Meningioma: not always a benign tumor. A review of advances in the treatment of meningiomas

Meningiomas are the most common primary intracranial tumors. The majority of meningiomas are benign, but they can present different grades of dedifferentiation from grade I to grade III (anaplastic/malignant) that are associated with different outcomes. Radiological surveillance is a valid option for low-grade asymptomatic meningiomas. In other cases, the treatment is usually surgical, aimed at achieving a complete resection. The use of adjuvant radiotherapy is the gold standard for grade III, is debated for grade II and is not generally indicated for radically resected grade I meningiomas. The use of systemic treatments is not standardized. Here we report a review of the literature on the clinical, radiological and molecular characteristics of meningiomas, available treatment strategies and ongoing clinical trials.

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MR Imaging of Hepatocellular Carcinoma

Acta Radiologica ◽

10.1177/028418519503600211 ◽

1995 ◽

Vol 36 (2) ◽

pp. 163-167 ◽

Cited By ~ 7

Author(s):

H. Honda ◽

H. Onitsuka ◽

Y. Kanazawa ◽

T. Matsumata ◽

T. Hayashi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Mr Imaging ◽

Low Grade ◽

Hepatic Parenchyma ◽

Grade Ii ◽

Paramagnetic Ions ◽

Grade Malignancy ◽

Histopathologic Findings ◽

Signal Intensities ◽

Grade Iii

In order to clarify the factors contributing to the signal intensities (SIs) of HCC on T1-weighted images, the amount of water, lipid, copper (Cu), iron (Fe), and manganese (Mn) was determined in HCC and surrounding hepatic parenchyma of 13 patients. The relationships among these findings, the histopathologic findings, and the SIs of T1-weighted images were evaluated. Among the 13 HCC, 3 had a high SI, 5 were isointense, and 5 had a low SI on T1-weighted images compared to the surrounding hepatic parenchyma. The paramagnetic ions which contributed to the SI patterns were assumed to be Cu in HCC (38.0±62.4 μg/g ww), and Fe in the liver (61.1±42.4 μg/g ww) and HCC (40.0±34.3 μg/g ww). In 8 HCC with high- or isointensity, 2 were grades I, 5 were grade II, and one was grade III according to the Edmondson-Steiner's histopathologic classification. It is concluded that the SI patterns alone can not be a sign of low grade malignancy because of the existence of Fe in livers and HCC.

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Clinicohistopathological study of astrocytomas along with Ki-67 proliferative index

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20180317 ◽

2018 ◽

Vol 6 (2) ◽

pp. 665 ◽

Cited By ~ 1

Author(s):

Basumitra Das ◽

Kurimella Vamsya Raj ◽

Bhagyalakshmi Atla

Keyword(s):

Histological Grade ◽

Research Work ◽

Low Grade ◽

Proliferative Index ◽

Ki 67 ◽

Biologic Marker ◽

Grade Ii ◽

The Mean ◽

The Difference ◽

Grade Iii

Background: Astrocytomas form the largest group of gliomas (>75%) and diffusely infiltrating accounting for more than 60% of all the primary brain tumors. The ki67 proliferative index is a potent biologic marker that estimates the growth of neoplasms quantitatively and thus will aid in identifying the prognosis for patients with neoplasms. The aim of the research work was to study various histopathological and clinical features of Astrocytomas in detail, to evaluate Ki-67 proliferative index in patients of Astrocytomas and to compare the results of Immunohistochemistry with histological grade of Astrocytomas.Methods: A total number of 40 cases of Astrocytomas were included in the study. Ki-67 immunostaining was done on all cases and compared with WHO histological grading of astrocytomas.Results: The mean Ki‑67 LI in Grade I astrocytomas was 4.66, range 4-5 , in Grade II astrocytomas mean was 8.07, range 5-12 ,in Grade III astrocytomas mean was 13.5 , range 8-20, in Grade IV astrocytomas mean was 22.93, range 15-50. There was a highly significant correlation between the histopathological grade of astrocytomas and Ki-67 LI (p<0.05).Conclusions: The monoclonal antibody Ki-67 has proven its prognostic and diagnostic power in astrocytic tumors. Ki-67 LI is the simplest and the most reliable method for evaluating cell proliferation. Ki-67 LI increased with histological grade and the difference between low grade (I and II astrocytomas) and high grade (grade III and IV) is significant. In the present study Ki-67 LI is not dependent on factors like age and sex and is solely dependent on histological grade.

