Clinical and histopathological analysis of proliferative potentials of recurrent and non-recurrent meningiomas

The pre-and postoperative radiological predictive factors for the regrowth of residual benign meningiomas were investigated in 80 of 327 patients who underwent first surgery for intracranial meningioma, who met the following conditions: residual tumor observed on postoperative imaging, follow up for more than 5 years or until regrowth of the residual tumor, histological diagnosis of World Health Organization grade I, and no additional therapy performed within 1 month after surgery. These 80 patients were divided into those with no regrowth during the follow-up period (Group A, n ＝ 54) and those with regrowth (Group B, n ＝ 26), and the clinical characteristics and pre-and postoperative imaging findings were compared. Univariate analysis of factors influencing regrowth showed 6 factors were significant: tumor size AE4 cm (p ＝ 0.043), tumor volume AE30 cm 3 (p ＝ 0.026), presence of edema (p ＝ 0.036), unclear brain-tumor interface (p º 0.001), presence of a pial-cortical blood supply (p ＝ 0.031), and residual tumor volume AE3.0 cm 3 (p º 0.001). Multivariate analysis showed only residual tumor volume AE3.0 cm 3 was significant (p ＝ 0.001). Generally, the significant imaging findings on univariate analysis suggest malignant meningioma. Similar findings may be observed even in grade I cases, and residual tumors may regrow in such cases. The possibility is particularly high if the residual tumor volume exceeds 3.0 cm 3 , so early radiotherapy should be performed to prevent regrowth.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Radiological Predictive Factors for Regrowth of Residual Benign Meningiomas

Fujimoto¹,

Ishida²,

Uchiyama³

et al. 2011

“…Meningiomas with a MIB-1 staining index of 3% or more have a significantly higher tendency for recurrence than those with lower MIB-1 staining index. 15) Thus, progression of the tumor may have resulted from the natural course of the disease, rather than representing an adverse effect of GKR. Retrospectively, we speculate that if a tumor is located in a resectable region and Simpson grade I or II tumor resection is possible, direct surgery is a safer option than GKR.…”

Section: Discussionmentioning

confidence: 99%

Malignant Intracranial Meningioma With Spinal Metastasis -Case Report-

Kuroda

Kashimura

Ogasawara

et al. 2009

A 48-year-old woman presented with a left cerebellopontine angle mass. Over a 93-month period, the patient underwent seven surgeries, two radiosurgeries, and one external beam radiotherapy. The tumor was histologically benign at the first operation, but exhibited unusually aggressive behavior after failed radiosurgery and demonstrated clinical characteristics of malignancy such as spinal metastasis. The patient underwent gamma knife radiosurgery (GKR) for recurrence after the first operation, despite the tumor being located in a resectable region. The tumor did not respond. Six months after the sixth surgery, the patient presented with progressive lower extremity paraparesis and sensory disturbance below the T11 dermatome. Magnetic resonance imaging revealed multiple intradural mass lesions located at the T2, T11-T12, and L2 levels. She died 4 months after the diagnosis of spinal metastases. Retrospectively, we speculate that if a tumor is located in a resectable region and Simpson grade I or II tumor resection is possible, direct surgery may be a safer option than GKR.

“…16,23) The meningiomas in Werner syndrome are almost always benign and tend to occur about two times more frequently in men than in women, and about 10 to 30 years earlier than meningiomas in the general population. 4,15,19) Other types of CNS tumor have also been reported, such as two cases of intracranial astrocytomas, one case of glioma, and one case of spinal neurinoma. 12,14,17,31) Such brain tumors are non-epithelial tumors originating from the ectoderm.…”

Section: Discussionmentioning

confidence: 99%

Meningioma Associated With Werner Syndrome -Case Report-

Tsurubuchi

Yamamoto

et al. 2008

A 53-year-old man presented with a rare meningioma associated with Werner syndrome. Screening brain magnetic resonance (MR) imaging with gadolinium had detected multiple homogeneously enhanced tumors in the right convexity and in the anterior and posterior thirds of the falx cerebri after surgery for osteosarcoma in his right leg at age 52 years. Ten months later, the right convexity tumor was removed because follow-up MR imaging detected tumor growth. The histological diagnosis was transitional meningioma. The postoperative clinical course was good and the patient remains healthy. Review of the literature found meningiomas associated with Werner syndrome occur about two times more frequently in men than in women, and typically in the fourth decade. Most meningiomas associated with Werner syndrome are benign, but are sometimes complicated with extracranial tumors such as sarcoma, thyroid carcinoma, and others. Patients with meningioma associated with Werner syndrome should be carefully followed up to detect the occurrence of other extracranial tumors such as sarcoma by brain MR imaging, echography, or body computed tomography.