Meningiomas with Rhabdoid or Papillary Components : Prognosis and Comparison with Anaplastic Meningiomas

Abstract

Papillary and rhabdoid meningiomas are pathologically World Health Organization (WHO) grade III. Any correlation between clinical prognosis and pathologic component is not clear. We analyzed the prognoses of patients with meningiomas with a rhabdoid or papillary component compared to those of patients with anaplastic meningiomas. From 1994 to June 2013, 14 anaplastic meningiomas, 6 meningiomas with a rhabdoid component, and 5 meningiomas with papillary component were pathologically diagnosed. We analyzed magnetic resonance imaging (MRI) findings, extent of removal, adjuvant treatment, progression-free survival (PFS), overall survival (OS), and pathologic features of 14 anaplastic meningiomas (group A), 5 meningiomas with a predominant (≥50%) papillary or rhabdoid component (group B1), and 6 meningiomas without a predominant (<50%) rhabdoid or papillary component (group B2). Homogeneous enhancement on MRI was associated with improved PFS compared to heterogeneous enhancement (p=0.025). Depending on pathology, the mean PFS was 134.9±31.6 months for group A, 46.6±13.4 months for group B1, and 118.7±19.2 months for group B2. The mean OS was 138.5±24.6 months for group A and 59.7±16.8 months for group B1. All recurrent tumors were of the previously diagnosed pathology, except for one tumor from group B1, which recurred as an atypical meningioma without a papillary component. Group B1 tumors showed a more aggressive behavior than group B2 tumors. In group B2 cases, the pathologic findings of non-rhabdoid/papillary portion could be considered for further adjuvant treatment.

Malignant meningioma

“…Importantly, this cluster also included meningiomas with concomitant anaplasia and patients with aggressive clinical courses. A previous study and meta‐analysis on rhabdoid meningiomas without anaplastic features suggested grading independent on morphology, 262 but such a thorough report does not exist for the papillary subtype, and non‐anaplastic cohorts are in general limited by small sample sizes 263,264 . Due to the highly varying but frequently aggressive clinical courses and risk of later anaplastic transformation, we argue that papillary and rhabdoid meningiomas, with or without concomitant anaplasia, should be addressed together with WHO grade 3 meningiomas.…”

“…A previous study and meta-analysis on rhabdoid meningiomas without anaplastic features suggested grading independent on morphology, 262 but such a thorough report does not exist for the papillary subtype, and non-anaplastic cohorts are in general limited by small sample sizes. 263,264 Due to the highly varying but frequently aggressive clinical courses and risk of later anaplastic transformation, we argue that papillary and rhabdoid meningiomas, with or without concomitant anaplasia, should be addressed together with WHO grade 3 meningiomas. It is necessary to increase knowledge of the clinical courses and anaplastic transformation of recurrences and compare to previous studies, including ours.…”

Base MRI Imaging Characteristics of Meningioma Patients to Discuss the WHO Classification of Brain Invasion Otherwise Benign Meningiomas

“…7,[33][34][35] Fingerlike protuberance and mushroom sign have also been reported by many scholars as the characteristic of malignant meningiomas. 5,26,36 The pathological basis is caused by tumor invasion of the adjacent dural surface, dura mater, arachnoid membrane, subarachnoid space, pia mater, and brain. 33,37 These are usually accompanied by an unclear and continuous tumor-brain interface.…”

Anaplastic Meningioma: Clinical Characteristics, Prognostic Factors and Survival Outcome

“…Most meningiomas are benign, and have favorable outcomes with treatment using “wait and scan” or “stereotactic radiosurgery,” or “surgical resection” [ 2 ]. Anaplastic meningioma (World Health Organization [WHO] grade 3) consists of 1%–2% of all meningiomas and presents a particularly aggressive clinical course and a poor survival outcome [ 2 3 4 5 6 7 ]. In United States, population based study showed 5-year survival rate of patients with anaplastic meningiomas was 41.4% and factors associated with increased risk of death were older age, high comorbidity score, and subtotal resection [ 1 ].…”

“…There has been a consensus in the literature that adjuvant irradiation is essential regardless of the extent of resection in patients with anaplastic meningioma [ 5 7 9 10 ]. However, due to the rarity of the anaplastic meningioma itself, there are few studies that have proven its prognostic value statistically [ 2 3 4 6 10 11 ].…”