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RADIOMICS BASED SINGLE AND MULTI-CLASS GLIOMA CLASSIFICATION USING SUPPORT VECTOR MACHINE VARIANTS

Biomedical Sciences Instrumentation ◽

10.34107/yhpn9422.04265 ◽

2021 ◽

Vol 57 (2) ◽

pp. 265-273

Author(s):

P.D. Seema ◽

◽

T. Bobby Christy ◽

K.R. Anandh ◽

◽

...

Keyword(s):

Support Vector Machine ◽

Classification Accuracy ◽

Clinical Decision Making ◽

World Health ◽

Support Vector ◽

Low Grade ◽

Whole Brain ◽

Grade Ii ◽

Linear Svm ◽

Grade Iii

The common type of primary brain tumor is glioma. The mortality rate of glioma patients is high due to delayed diagnosis, incorrect grading and treatment planning. Traditionally, gliomas were classified into Low Grade (grade-I and grade-II) and High Grade (grade-III and grade-IV). However, World Health Organization has insisted to classify the grades into grade-I(G-I), grade II(G-II), grade III(G-III) and grade IV(G-IV) individually to aid the physicians in clinical decision-making. Although there are limited number of studies reported to differentiate individual grades, the classification accuracy was low. Consequently, in this work single-class (G-II vs. G-III, G-II vs. G-IV and G-III vs. G-IV) and multi-class (G-II vs. G-III+IV, G-III vs. G-II+IV and G-IV vs. G-II+III) analysis was performed using specific region of tumor and whole brain as Regions of Interest(ROI) by extracting radiomic features. The images for this study (N=75) were obtained from The Cancer Imaging Archive. Further, the statistically significant features were used in the classification of individual grades by implementing variants of Support Vector Machine (SVM) algorithm: SVM, Linear-SVM and Least-Squared SVM. Among these, Linear-SVM resulted in the highest classification accuracy (>80%) with average sensitivity, specificity and AUC values of >70%. The comparative analysis of whole brain versus tumor ROI showed that the latter yielded better classification accuracy.

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Clinicopathologic analysis of microscopic tumor extension in glioma for external beam radiotherapy planning

BMC Medicine ◽

10.1186/s12916-021-02143-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Shulun Nie ◽

Yufang Zhu ◽

Jia Yang ◽

Tao Xin ◽

Song Xue ◽

...

Keyword(s):

Dna Methyltransferase ◽

External Beam Radiotherapy ◽

High Grade Glioma ◽

Tumor Grade ◽

Radiotherapy Planning ◽

Low Grade ◽

Clinical Trial Registry ◽

Tumor Extension ◽

Grade Ii ◽

Grade Iii

Abstract Background There is no consensus regarding the clinical target volume (CTV) margins in radiotherapy for glioma. In this study, we aimed to perform a complete macropathologic analysis examining microscopic tumor extension (ME) to more accurately define the CTV in glioma. Methods Thirty-eight supra-total resection specimens of glioma patients were examined on histologic sections. The ME distance, defined as the maximum linear distance from the tumor border to the invasive tumor cells, was measured at each section. We defined the CTV based on the relationships between ME distance and clinicopathologic features. Results Between February 2016 and July 2020, a total of 814 slides were examined, corresponding to 162 slides for low-grade glioma (LGG) and 652 slides for high-grade glioma (HGG). The ME value was 0.69 ± 0.43 cm for LGG and 1.29 ± 0.54 cm for HGG (P < 0.001). After multivariate analysis, tumor grade, O6-methylguanine-DNA-methyltransferase promoter methylated status (MGMTm), isocitrate dehydrogenase wild-type status (IDHwt), and 1p/19q non-co-deleted status (non-codel) were positively correlated with ME distance (all P < 0.05). We defined the CTV of glioma based on tumor grade. To take into account approximately 95% of the ME, a margin of 1.00 cm, 1.50 cm, and 2.00 cm were chosen for grade II, grade III, and grade IV glioma, respectively. Paired analysis of molecularly defined patients confirmed that tumors that had all three molecular alterations (i.e., MGMTm/IDHwt/non-codel) were the most aggressive subgroups (all P < 0.05). For these patients, the margin could be up to 1.50 cm, 2.00 cm, and 2.50 cm for grade II, grade III, and grade IV glioma, respectively, to cover the subclinical lesions in 95% of cases. Conclusions The ME was different between the grades of gliomas. It may be reasonable to recommend 1.00 cm, 1.50 cm, and 2.00 cm CTV margins for grade II, grade III, and grade IV glioma, respectively. Considering the highly aggressive nature of MGMTm/IDHwt/non-codel tumors, for these patients, the margin could be further expanded by 0.5 cm. These recommendations would encompass microscopic disease extension in 95% of cases. Trial registration The trial was registered with Chinese Clinical Trial Registry (ChiCTR2100049376).

