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Chinese Clinical Oncology Jul 2017Meningiomas account for approximately one-third of primary central nervous system tumors with a subset that are aggressive and carry significant morbidity and mortality.... (Review)
Review
Meningiomas account for approximately one-third of primary central nervous system tumors with a subset that are aggressive and carry significant morbidity and mortality. Treatment of these high-grade meningiomas, classified by the World Health Organization as grade II (atypical) and grade III (anaplastic) meningiomas, typically includes the combination of surgery and radiotherapy. However, current data guiding the timing, dosage, and modality of radiation treatment (RT) has been limited to case series and retrospective studies. Nevertheless, most studies support that radiation therapy reduces recurrence risk and improves overall survival (OS) for patients with high-grade meningiomas. In this review, we examine the evidence for radiation therapy in the management of patients with atypical and anaplastic meningiomas and discuss current ongoing prospective trials that will further elucidate the optimal role of radiotherapy in the treatment of these aggressive tumors.
Topics: Humans; Meningeal Neoplasms; Meningioma; Neoplasm Grading; Prospective Studies; Radiosurgery; Retrospective Studies
PubMed: 28758409
DOI: 10.21037/cco.2017.06.09 -
International Journal of Surgical... Sep 2023Snail family transcriptional repressor 2 (SNAI2, Slug) is a transcription factor that belong to the Slug/Snail superfamily. Site specific phosphorylation of slug (pSlug)...
Snail family transcriptional repressor 2 (SNAI2, Slug) is a transcription factor that belong to the Slug/Snail superfamily. Site specific phosphorylation of slug (pSlug) is detected during the M phase, and thus, this phosphorylated protein is considered a novel marker for detecting mitotic figures. Herein, we investigated whether the detection of mitosis using pSlug expression can be used in the histological grading of meningioma. We performed immunohistochemistry for pSlug and PHH3 in tissue samples of 61 patients with meningioma and examined the association between mitotic counts using pSlug and recurrence-free survival (RFS). The nuclear expression of pSlug was observed in the cell with mitotic figures. Tumor grading based on pSlug was significantly associated with the RFS ( < .001). It can be concluded that pSlug is a useful and practical marker to detect mitosis and seems to be reliable for the counting of mitoses in histological grading of meningioma.
Topics: Humans; Meningioma; Histones; Mitotic Index; Immunohistochemistry; Mitosis; Neoplasm Grading; Meningeal Neoplasms; Biomarkers, Tumor
PubMed: 36172742
DOI: 10.1177/10668969221126121 -
Neuro-oncology Jan 2022
Topics: Benchmarking; Boron Neutron Capture Therapy; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local
PubMed: 34508643
DOI: 10.1093/neuonc/noab217 -
Interventional Neuroradiology : Journal... Oct 2023Meningiomas with transosseous extension provide opportunities for extensive preoperative embolization, through conventional trans-arterial approaches, and also through...
Meningiomas with transosseous extension provide opportunities for extensive preoperative embolization, through conventional trans-arterial approaches, and also through less commonly used percutaneous methods. This video demonstrates embolization of a 7.6 × 9.5 × 9.9 cm transosseous WHO grade II meningioma. Trans-arterial embolization was conducted via the left middle meningeal, occipital, and superficial temporal arteries. Only one superficial temporal artery was embolized to preserve vascular supply to the skin flap. To further devascularize the tumor, concomitant percutaneous embolization was performed. Transosseous extension of the tumor facilitated extensive percutaneous embolization of both the intracranial and extracranial components of the mass. Intraoperative bleeding from the scalp and extracranial component of the tumor was minimal. The intracranial tumor was soft and necrotic and was removed with suction and gentle dissection. Residual tumor was left behind within and adjacent to the superior sagittal sinus. The patient recovered without neurological deficit and was referred for radiation of the residual tumor.
Topics: Humans; Meningioma; Meningeal Neoplasms; Neoplasm, Residual; Embolization, Therapeutic; Preoperative Care
PubMed: 35506928
DOI: 10.1177/15910199221095982 -
Neuro-Chirurgie Aug 2016Based on the 2007 WHO classification, the proportion of atypical meningiomas has steeply increased. Complete resection is usually considered curative, however, the... (Review)
Review
Based on the 2007 WHO classification, the proportion of atypical meningiomas has steeply increased. Complete resection is usually considered curative, however, the recurrence rate remains high. The treatment of more aggressive meningiomas remains problematic. We performed a literature review via the PubMed database with specific attention to radiological, pathological, genetic and molecular aspects particular to WHO grade II meningiomas and current therapeutic strategies. We also reviewed the role of surgery and summarized the results of the principal studies dealing with adjuvant strategies based on the most recent evidence. Adjuvant radiotherapy, administered as stereotactic radiosurgery or conventional external beam irradiation, should be strongly considered in selected cases. Limited data exist regarding the role of hormonal treatment or chemotherapy as adjunct therapy. A target therapy modulating the altered molecular balance may be the key to revolutionize the prognosis of these patients.
