WHO grade of intracranial meningiomas differs with respect to patient’s age, location, tumor size and peritumoral edema

Ressel, Anne; Fichte, Susanne; Brodhun, Michael; Rosahl, Steffen K.; Gerlach, Ruediger

doi:10.1007/s11060-019-03293-x

Cited by 46 publications

(46 citation statements)

References 62 publications

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“…In our reviewed series of giant meningiomas (Table 3 ), an atypical diagnosis was found in 0–24% of the cases [ 6 , 7 , 14 , 17 , 18 , 20 – 22 ]. Recently, a larger tumor size has been associated with atypical histopathology [ 26 – 28 ]. Interestingly, the rate of atypical meningiomas reported in the literature has increased from 5% to 20–35% since the revised 2007 WHO criteria for histopathological grading of meningiomas has been applied [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

et al. 2021

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Purpose Surgical resection of intracranial meningiomas in patients that are 80 years old and older, i.e. very old patients, is increasingly considered. Meningiomas with a largest diameter of at least 5 cm—‘giant meningiomas’—form a distinct entity, and their surgical resection is considered more difficult and prone to complications. Here, we evaluated functional outcome, morbidity and mortality, and the prognostic value of tumor size in very old patients who underwent resection of giant supratentorial meningiomas. Methods We retrospectively reviewed clinical and radiological data, functional performance (Karnofsky Performance Score), histopathological diagnosis and complications of very old patients who underwent surgery of a supratentorial meningioma at the Helsinki University Hospital between 2010 and 2018. Results We identified 76 very old patients, including 28 with a giant meningioma. Patients with a giant meningioma suffered from major complications more commonly than those with a non-giant meningioma (36% vs. 17%, p = 0.06), particularly from postoperative intracranial hemorrhages (ICH). At the 1-year follow-up, functional performance and mortality rate were comparable between patients with giant meningiomas and those with non-giant meningiomas. An exceptionally high rate of giant meningiomas were diagnosed as atypical meningiomas (WHO II) at an (11 out of 28 cases). Conclusions Giant meningioma surgery entails a high complication rate in frail, very old patients. The prevention of postoperative ICH in this specific patient group is of utmost importance. An atypical histopathology was notably frequent among very old patients with a giant meningioma, which should be taken into account when planning the surgical strategy.

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Section: Discussionmentioning

confidence: 99%

Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

et al. 2021

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“…Skull-base lesions insult memory more seriously than convexity ones do (7). Atypical meningiomas are associated with a location on the convexity, and Simpson grade is correlated to the high risk of recurrence for tumors in this location instead of falx and posterior fossa (8)(9)(10). Therefore, the location-specific difference in meningioma greatly influences clinical decisions and therapeutic strategies.…”

Section: Introductionmentioning

confidence: 99%

The Preferred Locations of Meningioma According to Different Biological Characteristics Based on Voxel-Wise Analysis

Sun

Dou

et al. 2020

Front. Oncol.

