scholarly journals Extracerebral Pterional Metastasis from Malignant Meningioma: A Case Report

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.

scholarly journals Incidental Metastatic Meningioma Presenting as a Large Liver Mass

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ifeyinwa E. Obiorah ◽  
Metin Ozdemirli
Keyword(s):  
Previous History ◽  
Clinical History ◽  
World Health ◽  
Intracranial Meningioma ◽  
Liver Mass ◽  
Benign Meningioma ◽  
Who Grade ◽  
Precise Diagnosis ◽  
History Of ◽  
Health Organization

Meningiomas are slow growing neoplasms of the central nervous system (CNS). Most of the tumors are benign and distant metastasis from a benign meningioma is rare. Metastasis to the liver, although rare, usually presents with hypoglycemia or occurs in conjunction with a clinical history of an intracranial meningioma or following the resection of a prior CNS meningioma, thus making clinical diagnosis relatively easy. Here we present an unusual case of metastatic meningioma to the liver in a 54-year-old female who presented with an incidental liver mass by ultrasound. Her clinical history and physical examination were unremarkable. A partial hepatectomy revealed a meningioma on histology. Further investigation by imaging studies showed a frontal parasagittal dural mass which was confirmed to be a World Health Organization (WHO) grade 1 meningioma. To our knowledge, this is the first report of a clinically silent metastatic meningioma to the liver without either a concurrent or a previous history of meningioma. Precise diagnosis of this challenging case requires high clinical suspicion, histopathology, and immunohistochemistry.

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

2020 ◽  
Vol 11 (04) ◽  
pp. 552-557
Author(s):  
Jeni Poniman ◽  
Muh Husni Cangara ◽  
Cahyono Kaelan ◽  
Upik A. Miskad ◽  
Gunawan Arsyadi ◽  
...  
Keyword(s):  
Progesterone Receptor ◽  
Clear Cell ◽  
Receptor Expression ◽  
World Health ◽  
P Value ◽  
Who Grade ◽  
Paraffin Block ◽  
Health Organization ◽  
Who Grade Iii ◽  
Grade Iii

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.

Stereotactic radiation treatment for recurrent nonbenign meningiomas

2007 ◽  
Vol 106 (5) ◽  
pp. 846-854 ◽  
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.

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

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.

scholarly journals Analysis of Prognostic Factors of World Health Organization Grade Ⅲ Meningiomas

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&lt;0.001) and postoperative radiotherapy (PFS, p=0.006; OS, p&lt;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.

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

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.

scholarly journals Falx Cerebelli Meningioma: Case Report of a Rarely Occurring Tumor, Management Nuances, and Literature Review

2021 ◽  
Vol 82 (03) ◽  
pp. e32-e35
Author(s):  
Elizabeth Gallo ◽  
Grzegorz Brzezicki ◽  
Raafat Makary ◽  
Gazanfar Rahmathulla ◽  
Dinesh Rao ◽  
...  
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Collagen Matrix ◽  
World Health ◽  
Who Grade ◽  
Lumbar Drain ◽  
History Of ◽  
Tumor Management ◽  
Health Organization ◽  
Midline Approach ◽  
Fluid Leak

AbstractThe falx cerebelli is a small crescent fold of dura mater that is attached to the internal occipital crest and projects forward into the posterior cerebellar notch between the cerebellar hemispheres. We report a rare case of a 61-year-old female who presented with a 1-month history of headache and gait instability. Imaging findings were suggestive of a meningioma arising from the falx cerebelli. Complete surgical resection was achieved with a standard posterior fossa midline approach. Duraplasty was performed using animal allograft dura (Duraguard) and additional layers of oxidized cellulose preparation (Surgicel), fibrin sealant, and nonsuturable collagen matrix (Duragen) were utilized to reduce the risk of a cerebrospinal fluid leak. Pathology confirmed a World Health Organization (WHO) grade-I meningioma. Postoperatively, patient with asymptomatic thrombosis of the left transverse/sigmoid sinuses and later with a pseudomeningocele managed with a lumbar drain. To our knowledge, this is the second documented case in the literature. We discuss intraoperative nuances and unique aspects in the postoperative care and management of these patients.

scholarly journals Imaging and Histopathologic Nuances of Epithelioid Glioblastoma

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Brian H. Le ◽  
Richard A. Close
Keyword(s):  
Mass Effect ◽  
Clonic Seizure ◽  
Cystic Mass ◽  
Braf V600e ◽  
World Health ◽  
Significant Past Medical History ◽  
Who Grade ◽  
Epithelioid Glioblastoma ◽  
Health Organization ◽  
The Right