Topics: Combined Modality Therapy; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Radiosurgery; Radiotherapy, Adjuvant; Retrospective Studies; Treatment Outcome
PubMed: 27370103
DOI: 10.1016/j.neuchi.2016.02.003 -
Clinical manifestation, management and prognosis of clear cell meningioma: an evidence-based review.The International Journal of... Jun 2023Clear cell meningioma (CCM) is an uncommon histologic subtype of meningioma classified as a WHO grade II tumor and accounting for less than 1% of all meningiomas.... (Review)
Review
Clear cell meningioma (CCM) is an uncommon histologic subtype of meningioma classified as a WHO grade II tumor and accounting for less than 1% of all meningiomas. Demographically, younger patients are commonly affected without any remarkable gender preference. Moreover, CCM shows a unique anatomical site of involvement. It tends to occur in the cranium than the spine, whereas the basilar skull, posterior fossa and lumbar spine have been the most frequently affected area. Although most cases present as typical the mass effect by the tumor, CCM exhibits characteristic imaging and histologic patterns. Even though surgical resection is the treatment of choice, recurrence-free survival is the biggest challenge and has been attempting to improve by adjuvant therapy. There is still debate about its management, outcome and factors defining it. Herein, we aimed to summarize natural history, radiographic characteristics, histological features, treatment strategies to guide the best possible individualized care for the most favorable outcome.
Topics: Humans; Meningioma; Meningeal Neoplasms; Prognosis; Combined Modality Therapy; Neurosurgical Procedures; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 34319820
DOI: 10.1080/00207454.2021.1956919 -
Acta Neurochirurgica Jul 2023Meningiomas of the rolandic region are associated to high risk of postoperative motor deficits. This study discusses the factors affecting motor outcome and recurrences... (Review)
Review
OBJECTIVE
Meningiomas of the rolandic region are associated to high risk of postoperative motor deficits. This study discusses the factors affecting motor outcome and recurrences from the analysis of a monoinstitutional case series and eight studies from a literature review.
METHODS
Data of 75 patients who underwent surgery for meningioma of the rolandic region were retrospectively reviewed. The analyzed factors included tumor location and size, clinical presentation, magnetic resonance imaging (MRI) and surgical findings, brain-tumor interface, extent of resection, postoperative outcome and recurrence. Eight studies from literature on rolandic meningiomas treated with or without intraoperative monitoring (IOM) were reviewed with the aim to define the impact of IOM on the extent of resection and motor outcome.
RESULTS
Among the 75 patients of the personal series, the meningioma was on the brain convexity in 34 (46%), at the parasagittal region in 28 (37%) and at the falx in 13 (17%). The brain-tumor interface was preserved in 53 cases (71%) at MRI and in 56 (75%) at surgical exploration. Simpson grade I resection was obtained in 43% of patients, grade II in 33%, grade III in 15% and grade IV in 9%. The motor function worsened postoperatively in 9 among 32 cases with preoperative deficit (28%) and in 5 among 43 with no preoperative deficit (11.5%); definitive motor deficit was evidenced in overall series at follow-up in 7 (9.3%). Patients with meningioma with lost arachnoid interface had significant higher rates of worsened postoperative motor deficit (p = 0.01) and seizures (p = 0.033). Recurrence occurred in 8 patients (11%). The analysis of the 8 reviewed studies (4 with and 4 without IOM) shows in the group without IOM higher rates of Simpson grades I and II resection (p = 0.02) and lower rates of grades IV resection (p = 0.002); no significant differences in postoperative immediate and long-term motor deficits were evidenced between the two groups.
CONCLUSIONS
Data from literature review show that the use of IOM does not affect the postoperative motor deficit Therefore, its role in rolandic meningiomas resection remains to be determined and will be defined in further studies.
Topics: Humans; Meningioma; Meningeal Neoplasms; Retrospective Studies; Neurosurgical Procedures; Monitoring, Intraoperative; Brain Neoplasms; Risk Factors; Neoplasm Recurrence, Local; Treatment Outcome
PubMed: 37277557
DOI: 10.1007/s00701-023-05630-6 -
Veterinary Pathology Sep 2022Rhabdoid meningioma is a rare type of meningeal neoplasm in humans. This study reports the clinical, pathological, and ultrastructural features of 4 cases of canine...
