Secretory meningiomas: A benign subgroup causing life-threatening complications

Abstract

While meningiomas are known as slow-growing extracerebral neoplasms, the subgroup of secretory meningiomas with histologically benign characteristics tend to cause disproportional peritumoral edema, frequently leading to severe medical and neurological complications in postoperative management. Among 1,484 meningiomas that were resected at our institution between 1990 and 2007, 44 (3%) patients were found to have the histological diagnosis of a secretory meningioma. The clinical course, radiological appearance, and histopathological features were retrospectively analyzed to examine the specifics of these benign lesions. Meningiomas were located at the convexity (n = 14), the cranial base (18), and the sphenoid ridge (12). A severe, nearly hemispheric perifocal edema disproportional to tumor size was seen on preoperative MR imaging in 18 (41%) patients. Following surgical resection, the postoperative course was uneventful in 29 patients. In 15 patients, severe peritumoral edema continued or even increased on postoperative CT imaging. Six patients showed midline shift and clinical worsening necessitating respirator-assisted ventilation and intracranial pressure monitoring. An association between the extent of brain edema and number of periodic acid Schiff-positive pseudopsammomas was found (p < 0.02). Further, the size of the edema correlated with the number of immunohistochemically detected cells expressing carcinoembryonic antigen (CEA) and cytokeratin (CK) (p < 0.01). Mean MIB-1 (Ki-67 antigen) proliferation index was 3.0% (range, 0%-17%) and did not correlate with edema or tumor recurrence. Secretory meningiomas are frequently associated with severe peritumoral edema. The extent of edema correlates with immunohistochemically detected expression of CEA and CK. Extended perifocal edema in meningiomas is an unusual finding and should alert the neurosurgeon that surgery may aggravate edema excessively, leading to a life-threatening postoperative situation.

A Left Frontal Secretory Meningioma Can Mimic Transformed Migraine With and Without Aura

“…In a series of 44 patients, the mean age was 58 years (range, 35-78 years). 11 There was a female preponderance as in other studies (8:1 female to male ratio), which may reflect this meningioma's high rates of progesterone and estrogen receptors.…”

“…Secretory meningiomas are an uncommon subtype of benign meningiomas with glandular lumina with secretory globules variably accounting for 1.2‐9.3% of meningiomas. In a series of 44 patients, the mean age was 58 years (range, 35‐78 years) . There was a female preponderance as in other studies (8:1 female to male ratio), which may reflect this meningioma's high rates of progesterone and estrogen receptors.…”

Predictors of response to Gamma Knife radiosurgery for intracranial meningiomas

“…The expression of molecules such as CEA (carcinoembryonic antigen), CK (creatine kinase), VEGF (vascular endothelial growth factor), and HIF-1 (hypoxia-inducible factor) has been shown to be predictive of the development of edema in meningiomas following radiosurgery. 13,36 In the current study, the correlation between the CI RTOG value and the presence of edema is likely attributable to the combination of lesion shape irregularities, our attempt to provide dose coverage to the dural tail while minimizing irradiation to healthy brain tissue (thereby resulting in an absence of coverage in certain areas of the dural tail), and the underlying biology of the lesions.…”

Open Heart Surgery with Intracranial Meningioma: Case Report & Literature Review

“…A small proportion of benign meningiomas called secretory meningiomas are known to secrete vasoactive substances and are associated with the presence of peri-tumoural cerebral oedema [9]. The pathogenesis of cerebral oedema surrounding these tumours is still poorly understood.…”