A 27-year-old male without significant past medical history presented following collapse resulting from a syncopal episode at work. There was an episode of vomiting, and one of tonic-clonic seizure activity, which was spontaneously resolved after approximately one minute. His neurologic exam was nonfocal, with full strength in the bilateral upper and lower extremities, and no sensory deficits were elicited. MRI studies demonstrated a 4.7 cm rim-enhancing cystic mass in the right temporal-parietal region, with resultant mass effect and edema. At surgery, intraoperative pathologic consultation favoured a primary glial neoplasm. Subsequent complete histologic examination on permanent sections confirmed the presence of glioblastoma, with a morphologic pattern and immunohistochemical profile most consistent with epithelioid glioblastoma (WHO grade IV). Epithelioid glioblastoma is a rare, especially aggressive variant of IDH-wildtype glioblastoma, recognized in the 2016 World Health Organization classification. Approximately 50% of such tumors harbour the BRAF V600E mutation, which has also been observed in some melanomas where selective inhibitors have demonstrated a therapeutic role. The especially aggressive behaviour and poor clinical outcome typically observed for this variant of glioblastoma demonstrate the importance of emerging areas relevant to neurooncology, specifically those of proteomic characterization and therapeutic nanomedicine.

Pathology of Spinal Ependymomas

Neurosurgery ◽  
2013 ◽  
Vol 73 (2) ◽  
pp. 247-255 ◽  
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 &lt; .001). In grade II ependymomas, mean PFS was 11.2 years with subtotal resection and 17.8 years with gross total resection (P &lt; .01). PFS of patients who underwent subtotal resection was not significantly changed by adjuvant radiotherapy (P &lt; .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.

Hydroxyurea for treatment of unresectable and recurrent meningiomas. II. Decrease in the size of meningiomas in patients treated with hydroxyurea

1997 ◽  
Vol 86 (5) ◽  
pp. 840-844 ◽  
Author(s):  
Uwe M. H. Schrell ◽  
Michael G. Rittig ◽  
Marc Anders ◽  
Uwe H. Koch ◽  
Rolf Marschalek ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Cavernous Sinus ◽  
World Health ◽  
Malignant Meningioma ◽  
Who Grade ◽  
Content Type ◽  
Fourth Patient ◽  
Long Term Treatment ◽  
The Right ◽  
Fine Print

✓ In this paper the authors present the first evidence that meningiomas respond to treatment with hydroxyurea. Hydroxyurea was administered as an adjunct chemotherapeutic treatment in patients with recurrent and unresectable meningiomas. Hydroxyurea was used because experimental data demonstrated that it inhibits growth of cultured human meningioma cells and meningioma transplants in nude mice by inducing apoptosis. The authors therefore treated four selected patients with hydroxyurea. All patients had undergone multiple gross resections and all except one received radio-therapy. Three patients with recurrent Grade I meningiomas assessed according to World Health Organization (WHO) guidelines received hydroxyurea because of an increased tumor growth rate, documented by magnetic resonance (MR) imaging, within a 6- or 12-month interval. A fourth patient with a malignant meningioma (WHO Grade III) began a course of treatment with hydroxyurea immediately after his sixth palliative operation without waiting for another relapse to be demonstrated on MR imaging. Because of their location and invasive growth behavior none of the meningiomas could have been removed completely by surgical intervention. All patients received hydroxyurea at a dosage level of 1000 to 1500 mg/day (approximately 20 mg/kg/day). In a man with a large sphenoid wing meningioma invading the right cavernous sinus and the temporal base, the intracranial tumor mass was reduced by 60% during 6 months of treatment. A woman with a large ball-shaped meningioma of the right sphenoid wing invading the cavernous sinus exhibited a 74% decrease of the initial tumor volume in 10 months of treatment with oral hydroxyurea. Serial MR images obtained monthly revealed that the process of size reduction was continuous and proportionate. The shrinkage of the tumor was accompanied by a complete remission of symptomatic trigeminal neuralgia after 2 months and by improved abducent paresis after 5 months. The third patient had a slowly growing meningioma that exhibited a 15% reduction in mass when reassessed after 5 months of hydroxyurea treatment. The fourth patient with the malignant meningioma in the left cerebellopontine angle has had no recurrence for 24 months. Long-term treatment with hydroxyurea may result in full remission of tumors in meningioma patients. The preliminary data indicate that hydroxyurea provides true medical treatment in patients with unresectable and recurrent meningiomas, replacing palliative surgery and radiotherapy in the management of this disease.

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