Progesterone Receptor Expression and Score Differences in Determining Grade and Subtype of Meningioma

Abstract Background Meningioma is the most common brain tumor in which therapy and monitoring depend on the histopathological grade (World Health Organization [WHO] Grade). Progesterone receptor (PR) expression was reported positive in meningothelial cells and meningiomas with various degrees of positivity. We evaluated PR expression to determine its correlation with WHO Grade and each subtype of meningioma. Materials and Methods This study used 70 samples of paraffin block that were diagnosed as meningioma and classified into WHO Grade I, II, and III. The paraffin blocks were sectioned in 5 µm thickness and immunohistochemically stained with the anti-PR antibody. Results PR expression was found positive in WHO Grade I and II groups, but negative in WHO Grade III group with the score of +2 found in clear cell and atypical subtype. These results were statistically significant with p-value < 0.05. Conclusion PR can be used as an additional marker to determine WHO Grade and subtype of meningioma.

Download Full-text

Extracerebral Pterional Metastasis from Malignant Meningioma: A Case Report

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1722247 ◽

2021 ◽

Author(s):

Edmundo Luís Rodrigues Pereira ◽

Diego Arthur Castro Cabral ◽

Fernanda Myllena Sousa Campos

Keyword(s):

Distant Metastases ◽

World Health ◽

Malignant Meningioma ◽

Benign Meningioma ◽

Who Grade ◽

History Of ◽

Health Organization ◽

The Right ◽

Who Grade Iii ◽

Grade Iii

AbstractAnaplastic or malignant meningiomas that are classified as World Health Organization (WHO) grade III account for less than 1% of all meningiomas diagnosed. Despite the aggressive course, distant metastases are a rarity, occurring in only 0.1% to 0.2% of cases. We report the case of a 56-year-old woman who presented with parasagittal benign meningioma that underwent malignant transformation along with metastasis into the right orbitosphenoid region. The clinical, radiological, and histopathological aspects are highlighted, with an emphasis on the natural history of meningiomas.

Download Full-text

The Expression of Progesterone Receptors in Meningiomas of Different Grades

Journal of Islamabad Medical & Dental College ◽

10.35787/jimdc.v8i2.357 ◽

2019 ◽

Vol 8 (2) ◽

pp. 65-69

Author(s):

Mohammad Tahir ◽

Tehreem Atif ◽

Summaya Sohail ◽

Arfa Nawazish ◽

Huma Mushtaq

Keyword(s):

Progesterone Receptor ◽

Treatment Options ◽

Progesterone Receptors ◽

Lower Grade ◽

Immunoperoxidase Method ◽

Nuclear Staining ◽

Who Grade ◽

Grade Ii ◽

Who Grade Iii ◽

Grade Iii

Background: Meningiomas are slow growing intracranial and intraspinal neoplasms with a tendency to recur locally. WHO grades them as I (benign), II (atypical) and III (anaplastic) in order of their increasing aggressiveness, based on histological parameters and brain parenchymal invasion. Progesterone receptors (PR) are more prevalent amongst the lower grade meningiomas. The objective of this study was to determine the immunohistochemical expression of progesterone receptors in meningiomas of different grades.Material and Methods: A total of 100 cases were selected over a period of 2.5 years. Three to five microns’ thick sections stained with Hematoxylin and Eosin were examined microscopically by a team of two Histopathologists and graded into grades I, II and III, according to 2016 WHO classification criteria. Another section of the original tumor was stained with progesterone receptor antibody using the conventional immunoperoxidase method. Stained slides were than examined by the same team of Histopathologists and declared positive (if nuclear staining was observed in more than 10% of tumor cells) or negative. Statistical analysis was done using SPSS version 21.Results: Out of a total of 100 cases of meningioma, there were 79 cases of benign/typical WHO grade I, 15 cases of atypical/ WHO grade II and 6 cases of anaplastic/ WHO grade III tumor. PR status was positive in 89.8 % (71/79) of grade I meningiomas and 46.6 % (7/15) of grade II/Atypical meningiomas. The 06 cases of Anaplastic/WHO grade III tumors were negative for PR. There was a higher prevalence of Progesterone receptors in female patients (89.8%; 53/59) as compared to male meningioma patients (60.9%; 25/41).Conclusion: We observed a decreased expression of progesterone receptor in higher grades of meningioma in this study. It is an effort to explore conservative treatment options for inoperable lesions, as anti-progesterone therapy may hold a promise as a new treatment option in the near future.

