Clinicopathological Characteristics of Meningiomas: A tricentric Study
DOI:
https://doi.org/10.35516/jmj.v59i5.3127Keywords:
Meningioma, Brain tumors, Histopathology, Recurrence, PrognosisAbstract
Background and Aims: Meningioma is the most common brain tumor in Jordanian adults. This study aimed to analyze the macro- and microscopic features of meningiomas with emphasis on the correlation with tumor recurrence.
Materials and Methods: This retrospective study comprised all the meningioma cases diagnosed at three major tertiary care centers in Jordan in 2007-2021. The clinicopathologic data were retrieved from the patients’ records.
Results: A total of 690 cases were studied, with the peak age being 45 years. The female-to-male ratio was 2.3:1. Based on the available data for most patients among the cohort, tumor size ranged from 0.5 cm to 11.5 cm, and the most common site was the frontal lobe. The great majority of tumors were grade 1 (80.2%). Male sex was significantly associated with a higher tumor grade and a larger tumor size (p = 0.003 and 0.001, respectively). The 5-year follow up data was retrieved for 206 patients. The recurrence rate was about 28%. Recurrence was significantly associated with tumor size (p = 0.000). The tumor size was also significantly associated with the histologic grade (p = 0.003). Multivariate analysis showed that intracranial tumors were significantly more associated with recurrence than spinal ones (p = 0.017), and that mitotic index was significantly associated with recurrence (p = 0.002).
Conclusions: Our results were concordant with international reports. Spinal tumors showed less recurrence rate than intracranial ones, and the mitotic index and tumor size were significantly associated with a higher recurrence rate.
References
Longstreth WT Jr, Dennis LK, McGuire VM, Drangsholt MT, Koepsell TD: Epidemiology of intracranial meningioma. Cancer. 1993; 72:639–648.
Rami A, Suzan E, Rafeed A, Nooruddeen AM, Lamees A, Duaa A, Hussam AN, Amer AS: The Sovereignty of Primary Cranial Tumors–Meningiomas: Vetting the Cardinal Epidemiological Features. Medical Archives. 2018; 72:434.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P: The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97-109.
Hashiba T, Hashimoto N, Izumoto S, Suzuki T, Kagawa N, Maruno M, Kato A, Yoshimine T: Serial volumetric assessment of the natural history and growth pattern of incidentally discovered meningiomas. J Neurosurg. 2009; 110:675–684.
Menon G, Nair S, Sudhir J, Rao BR, Mathew A, Bahuleyan B: Childhood and adolescent meningiomas: a report of 38 cases and review of literature. Acta Neurochir. 2009; 151:239–244.
Al-Hadidy A, Maani W, Mahafza W, Al-Najar M, Al-Nadii, M: Intracranial meningioma. Jordan Med J. 2007; 41:37-51.
Uduma UF, Emejulu JC: Intracranial meningiomas in the present era of modern neuroimaging: diagnostic and management options, with radiological illustrations. Orient J Med. 2013; 25:67–74.
Jaggon JR, Char G: Epidemiologic Data on Meningiomas in Jamaica: The First from the Caribbean. The Internet Journal of Third World Medicine. 2007; 5.
Mattox A, Hughes B, Oleson J, Reardon D, McLendon R, Adamson C: Treatment recommendations for primary extradural meningiomas. Cancer. 2011; 117:24–38.
Perry A, Louis DN, Scheithauer BW, Budka H, von Deimling A. WHO classification of tumours of the central nervous system. In: Louis DN, Ohgaki H, Wiestler OD, cavenee WK, editors. IARC. Lyon: 2007. pp. 164–172. Meningiomas.
Riemenschneider MJ, Perry A, Reifenberger G: Histological classification and molecular genetics of meningiomas. