Chordoid meningioma in a patient with lymphangioleiomyomatosis

Journal of Neuro-Oncology -     

Malignant meningioma with extracranial metastasis

We report case of malignant meningioma involving the lumbar vertebra (3rd and 4th). A 53-year-old man who developed occipitalgia in April 1977 was operated under the diagnosis of posterior fossa tumor in August 1977. The tumor was totally removed macroscopically Simpson grade 2. The histological diagnosis was malignant meningioma, He complained of lumbago and right leg pain since June 1981. Destruction and tumor stain of the 3rd and 4th lumbar vertebrae were recognized on CT scans. In May 1982, surgical decompression and spinal fixation were attempted. The surgical specimen was verified as a malignant meningioma. Therefore, he underwent irradiation therapy to the lumbar spine (total dose 50 Gray). He presented with occipitalgia in March 1983. CT scan detected tumor recurrence in the suboccipital region. The recurrent tumor was totally removed immediately. The histological feature was malignant meningioma. The mode and site of metastasizing meningioma are discussed with a review of the literature.     

Experience with surgery of parasagittal meningioma

The study included 106 patients operated for parasagittal meningioma. Occlusion of the superior sagittal sinus (SSS) was recorded in 50 cases: partial-21, complete-29. Other pathologies-18. Fifty-five patients received standard surgical procedures without interfering with the SSS; microsurgery was given another 51 patients using reconstruction of the SSS. A comparison of the results pointed to the advantages offered by the latter procedure in excision of parasagittal meningioma.     

Association of meningioma with reproductive factors

Meningiomas occur more commonly in females. The coincidence between meningioma and breast cancer and case reports of tumor growth during pregnancy support a hormonal hypothesis. A case control study was conducted to investigate this. Female subjects treated between 1987 and 1992 were identified from 3 hospitals in the Chicago area. Female spouses of male back pain patients were recruited as controls. A self-administered mail questionnaire focused on exogenous, endogenous and other hormonal factors, personal and family medical history as well as radiation exposures. Odds ratios and 95% confidence intervals were estimated using crude, stratified and multivariable logistic models including 219 cases and 260 controls. Participation rates were 86% among cases and 75% among controls. An increased odds ratio (OR) was observed comparing African Americans to Caucasians [OR = 2.4, 95% confidence interval (CI) = 1.0-6.1]. A protective effect was observed for pregnancy, which increased with number and age at first pregnancy. The odds ratio for 3 or more pregnancies compared to none was 0.3 (95% CI = 0.2-0.6). Age at menarche or total period of hormonal activity was not protective. Ever smokers showed a decreased odds ratio for meningioma (OR = 0.6, 95% CI = 0.4-0.9). The increased odds ratios with African Americans was retained in post-menopausal women, while the protective odds ratios for pregnancy, smoking and oral contraceptives (OCs) became stronger in pre-menopausal women. The pattern by duration and timing of use does not suggest an etiologic role for OCs or hormone replacement therapy. These data add to the evidence that factors known to influence endogenous hormones (pregnancy and indirectly smoking) may have protective effects for meningiomas primarily in premenopausal women.     

立体定向放射治疗脑膜瘤48例临床分析

目的　探讨立体定向放射神经外科 (SRS)治疗脑膜瘤的疗效和方法。方法　应用 SRS治疗脑膜瘤 48例 ,并随访 6个月至 36个月。单次治疗 31例 ,分次治疗 17例。治疗前 KPS评分 87(4 0～10 0 )。结果　显效 3例 ,有效 2 5例 ,无变化 12例 ,进展 5例。 KPS评分 92 (5 5～ 10 0 )。结论　 SRS治疗脑膜瘤是一种安全有效的方法 ;分次治疗对较大病灶也有较好的疗效 ,但应掌握好肿瘤大小、部位、形态与周边剂量的关系     

Risk of post-operative venous thromboembolism in patients with meningioma

The surgical resection of meningiomas can be complicated by venous thromboembolism (VTE) in the post-operative period, but the exact incidence of this event is not known. Aim of this study was to assess the occurrence of VTE in patients operated for meningioma who underwent a post-operative clinical and objective screening for VTE. Patients undergoing meningioma resection between 2000 and 2010 who accepted to be investigated for VTE in the post-operative period were included in the study. The screening included daily clinical assessment, pulmonary perfusion scintigraphy (Q-SCAN) on day 2 and venous compression ultrasonography (CUS) of the lower limbs within day 7. The univariate and multivariate statistical analysis of risk factors for VTE included sex, age, presence of comorbidities, pre- and post-operative Karnofsky Performance scale (KPS), post-operative neurological worsening and post-operative walking ability. Two-hundred and seventy-five patients were included in the study. VTE was diagnosed in 82 patients (29.8%). Univariate analysis revealed that age?≥?65 years, cardiovascular comorbidities, pre- and post-operative KPS?<?80/100, post-operative neurological worsening and impaired post-operative walking ability were significantly associated with VTE. Multivariate analysis confirmed only age?≥?65 years (p?=?0.011) and post-operative KPS?<?80/100 (p?=?0.002) as independent risk factors for VTE. Patients operated for meningioma have a 30% risk of VTE. Age?≥?65 years and post-operative KPS?<?80 were independent risk factors for VTE.     