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Expression of Mesothelioma-Related Markers in Meningiomas: An Immunohistochemical Study

BioMed Research International ◽

10.1155/2014/968794 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Eman Abdelzaher ◽

Dina Mohamed Abdallah

Keyword(s):

Immunohistochemical Study ◽

Diagnostic Markers ◽

Intracranial Tumors ◽

Keratin 5 ◽

Grade Ii ◽

Lower Expression ◽

Grade Iii

Background. Meningiomas are common intracranial tumors. Recently, histogenetic and phenotypic similarities between meningiomas and mesotheliomas have been proposed. We were interested in whether these similarities are reflected on the immunohistochemical level, which would add new potentially diagnostic markers for meningiomas.Methods. The expression of mesothelioma-related markers (D2-40, Calretinin, Keratin 5/6, WT1, and Methotheioma-Ab1) was investigated in 87 cases of meningiomas and compared to EMA expression.Results. 73.6% of meningioma cases were grade I, 20.7% were grade II, and 5.7% were grade III. 83.9% of meningioma cases were classical and 16.1% had special nonmeningothelial features. D2-40 was expressed in 37.9% of cases and was significantly restricted to classical meningiomas. Calretinin and WT1 were negative while Keratin 5/6 and Mesothelioma-Ab1 were weakly expressed in classical variants (5.7% and 3.4%, resp.). EMA was consistently expressed in all cases. Its expression was significantly higher than that of mesothelioma-related markers; this held true also when D2-40 expression was considered separately.Conclusions. Mesothelioma-related markers are not extensively expressed in meningiomas, a finding that argues against their proposed histogenetic and phenotypic similarities. Compared to EMA, the significantly lower expression of mesothelioma-related markers and their restricted expression to classical meningioma variants hamper their potential future use as diagnostic markers for meningioma.

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Discrimination between low-grade oligodendrogliomas and diffuse astrocytoma with the aid of 11C-methionine positron emission tomography

Journal of Neurosurgery ◽

10.3171/2010.11.jns10553 ◽

2011 ◽

Vol 114 (6) ◽

pp. 1640-1647 ◽

Cited By ~ 46

Author(s):

Natsuki Shinozaki ◽

Yoshio Uchino ◽

Kyosan Yoshikawa ◽

Tomoo Matsutani ◽

Azusa Hasegawa ◽

...

Keyword(s):