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Objective: Meningiomas presented preferred intracranial distribution, which may reflect potential biological natures. This study aimed to analyze the preferred locations of meningioma according to different biological characteristics. Method: A total of 1,107 patients pathologically diagnosed with meningiomas between January 2012 and December 2016 were retrospectively analyzed. Preoperative MRI were normalized, and lesions were semiautomatically segmented. The stereospecific frequency and p value heatmaps were constructed to compare two biological phenotypes using two-tailed Fisher's exact test. Age, sex, WHO grades, extent of resection (EOR), recurrence, and immunohistochemical markers including p53, Ki67, epithelial membrane antigen (EMA), progesterone receptor (PR), and CD34 were statistically analyzed. Recurrence-free survival (RFS) were analyzed by Kaplan-Meier method. Result: Of 1,107 cases, convexity (20.8%), parasagittal (16.1%), and falx (11.4%) were the most predominant loci of meningiomas. The p-value heatmap suggested lesion predominance in the left frontal and occipital convexity among older patients while in the left sphenoid wing, and right falx, parasellar/cavernous sinus, and middle fossa among younger patients. Lesions located at anterior fossa and frontal structures were more frequently seen in the male while left parietal falx and tentorial regions, and right cerebellopontine angle in the female. Grades II and III lesions presented predominance in the frontal structures compared with grade I ones. Meningiomas at the left parasagittal sinus and falx, tentorium, intraventricular regions, and skullbase structures were significantly to receive subtotal resection. Lesions with p53 positivity were statistically located at the left frontal regions and parasellar/cavernous sinus, higher Ki67 index at the left frontal and bilateral parietal convexity and right parasellar/cavernous sinus, EMA negativity at the right olfactory groove and left middle fossa, and CD34 positivity at the sellar regions and right sphenoid wing. Tumor recurrence rates for grades I, II, and III were 2.8, 7.9, and 53.8%, respectively. Inferior RFS, higher Sun et al. The Preferred Locations of Meningioma Ki67 index, grades II and III, and a larger preoperative volume were observed in older patients. Recurrent meningiomas were more frequently found at the occipital convexity, tentorium, sellar regions, parasagittal sinus, and left sphenoid wing. Conclusion: The preferred locations of meningioma could be observed according to different biological characteristics, which might be helpful for clinical decisions.

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“…Because miRNAs are involved in the regulation of embryonic stem cell development and signaling, 34 these findings further support the view that biological properties of meningiomas may be derived from site-specific progenitor/cancer stem cells regulated by respective miRNAs. Moreover, as WHO grade II and III meningiomas are significantly more frequent in the younger patients, 35 it seems that a specific expression profile of the 13 miRNAs can recognize recurrent high-grade meningiomas in older subjects as a biologically distinct tumor subgroup. Basically, this may indicate 2 distinct biological mechanisms required for tumor recurrence, with the mechanism observed in older subjects requiring just the upregulation of the miRNAs.…”

Section: Discussionmentioning

confidence: 99%

Identification of Meningioma Patients at High Risk of Tumor Recurrence Using MicroRNA Profiling

et al. 2020

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BACKGROUND Meningioma growth rates are highly variable, even within benign subgroups, with some remaining stable, whereas others grow rapidly. OBJECTIVE To identify molecular-genetic markers for more accurate prediction of meningioma recurrence and better-targeted therapy. METHODS Microarrays identified microRNA (miRNA) expression in primary and recurrent meningiomas of all World Health Organization (WHO) grades. Those found to be deregulated were further validated by quantitative real-time polymerase chain reaction in a cohort of 172 patients. Statistical analysis of the resulting dataset revealed predictors of meningioma recurrence. RESULTS Adjusted and nonadjusted models of time to relapse identified the most significant prognosticators to be miR-15a-5p, miR-146a-5p, and miR-331-3p. The final validation phase proved the crucial significance of miR-146a-5p and miR-331-3p, and clinical factors such as type of resection (total or partial) and WHO grade in some selected models. Following stepwise selection in a multivariate model on an expanded cohort, the most predictive model was identified to be that which included lower miR-331-3p expression (hazard ratio [HR] 1.44; P < .001) and partial tumor resection (HR 3.90; P < .001). Moreover, in the subgroup of total resections, both miRNAs remained prognosticators in univariate models adjusted to the clinical factors. CONCLUSION The proposed models might enable more accurate prediction of time to meningioma recurrence and thus determine optimal postoperative management. Moreover, combining this model with current knowledge of molecular processes underpinning recurrence could permit the identification of distinct meningioma subtypes and enable better-targeted therapies.

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WHO grade of intracranial meningiomas differs with respect to patient’s age, location, tumor size and peritumoral edema

Cited by 46 publications

References 62 publications

Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

The Preferred Locations of Meningioma According to Different Biological Characteristics Based on Voxel-Wise Analysis

Identification of Meningioma Patients at High Risk of Tumor Recurrence Using MicroRNA Profiling

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