Aggressive meningeal tumors: review of a series

Abstract

A series of 25 patients with aggressive meningeal tumors was studied to determine the efficacy of various management options. The median age of the patients was 52 years, with a range of 13 to 73 years. A marked male preponderance (64%) was noted. Twenty of 25 patients experienced recurrence during a median follow-up time of 47 months. Survival and freedom from recurrence varied with histological diagnosis. Recurrence was noted sooner in patients who had received partial resections on first presentation of tumor than in those who had received total resections at first presentation. Survival time was also shorter for patients who underwent partial resections at first presentation than for patients who underwent total resections. Patients' prognoses did not improve as a result of either chemotherapy or radiotherapy. Of six patients with extracranial metastases, the median time to metastasis was 102 months, with a 5-year metastasis-free rate of 85%. The most common sites of metastasis in these six patients were lung and bone. In each tumor type, histological features used in diagnosis and radiological features studied from computerized tomography and magnetic resonance imaging were evaluated, compared, and discussed. Of eight patients studied with an in vivo bromodeoxyuridine (BUdR) labeling index (LI), seven showed an LI of 1% or more. The authors support the incorporation of the BUdR LI into the diagnostic process to provide a better estimate of the potential for tumor recurrence.

Anaplastic meningioma: case report

“…This suggests a likelihood that any benign tumor that recurs will be malignant 1,6 . Whereas benign meningiomas tend to show preponderance in females, atypical and malignant meningiomas have a male preponderance 12,14 .…”

“…The peak incidence of atypical and malignant meningioma was in the seventh and sixth decades, respectively 7 . These malignant meningiomas are defined by several criteria including: 1) invasion of adjacent brain parenchyma or skull; 2) numerous mitoses (> 5/high-powered field); 3) elevated proliferative index (>3%) as assessed by either 5-bromodeoxyuridine or KI-67 staining; 4) necrosis; 5) increased cellularity; 6) nuclear pleomorphism; and 7) metastasis 1,5,[8][9][10][11][12] .…”

“…Servo et al 16 and Younis et al 12 determined that CT cannot reliably distinguish malignant meningiomas from benign ones. There are, however, some CT or MRI trends that point in favor of malignant meningioma: 1) the absence of visible calcium aggregates 12 ; 2) "mushrooming" or the presence of a prominent pannus of tumor extending well away from the globoid mass 7,10,12 ; 3) nonhomogeneous enhancement 10 ; 4) necrosis 10 ; and 5) presence of indistinct tumor margins 7,12,16 .…”

“…There are, however, some CT or MRI trends that point in favor of malignant meningioma: 1) the absence of visible calcium aggregates 12 ; 2) "mushrooming" or the presence of a prominent pannus of tumor extending well away from the globoid mass 7,10,12 ; 3) nonhomogeneous enhancement 10 ; 4) necrosis 10 ; and 5) presence of indistinct tumor margins 7,12,16 . If angiography is performed, arteriovenous shunting is a feature that suggests malignancy 1 .…”

Meningiomas: estudo epidemiologic e anátomo-patológico de 304 casos

“…Os meningiomas atípicos e anaplásicos ou malignos são as variantes mais agressivas dos meningiomas 4,815,32,33 . Os atípicos caracterizam-se por apresentar hipercelularidade, alto índice núcleo-citoplasma, atividade mitótica elevada, atipia nuclear com nucléolos proeminentes, padrão de crescimento ininterrupto com formação de grandes lençóis tumorais com pequenos focos de necrose (Figuras 3 e 4) e representam cerca de 7% dos meningiomas 4,8,15,33 .…”