Download Full-text

Stereotactic radiation treatment for recurrent nonbenign meningiomas

Journal of Neurosurgery ◽

10.3171/jns.2007.106.5.846 ◽

2007 ◽

Vol 106 (5) ◽

pp. 846-854 ◽

Cited By ~ 48

Author(s):

Carlos A. Mattozo ◽

Antonio A. F. De Salles ◽

Ivan A. Klement ◽

Alessandra Gorgulho ◽

David McArthur ◽

...

Keyword(s):

Radiation Treatment ◽

Progression Free Survival ◽

Malignant Progression ◽

World Health ◽

Who Grade ◽

Stereotactic Radiation ◽

Grade Ii ◽

Health Organization ◽

Grade Iii

Object The authors analyzed the results of stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) for the treatment of recurrent meningiomas that were described at initial resection as showing aggressive, atypical, or malignant features (nonbenign). Methods Twenty-five patients who underwent SRS and/or SRT for nonbenign meningiomas between December 1992 and August 2004 were included. Thirteen of these patients underwent treatment for multiple primary or recurrent lesions. In all, 52 tumors were treated. All histological sections were reviewed and reclassified according to World Health Organization (WHO) 2000 guidelines as benign (Grade I), atypical (Grade II), or anaplastic (Grade III) meningiomas. The median follow-up period was 42 months. Seventeen (68%) of the cases were reclassified as follows: WHO Grade I (five cases), Grade II (11 cases), and Grade III (one case). Malignant progression occurred in eight cases (32%) during the follow-up period; these cases were considered as a separate group. The 3-year progression-free survival (PFS) rates for the Grades I, II, and III, and malignant progression groups were 100, 83, 0, and 11%, respectively (p < 0.001). In the Grade II group, the 3-year PFS rates for patients treated with SRS and SRT were 100 and 33%, respectively (p = 0.1). After initial treatment, 22 new tumors required treatment using SRS or SRT; 17 (77%) of them occurred inside the original resection cavity. Symptomatic edema developed in one patient (4%). Conclusions Stereotactic radiation treatment provided effective local control of “aggressive” Grade I and Grade II meningiomas, whereas Grade III lesions were associated with poor outcome. The outcome of cases in the malignant progression group was intermediate between that of the Grade II and Grade III groups, with the lesions showing a tendency toward malignancy.

Download Full-text

Histological-subtypes and anatomical location correlated in meningeal brain tumors (meningiomas)

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-1700321 ◽

2014 ◽

Vol 05 (03) ◽

pp. 244-249

Author(s):

Abdul Rashid Bhat ◽

Muhammed Afzal Wani ◽

Altaf Rehman Kirmani ◽

Altaf Umar Ramzan

Keyword(s):

Brain Tumors ◽

High Mortality ◽

World Health ◽

Anatomical Location ◽

X Rays ◽

Histological Subtypes ◽

Who Grade ◽

Sphenoid Ridge ◽

Who Grade Iii ◽

Grade Iii

ABSTRACT Context: Not enough literature is available to suggest a link between the histological subtypes of intracranial meningeal brain tumors, called ‘meningiomas’ and their location of origin. Aim: The evidence of correlation between the anatomical location of the intracranial meningiomas and the histopathological grades will facilitate specific diagnosis and accurate treatment. Materials and Methods: The retrospective study was conducted in a single high-patient-inflow Neurosurgical Center, under a standard and uniform medical protocol, over a period of 30 years from December 1982 to December 2012. The records of all the operated 729 meningiomas were analyzed from the patient files in the Medical Records Department. The biodata, x-rays, angiography, computed tomography (CT) scans, imaging, histopathological reports, and mortality were evaluated and results drawn. Results: The uncommon histopathological types of meningiomas (16.88%) had common locations of origin in the sphenoid ridge, posterior parafalcine, jugular foramen, peritorcular and intraventricular regions, cerebellopontine angle, and tentorial and petroclival areas. The histopathological World Health Organization (WHO) Grade I (Benign Type) meningiomas were noted in 89.30%, WHO Grade II (Atypical Type) in 5.90%, and WHO Grade III (Malignant Type) in 4.80% of all meningiomas. Meningiomas of 64.60% were found in females, 47.32% were in the age group of 41-50 years, and 3.43% meningiomas were found in children. An overall mortality of 6.04% was noted. WHO Grade III (malignant meningiomas) carried a high mortality (25.71%) and the most common sites of meningiomas with high mortality were: The cerebellopontine angles, intraventricular region, sphenoid ridge, tuberculum sellae, and the posterior parafalcine areas. Conclusion: The correlation between the histological subtypes and the anatomical location of intracranial meningeal brain tumors, called meningiomas, is evident, but further research is required to establish the link.