Mr Imaging ◽

Histological Type ◽

Labeling Index ◽

Low Grade ◽

Astrocytic Tumors ◽

Ki 67 ◽

Oligodendroglial Tumors ◽

Grade Ii ◽

The Mean ◽

Grade Iii

Object The diagnostic usefulness of 11C-methionine PET scans in gliomas is still controversial. The authors investigated the clinical significance of 11C-methionine PET findings in preoperative diagnosis of histological type and grade. Methods The tissue uptake of 11C-methionine was assessed using PET in 70 patients with histologically confirmed intracerebral gliomas. The ratio of maximum standard uptake values in tumor areas to the mean standard uptake values in the contralateral normal brain tissue (tumor/normal tissue [T/N] ratio) was calculated and correlated with tumor type, histological grade, contrast enhancement on MR imaging, Ki 67 labeling index, and 1p/19q status. Results The T/N ratio was significantly increased as tumor grade advanced in astrocytic tumors (WHO Grade II vs Grade III, p = 0.0011; Grade III vs Grade IV, p = 0.0007). Among Grade II gliomas, the mean T/N ratio was significantly higher in oligodendroglial tumors than in diffuse astrocytomas (DAs) (p < 0.0001). All T/N ratios for oligodendroglial tumors were ≥ 1.46, and those for DA were consistently < 1.46, with the exception of 2 cases of gemistocytic astrocytoma. The Ki 67 labeling index significantly correlated with T/N ratio in astrocytic tumors, but not in oligodendrogliomas. Oligodendroglial tumors without 1p/19q deletion had a significantly higher T/N ratio than those with the codeletion. In combination with Gd-enhanced MR imaging, 67% of nonenhanced tumors with a T/N ratio of ≥ 1.46 were proved to be Grade II oligodendrogliomas. Conclusions These results clearly show that 11C-methionine PET T/N ratios in Grade II oligodendrogliomas were higher than those in DAs independently of their proliferative activity. This information contributes to preoperative differential diagnoses of histological type, especially in suspected low-grade gliomas.

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Capecitabine and Temozolomide in Neuroendocrine Tumor of Unknown Primary

Journal of Oncology ◽

10.1155/2018/3519247 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Aman Chauhan ◽

Zainab Farooqui ◽

Le Aundra Murray ◽

Heidi L. Weiss ◽

Zin War Myint ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Progression Free Survival ◽

Metastatic Tumor ◽

The United States ◽

Unknown Primary ◽

Clinical Activity ◽

Low Grade ◽

Bulky Disease ◽

Systemic Treatments ◽

Grade Ii

Incidence of low grade well-differentiated neuroendocrine tumors (NET) is on the rise. The North American Neuroendocrine Tumor Society estimates that the United States has more than 150,000 gastroenteropancreatic NET patients. About 10% of metastatic NETs can be unknown primary, and due to their rarity, dedicated treatment algorithms and regimens are not defined. Combination of capecitabine and temozolomide (CAPTEM) is one of the systemic treatments used in gastroenteropancreatic NETs. We explored clinical activity of CAPTEM in NET of unknown primary. Methods. Retrospective review of NET of unknown primary managed at the University of Kentucky over the past five years (2012–2016). Result. 56 patients with NET of unknown primary were identified; 12 patients were treated with CAPTEM. Median progression-free survival on CAPTEM in grade II and grade III NET of unknown primary was 10.8 and 7 months, respectively. Six patients showed reduction in metastatic tumor volume at three-month CT scan. Three patients had stable disease and three patients showed disease progression at the first surveillance scan. Common side-effects were as follows: four patients developed grade II thrombocytopenia, three patients developed grade I lymphocytopenia, and two patients developed hand foot syndrome (grades I and III). Six patients developed grade I fatigue. Conclusion. CAPTEM should be considered for grades I and II NET of unknown primary, especially in the case of visceral crisis or bulky disease.

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Intracranial solitary fibrous tumors/hemangiopericytomas: first report of malignant progression

Journal of Neurosurgery ◽

10.3171/2017.1.jns162593 ◽

2018 ◽

Vol 128 (6) ◽

pp. 1719-1724 ◽

Cited By ~ 9

Author(s):

Caroline Apra ◽

Karima Mokhtari ◽

Philippe Cornu ◽

Matthieu Peyre ◽

Michel Kalamarides

Keyword(s):