Rhabdoid meningioma is a rare type of meningeal neoplasm in humans. This study reports the clinical, pathological, and ultrastructural features of 4 cases of canine meningioma with rhabdoid features. The cases were female and 8 to 12 years of age. Biopsies from complete surgical resections were examined for all cases. The whole brain with tumor recurrence was collected at necropsy in 2 dogs. Histologically, the tumors consisted of discohesive sheets of oval-polygonal cells with abundant eosinophilic cytoplasm and occasional paranuclear hyaline-like inclusions. Cells were intensely immunopositive for vimentin, negative for melan A and S100 protein in all cases, and showed variable immunolabeling for cytokeratin in 2 cases. Focal glial fibrillary acidic protein (GFAP)-immunopositive cells were present in 1 case. Ultrastructurally, the rhabdoid cells in case 1 contained prominent cytoplasmic whorls of intermediate filaments, recapitulating the ultrastructural features of rhabdoid meningioma in humans. In cases 2 and 3, the meningioma cells contained interdigitating cell processes folded in a maze-like fashion resembling rhabdoid-like meningioma in humans. In case 4, the voluminous cytoplasm contained many round-to-flattened mitochondria admixed with rough endoplasmic reticulum, indicating a predominant oncocytic differentiation and not the rhabdoid differentiation suggested by light microscopy. Thus, rhabdoid morphology occurs in different types of meningiomas, and ultrastructural findings are essential for a correct diagnosis.
Topics: Animals; Dog Diseases; Dogs; Female; Humans; Immunohistochemistry; Male; Meningeal Neoplasms; Meningioma; Neoplasm Recurrence, Local; Rhabdoid Tumor
PubMed: 35674149
DOI: 10.1177/03009858221100436 -
Neuro-oncology Oct 2017With the release of the 2016 edition of the World Health Organization (WHO) Classification of Central Nervous System Tumors, brain invasion in meningiomas has been added... (Review)
Review
With the release of the 2016 edition of the World Health Organization (WHO) Classification of Central Nervous System Tumors, brain invasion in meningiomas has been added as a stand-alone criterion for atypia and can therefore impact grading and indirectly adjuvant therapy. Regarding this rising clinical importance, we have reviewed the current knowledge about brain invasion with emphasis on its implications on current and future clinical practice. We found various definitions of brain invasion and approaches for evaluation in surgically obtained specimens described over the past decades. This heterogeneity is reflected by weak correlation with prognosis and remains controversial. Similarly, associated clinical factors are largely unknown. Preoperative, imaging-guided detection of brain invasion is unspecific, and intraoperative assessment using standard and new high-magnification microscopic techniques remains imprecise. Despite the increasing knowledge about molecular alterations of the tumor/ brain surface, pharmacotherapeutic options targeting brain invasive meningiomas are lacking. Finally, we summarize the impact of brain invasion on histopathological grading in the WHO classifications of brain tumors since 1979.In conclusion, standardized neurosurgical sampling and neuropathological analyses could improve diagnostic reliability and reproducibility of future studies. Further research is needed to improve pre- and intraoperative visualization of brain invasion and to develop adjuvant, targeted therapies.
Topics: Brain Neoplasms; Humans; Meningeal Neoplasms; Meningioma; Neoplasm Grading; Neoplasm Invasiveness; World Health Organization
PubMed: 28419308
DOI: 10.1093/neuonc/nox071 -
The American Journal of Dermatopathology Mar 2022Meningiomas are the most common primary central nervous system tumors. These tumors predominantly arise from the neural crest-derived meningothelial cells of the... (Review)
Review
Meningiomas are the most common primary central nervous system tumors. These tumors predominantly arise from the neural crest-derived meningothelial cells of the arachnoid dural layer. Intracranial meningiomas are stratified with the World Health Organization classification of tumors. Cutaneous meningiomas present rarely and have their own criteria classification (Lopez classification) of 3 types. The first type is congenital. The second consists of ectopic soft-tissue meningiomas. The third involves tumors that extended into the dermis or subcutis that include the neuroaxis. We present a case of a 56-year-old woman with 4 facial tumors that clinically seemed to be cutaneous cysts or lipomas. She reported a history of surgical resection of an intracranial meningioma on the left forehead scalp line 15 years ago. A recent surgical resection of a glabellar tumor revealed a glistening white mass. Pathologic examination revealed a poorly circumscribed mass in the deep dermis and subcutaneous area with sheets of epithelioid and plasmacytoid tumor cells with nuclear pleomorphism. Mitotic figures and necrosis were also evident. Immunohistochemistry revealed positivity for epithelial membrane antigen, p63, and ERG. The tissue had negative staining for p40, CK7, SOX10, CD68, SMA, desmin, and CD34. The patient's medical history was remarkable in that these tumors had only been growing for several months. Brain magnetic resonance imaging demonstrated widespread tumors in bilateral frontal lobes, skull, orbits, and sinuses. Considering the transcranial extensions and 15-year recurrence time, she was diagnosed with a recurrent atypical brain meningioma type II and cutaneous meningioma Lopez type III.
Topics: Aged; Female; Forehead; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local
PubMed: 35171886
DOI: 10.1097/DAD.0000000000002061