Download Full-text

Analysis of Prognostic Factors of World Health Organization Grade Ⅲ Meningiomas

Frontiers in Oncology ◽

10.3389/fonc.2020.593073 ◽

2020 ◽

Vol 10 ◽

Author(s):

Weidong Tian ◽

Jingdian Liu ◽

Kai Zhao ◽

Junwen Wang ◽

Wei Jiang ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Cox Regression ◽

Postoperative Radiotherapy ◽

World Health ◽

Low Grade ◽

Ki 67 ◽

Who Grade ◽

Who Grade Iii ◽

Grade Iii

ObjectiveWHO grade III meningiomas are highly aggressive and lethal. However, there is a paucity of clinical information because of a low incidence rate, and little is known for prognostic factors. The aim of this work is to analyze clinical characteristics and prognosis in patients diagnosed as WHO grade III meningiomas.Methods36 patients with WHO grade III meningiomas were enrolled in this study. Data on gender, age, clinical presentation, preoperative Karnofsky Performance Status (KPS), histopathologic features, tumor size, location, radiologic findings, postoperative radiotherapy (RT), surgical treatment, and prognosis were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were evaluated using the Kaplan-Meier method. Univariate and multivariate analysis were conducted by the Cox regression model.ResultsMedian PFS is 20 months and median OS is 36 months in 36 patients with WHO grade III meningiomas. Patients with secondary tumors which transformed from low grade meningomas had lower PFS (p=0.0014) compared with primary group. Multivariate analysis revealed that tumors location (PFS, p=0.016; OS, p=0.013), Ki-67 index (PFS, p=0.004; OS, p<0.001) and postoperative radiotherapy (PFS, p=0.006; OS, p<0.001) were associated with prognosis.ConclusionWHO grade III meningiomas which progressed from low grade meningiomas were more prone to have recurrences or progression. Tumors location and Ki-67 index can be employed to predict patient outcomes. Adjuvant radiotherapy after surgery can significantly improve patient prognosis.

Download Full-text

Development and Validation of Prognostic Nomogram in Patients With WHO Grade III Meningioma: A Retrospective Cohort Study Based on SEER Database

Frontiers in Oncology ◽

10.3389/fonc.2021.719974 ◽

2021 ◽

Vol 11 ◽

Author(s):

Zetian Jia ◽

Yaqi Yan ◽

Jiuxin Wang ◽

He Yang ◽

Haihua Zhan ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

World Health ◽

Central Nervous System Tumor ◽

Seer Database ◽

Net Benefit ◽

Who Grade ◽

Who Grade Iii ◽

Grade Iii

IntroductionWorld Health Organization (WHO) Grade III meningioma is a central nervous system tumor with a poor prognosis. In this retrospective cohort study, the authors constructed a nomogram for predicting the prognosis of WHO Grade III meningioma.MethodsThe patients of this nomogram were based on the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2018. All patients were randomly divided into a development cohort (964 patients) and a validation cohort (410 patients) in a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression was used to screen the predictors. The Cox hazards regression model was constructed and the prognosis was visualized by nomogram. The performance of the prognostic nomogram was determined by consistency index (C-index), clinical net benefit, and calibration.ResultsEight variables were included in the nomogram: gender, race, age at diagnosis, histology, tumor site, tumor size, laterality, and surgical method. The C-index of the training set and verification set were 0.654 and 0.628. The calibration plots showed that the nomogram was in good agreement with the actual observation. The clinical decision curve indicates that the nomogram has a good clinical net benefit in WHO Grade III meningioma.ConclusionsA prognostic nomogram of a large cohort of WHO Grade III meningioma was established and verified based on the SEER database. The nomogram we established may help clinicians provide personalized treatment services and clinical decisions for patients.