Case Series ◽

Malignant Progression ◽

World Health ◽

Low Grade ◽

Lower Grade ◽

First Report ◽

Solitary Fibrous Tumors ◽

Initial Surgery ◽

Grade Ii ◽

Grade Iii

OBJECTIVEMeningeal solitary fibrous tumors/hemangiopericytomas (MSFTs/HPCs) are rare intracranial tumors resembling meningiomas. Their classification was redefined in 2016 by the World Health Organization (WHO) as benign Grade I fibrohyaline type, intermediate Grade II hypercellular type, and malignant highly mitotic Grade III. This grouping is based on common histological features and identification of a common NAB2-STAT6 fusion.METHODSThe authors retrospectively identified 49 cases of MSFT/HPC. Clinical data were obtained from the medical records, and all cases were analyzed according to this new 2016 WHO grading classification in order to identify malignant transformations.RESULTSRecurrent surgery was performed in 18 (37%) of 49 patients. Malignant progression was identified in 5 (28%) of these 18 cases, with 3 Grade I and 2 Grade II tumors progressing to Grade III, 3–13 years after the initial surgery. Of 31 Grade III tumors treated in this case series, 16% (5/31) were proved to be malignant progressions from lower-grade tumors.CONCLUSIONSLow-grade MSFTs/HPCs can transform into higher grades as shown in this first report of such progression. This is a decisive argument in favor of a common identity for MSFT and meningeal HPC. High-grade MSFTs/HPCs tend to recur more often and be associated with reduced overall survival. Malignant progression could be one mechanism explaining some recurrences or metastases, and justifying long-term follow-up, even for patients with Grade I tumors.

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P09.05 Treatment strategy of MRI postcontrast non-enhanced gliomas

Neuro-Oncology ◽

10.1093/neuonc/noab180.093 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii27-ii27

Author(s):

O Kalita ◽

L Hrabalek ◽

V Jan ◽

M Slachta ◽

Y Klementová ◽

...

Keyword(s):

Brain Tumor ◽

Brain Tumors ◽

Tumor Volume ◽

Residual Tumor ◽

Idh1 Mutation ◽

Low Grade ◽

Contrast Enhanced ◽

Grade Ii ◽

Grade Iii

Abstract BACKGROUND MRI postcontrast nonenhanced brain tumors are found benign biologic entities with the better prognosis. The aim of this paper is to evaluate predictive features on MRI considered definite diagnosis occurrence, tumor progression, upgrading and postcontrast enhancement evolution on follow-up serial MRI. MATERIAL AND METHODS We retrospectively collected patients with the initially MRI postcontrast nonenhanced brain tumors, treated in our hospital from January 2009 to June 1, 2006. All tumors were converted into WHO 2016 IDH status classifications in accordance with current recommendations. Information about surgeries, patient clinical condition, MRI, and results of histological, immunohistochemical, molecular genetic, and cytogenetic investigations were gathered. Semiautomatic segmentations were performed using FSLeyes software (part of FSL package) on preoperative and followed-up 3D T1-w MPRAGE, T2-w or FLAIR scans. We focused on residual tumor volume, and time distribution of T2/FLAIR changes and T1-w postcontrast enhancement evolution. RESULTS Seventy-eight patients were enrolled in this study. There were 47 gliomas grade II 22 grade III and 9 grade IV. Glioma II comprised 35 diffuse astrocytomas (23 patients had IDH1 mutation). Nine gliomas grade III and 6 gliomas grade IV had IDH1 mutation. Overall survival in glioma group grade II, grade III, grade IV was 187.9 months, 71.1 months and 25.2 months, respectively. Oncotherapy underwent 14 gliomas grade II after first surgery, 13 patients had radiotherapy a 1 patient had neoadjuvant chemotherapy. Seventeen gliomas grade III were indicated to oncotherapy, 5 patients had radiotherapy and 12 had chemoradiotherapy. All patients with glioma grade IV experienced oncotherapy. Time to progression of non-contrast enhanced brain tumor was 5.8 years. Time to up-grading of non-contrast enhanced brain tumor was 16.8 months. Detailed time relations of glioma subgroup will be displayed in tables. CONCLUSION Regarding MRI postcontrast non-enhanced tumors, predominantly low grade gliomas (LGG), aggressive oncotherapy are reluctant to use but they are prone to repeat surgeries. Decision making issues are age, clinical patient status, histologic and genetic tumor characteristics, residual tumor volume, published guidelines for brain tumor treatment, and patient′s willing. Generally, hyposignal on the T1 postcontrast scans strictly relate to the better prognosis, even in HGG. Longer survival expectancy increases quality of life awareness. Prior to MRI postcontrast enhanced evolution and up-grading, T2/FLAIR changes have been demonstrated. T2/FLAIR scans considered also main role in LGG follow-up strategy. Individual tailored therapy is principal strategy. Supported by Ministry of Health of the Czech Republic, grant nr. NV19-04-00281 and grant nr. NU21-03-00195

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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.

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