围术期营养治疗在脑膜瘤患者中的应用

目的 探讨围术期营养治疗在脑膜瘤患者中的应用效果。方法 选取宁夏医科大学总医院神经外科2017年1月至2018年11月行脑膜瘤切除术的患者65例,随机分为两组,试验组32例,对照组33例,试验组采用规范的围术期营养治疗,对照组采用传统治疗。观察术前、术后不同时间点空腹血糖、血清白蛋白、炎症指标差异及住院日、住院费在两组间的差异。结果 重复测量设计方差分析结果显示血清白蛋白、白细胞计数组间差异有统计学意义（P<0.05）,F值分别为8.450、18.647。两两比较结果显示：两组间空腹血糖、血清白蛋白、白细胞计数随时间的变化不同;试验组术后第3天空腹血糖、术后第3/5/8天白细胞计数较对照组低,术后第1天白蛋白水平较对照组高（P<0.05）。与对照组比较,试验组术后住院天数（13.63±3.82）d vs（16.58±6.60）d和抗生素费用（2,923±562.83）元vs（431.37±104.74）元,两组间差异有显著性统计学意义（P<0.05）。结论 围术期营养治疗对维持脑膜瘤患者术后血糖稳定、负氮平衡、预防炎症反应和缩短住院日等方面具有一定的作用。     

Lipomatous meningioma associated with cerebral vascular malformation

A unique epileptic patient with intracranial neoplasm is reported in which a meningioma with lipomatous and osseous components was found associated with cerebral arteriovenous malformation at the same location in the right frontal lobe. The development of the leptomeningeal neoplasm may have been influenced by the underlying vascular anomaly. The cerebral arteriovenous malformation and altered hemodynamics also could have induced the sudden onset of clinical seizures, hemiparesis, and unconsciousness.     

Granulofilamentous meningioma

A 55-year old female was referred to the Department of Neurosurgery, Kitasato Hospital, because of a hearing impairment. Neuroimaging revealed a typical meningioma attached to the falx in the right frontal region. During surgery, an encapsulated, circumscribed, reddish-gray, slightly hard tumor attached to the falx was completely removed by an interhemispheric approach. On light microscopy, many of the tumor cells contained eosinophilic inclusions with single or multiple vacuoles that displaced the cytoplasm. The nuclei of the tumor cells were eccentric. There were no signs of malignancy in the specimen. Electron microscopy revealed that most of the eosinophilic inclusions were composed of filaments measuring 12 nm in diameter. There have been several reports of benign meningiomas with eosinophilic inclusions composed of intermediate filaments. The microscopic differences between these types of tumor and rhabdoid meningiomas are very subtle, and it is important the two types of tumors are not confused. Benign meningiomas with eosinophilic inclusions comprising intermediate filaments, for example the tumor described in this report, have been diagnosed as granulofilamentous meningiomas, which is a subtype of benign meningioma.     

Extracranial meningioma

Meningioma can be a diagnostic problem for the head and neck surgeon and the surgical pathologist by reason of extracranial manifestation and the varying histological patterns seen in small biopsy specimens submitted from various extracranial sites. During the thirty year period 1940–1970, 405 cases of meningioma were seen at the New York Hospital and the Memorial Hospital and the clinical findings have been reviewed together with recent pertinent literature. Thirty-four cases were spinal in origin: 9 cervical, 22 dorsal, and 2 lumbar. An external mass was present in 20% of the intracranial tumors: the orbit was involved in 30 patients, the outer table and scalp in 25, the paranasal sinuses and nasal cavity in 10, and the parotid and parapharyngeal region in 5. Three cases are documented primary extracranial meningiomas arising is soft parts; one free in the orbit and two in the neck masquerading as deep lobe parotid gland tumors. The pathological features of extra-cranial meningioma were identical with the intracranial variety and a standard classification of the main histological types is outlined. A variety of differential diagnoses were entertained before the true nature of the neoplasm was established. The necessity for sophisticated radiographic studies and neurosurgical attention to the intracranial component of the tumor is emphasized.     