Download Full-text

Pathology of Spinal Ependymomas

Neurosurgery ◽

10.1227/01.neu.0000430764.02973.78 ◽

2013 ◽

Vol 73 (2) ◽

pp. 247-255 ◽

Cited By ~ 34

Author(s):

Phiroz E. Tarapore ◽

Peter Modera ◽

Agne Naujokas ◽

Michael C. Oh ◽

Beejal Amin ◽

...

Keyword(s):

Adjuvant Radiotherapy ◽

Histological Grade ◽

Progression Free Survival ◽

Extent Of Resection ◽

World Health ◽

Subtotal Resection ◽

Who Grade ◽

Grade Ii ◽

Health Organization ◽

Grade Iii

AbstractBACKGROUND:Ependymomas constitute approximately 40% of primary intraspinal tumors. Current World Health Organization (WHO) grading may not correlate with observed progression-free survival (PFS).OBJECTIVE:This retrospective study of prospectively collected data examines whether PFS is influenced by the histological grade or by the extent of resection. It also analyzes the usage and effectiveness of postoperative adjuvant radiotherapy.METHODS:We reviewed 134 consecutive patients with ependymomas of all grades. Pathology slides were re-reviewed and the histological grades were confirmed by a single neuropathologist. Postoperative residual or recurrence was evaluated with follow-up magnetic resonance imaging.RESULTS:There were 85 male and 49 female patients, ranging from 10 to 79 (median 41) years of age. Thirty patients had WHO grade I tumors, 101 had grade II tumors, and 3 had grade III tumors. Kaplan-Meier analysis of PFS demonstrated a mean duration of 6 years for grade I, 14.9 years for grade II, and 3.7 years for grade III (P < .001). In grade II ependymomas, mean PFS was 11.2 years with subtotal resection and 17.8 years with gross total resection (P < .01). PFS of patients who underwent subtotal resection was not significantly changed by adjuvant radiotherapy (P < .36).CONCLUSION:Patients with grade II ependymoma have significantly longer PFS than patients with grade I ependymoma. The extent of resection did not affect PFS in grade I ependymoma but it did in grade II. Contrary to its higher grade, WHO grade II ependymoma carries a better prognosis than WHO grade I ependymoma.

Download Full-text

Successful Treatment of a Spinal Clear Cell Meningiomas Patient With Anti-PD-1 Plus Anti- Angiogenesis

10.21203/rs.3.rs-756592/v1 ◽

2021 ◽

Author(s):

Yong Wang ◽

Baoyan Liu ◽

Rongjie Tao ◽

Yingxue Qi ◽

Ningning Luo ◽

...

Keyword(s):

Clear Cell ◽

Treatment Options ◽

Reference Value ◽

Treatment Method ◽

Disease Recurrence ◽

World Health ◽

High Recurrence Rate ◽

Who Grade ◽

Primary Tumors ◽

Health Organization

Abstract Clear cell meningioma (CCM), an unusual subtype of World Health Organization (WHO) grade II meningioma, represents only 0.2– 0.8% of meningiomas. Spinal CCMs are even rarer with unique clinical features: more common in younger patients; more likely to appear in lumbar spine; high recurrence rate. Although surgery and radiotherapy are the most common treatment for primary tumors and disease recurrence, there are lack of treatment options for recurrent or metastasis disease. It is urgent need to explore new effective treatment method. In our case, we firstly reported a rare spinal CCM patient with PD-L1 positive and multiple metastases benefiting from PD-1 inhibitor plus anti- angiogenesis therapy. This treatment program is effective, safe, and has a strong therapeutic reference value, which provides promising treatment options and the direction of future clinical trials for spinal CCMs.

