, isolated from stool cultures; from the same patient, before starting the treatment we isolated, from his blood sample, the strain S. typhi 221, sensitive to A, C, T, degraded phage-type Vi A. Factor R 552 fi- when infecting strains of S. typhi Vi A and of A degraded 221- leads to the conversion of the respective phage-types into non-typable ones, as a result of the restricting and modifying effect on phage Vi A and on the derivatives resulting from it. Derivative R 552-1 as a resistance marker to ampicilline has a restrictive effect on the phage of S. panama A 47 too. Not taking into account possible causes such as spontaneous mutation, lysogeny, and adsorption of phages, we reach for the conclusion that R factor 552, through is restrictive effect, is the only cause responsible for the existence in the same patient of two strains of S. typhi different from the point of view of phage-type and antibiotype.