Chordoid meningioma

Chordoid meningioma is a relatively rare variant that is often associated with peritumoral lymphoplasmacellular infiltration causing Castleman syndrome (CS). We present a 44-year-old woman with chordoid meningioma not associated with CS. The patient presented with epilepsy and right hemiparesis (Todd's palsy) on admission. The radiological findings revealed an extraaxial mass lesion in the premotor cortex. They were compatible with a preoperative diagnosis of meningioma. No physical abnormalities related to CS were detected. A left frontal craniotomy was performed. The tumor surface was gelatinous, and it was totally resected with the attached dura mater (Simpson grade I). The patient had an uneventful recovery, and her seizures subsided. The pathological findings of the specimens revealed nests and cords of spindle and epithelioid cells with abundant myxoid matrix, mimicking the features of chordoma. On the basis of radiological, immunohistochemical, and electron microscopic findings, chordoid meningioma was verified, and a review of the literature was performed. This case was reported at the 2nd International Symposium of Brain Tumor Pathology (May 12–13, 2000, Nagoya, Japan)     

The treatment of malignant meningioma with verotoxin

Malignant meningiomas (MMs) are aggressive intracranial neoplasms with a 75% 5-year recurrence rate. Verotoxin 1 (VT1) is an Escherichia coli toxin, which has recently been shown to have anti-neoplastic action by targeting the globotriosylceramide (Gb(3)) glycolipid on tumor cells and tumor neovasculature. To investigate the potential use of VT1 as a clinical agent for MM, we initially tested 16 meningiomas for Gb(3) expression. Nine of 11 MMs (82%), but only one of five benign meningiomas (20%), were positive for Gb(3). An orthotopic xenograft model was used to test the efficacy of VT1 treatment for MM. We first demonstrated that Gb(3) was highly expressed by the MM cell line, IOMM-Lee, and that this cell line was highly sensitive to VT1 treatment in vitro. A single intratumoral injection of VT1 significantly improved survival in nude mice harboring intracranial tumours (P<.0001). Factor-eight immunostaining of tumours harvested from VT1-treated animals revealed a marked reduction in the tumour microvascular density. In addition, the tumors of VT1-treated animals displayed increased apoptosis by TUNEL analysis and showed a significant decrease in cell proliferation, as determined by MIB-5 immunostaining. VT1 treatment of MM is effective in our orthotopic xenograft model, and warrants further exploration as a potential treatment for these highly anaplastic and aggressive neoplasms.     

Recurrent meningioma

Single meningiomas are histologically classified as benign tumors, but clearly malignant types have been encountered. The standard mode of management is total macroscopic removal with excision of the dural attachment and abnormal bone, if there is any. Despite this aggressive surgery, recurrence rates of approximately 9% have been reported with the removal of benign tumors, and the rate is much higher with the removal of malignant meningiomas. Recurrence most frequently occurs at the original tumor site and is most often explained by incomplete removal, which, in turn, is a function of the anatomic location of the tumor. Less common are regional recurrences, which may be explained on the basis of the multicentric origin of meningiomas. This theory may also explain the rare entity, "multiple meningioma." This article documents an unexpected regional recurrence of meningioma. The pertinent literature is reviewed.     

Specific genes expressed in association with progesterone receptors in meningioma

An association between hormones and meningioma has been postulated. No data exist that examine gene expression in meningioma by hormone receptor status. The data are surgical specimens from 31 meningioma patients undergoing neurosurgical resection at Brigham and Women's Hospital from March 15, 2004 to May 10, 2005. Progesterone and estrogen hormone receptors (PR and ER, respectively) were measured via immunohistochemistry and compared with gene expression profiling results. The sample is 77% female with a mean age of 55.7 years. Eighty percent were grade 1 and the mean MIB was 6.2, whereas 33% and 84% were ER+ and PR+, respectively. Gene expression seemed more strongly associated with PR status than with ER status. Genes on the long arm of chromosome 22 and near the neurofibromatosis type 2 (NF2) gene (22q12) were most frequently noted to have expression variation, with significant up-regulation in PR+ versus PR- lesions, suggesting a higher rate of 22q loss in PR- lesions. Pathway analyses indicated that genes in collagen and extracellular matrix pathways were most likely to be differentially expressed by PR status. These data, although preliminary, are the first to examine gene expression for meningioma cases by hormone receptor status and indicate a stronger association with PR than with ER status. PR status is related to the expression of genes near the NF2 gene, mutations in which have been identified as the initial event in many meningiomas. These findings suggest that PR status may be a clinical marker for genetic subgroups of meningioma and warrant further examination in a larger data set.