Download Full-text

Indications of 5-Aminolevulinic Acid and Intraoperative MRI in Glioma Surgery: First Cases in Latin America in a Single Reference Center

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1667182 ◽

2018 ◽

Vol 37 (02) ◽

pp. 088-094

Author(s):

Ricardo Ramina ◽

Erasmo Silva Júnior ◽

Felipe Constanzo ◽

Maurício Coelho Neto

Keyword(s):

Aminolevulinic Acid ◽

Complete Resection ◽

World Health ◽

Awake Surgery ◽

Glioma Surgery ◽

Who Grade ◽

Combined Use ◽

Grade Ii ◽

Who Grade Iii ◽

Grade Iii

Introduction The improvement on the extent of resection (EOR) of gliomas with the combination of 5-aminolevulinic acid (5-ALA) and intraoperative magnetic resonance imaging (iMRI) has been demonstrated in previous studies. We present our results with the combined use of 5-ALA and (iMRI) in the surgery of glial lesions. Methods A total of 64 cases of patients with intracranial gliomas who underwent image-guided surgery using 5-ALA with and without (iMRI) were reviewed. All patients underwent an early postoperative MRI to evaluate the EOR. Other intra-operative techniques (awake surgery, electrophysiological stimulation and monitoring) were also performed according to the location of the tumor. Results A total of 18 tumors did not show intraoperative 5-ALA fluorescence (according to the World Health Organization [WHO] classification of tumors, 2 WHO-grade I, 14 WHO-grade II, 1 WHO-grade III and 1 WHO-grade IV), and 46 tumors showed intraoperative 5-ALA fluorescence (3 WHO-grade II, 3 WHO-grade III, 40 WHO-grade IV). In 28 of the 46 5-ALA positive cases, a safe 5-ALA free resection was achieved. In the 5-ALA negative cases, the (iMRI) findings guided the EOR, and complete resection was achieved in 11 cases. Complete resection was opted out in gliomas infiltrating eloquent areas. Conclusions The combined use of 5-ALA and IMRI showed improved results in glioma surgery, offering the safest maximal EOR. In the 5-ALA positive cases (mostly high-grade), fluorescence was a more useful tool. In the 5- ALA negative cases (mostly low-grade), the (iMRI) was decisive to guide the EOR of the tumor.

Download Full-text

Polymorphisms of methionine metabolism and susceptibility to meningioma formation

Journal of Neurosurgery ◽

10.3171/jns/2008/108/5/0999 ◽

2008 ◽

Vol 108 (5) ◽

pp. 999-1004 ◽

Cited By ~ 16

Author(s):

Alexander Semmler ◽

Matthias Simon ◽

Susanna Moskau ◽

Michael Linnebank

Keyword(s):

Genetic Variants ◽

World Health ◽

Intracranial Meningioma ◽

Methionine Metabolism ◽

Chi Square ◽

Who Grade ◽

Functional Polymorphisms ◽

Age And Sex ◽

Who Grade Iii ◽

Grade Iii

Object Functionally relevant polymorphisms of methionine and folate metabolism have been shown to be associated with various human cancer entities including cerebral lymphoma and glioblastoma multiforme. The authors investigated the association of 7 functional polymorphisms of methionine metabolism with meningioma formation. Methods This case-controlled, monocenter association study included 290 patients of Caucasian origin undergoing surgical resection for intracranial meningioma (World Health Organization [WHO] Grade I, 190 cases; WHO Grade II, 82 cases; WHO Grade III, 18 cases) and 287 age- and sex-matched local controls. The authors analyzed the following genetic variants: dihydrofolate reductase c.594+59del19, 5,10-methylenetetrahydrofolate reductase c.677C > T and c.1298A > C, 5-methyltetrahydrofolate-homocysteine S-methyltransferase (MTR) c.2756A > G, reduced folate carrier 1 c.80G > A, cystathionine beta-synthase (CBS) c.844_855ins68 and transcobalamin 2 c.776C > G. Results The variant CBS c.844_855ins68—that is, the allele carrying the insertion (“ins” or “i”) as opposed to the wild-type allele designated as deletion (“del” or “d”)—was significantly overrepresented in meningioma patients (dd/ id/ii: 0.81/0.18/0.01) in comparison with the controls (dd/id/ii: 0.88/0.12/0; 2 df, chi-square 8.97, p = 0.011; multiple nominal regression with age and sex as covariables). In addition, explorative analyses revealed an association of the MTR c.2756A > G variant with meningioma WHO Grade III (AA/AG/GG: patients, 1.0/0/0; controls, 0.64/0.32/0.04; 2 df, chi-square 14.44, p = 0.001). Conclusions The results of this study suggest that genetic variants of methionine metabolism are associated with meningioma formation.

Download Full-text