Diagnostic challenges in meningioma

Abstract

Advances in molecular profiling and the application of advanced imaging techniques are currently refreshing diagnostic considerations in meningioma patients. Not only technical refinements but also sophisticated histopathological and molecular studies have the potential to overcome some of the challenges during meningioma management. Exact tumor delineation, assessment of tumor growth, and pathophysiological parameters were recently addressed by "advanced" MRI and PET. In the field of neuropathology, high-throughput sequencing and DNA methylation analysis of meningioma tissue has greatly advanced the knowledge of molecular aberrations in meningioma patients. These techniques allow for more reliable prediction of the biological behavior and clinical course of meningiomas and subsequently have the potential to guide individualized meningioma therapy. However, higher costs and longer duration of full molecular work-up compared with histological assessment may delay the implementation into clinical routine.This review highlights the diagnostic challenges of meningiomas from both the neuroimaging as well as the neuropathological side and presents the latest scientific achievements and studies potentially helping in overcoming these challenges. It complements the recently proposed European Association of Neuro-Oncology guidelines on treatment and diagnosis of meningiomas by integrating data on nonstandard imaging and molecular assessments most likely impacting the future.

Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database

“…5). While predictive modeling of imaging and molecular-genetic profiles should undoubtedly form part of the effort for more accurate diagnostic and prognostic tools, 31 we demonstrate here that the informational value to be gained from even the simplest of clinical variables is not to be ignored. Moreover, we position the value of such a tool as being of particular relevance at the pre-biopsy/surgery stage, which is of particular interest in the case of meningiomas where only roughly half of tumors are microscopically confirmed.…”

Identification of PD-L2, B7-H3 and CTLA-4 immune checkpoint proteins in genetic subtypes of meningioma

“…Meningioma, a most common primary brain tumor in adults has a prevalence of~98/100,000 people. 1,2 Based on World Health Organization (WHO) criteria that relies on histology alone,~80% of meningioma is classified as grade I or benign, 10-18% grade II or atypical and~2-4% grade III or malignant. 3 Grade II and III meningioma have a 5-year recurrence rate of~50% and~100% respectively and~30% of grade I meningioma will recur in a patient's lifetime, suggesting that a portion of grade I meningioma are biologically more aggressive.…”

Acute hydrocephalus secondary to meningioma with psychiatric symptoms as initial manifestation

“…Meningiomas are the most frequent primary tumors of the central nervous system (CNS) and represent 36.4% of all CNS tumors and 53.4% of CNS benign ones in some series. [4,5] Originating from the arachnoid cells, these tumors often present a slow growth, [4,6,7] being distant metastases rare. [7] In 98% of the cases, present an intracranial location, [7] specifically, are predominantly located in the cerebral hemispheres (20%-34%) and 1% are described located at the petro-clival level.…”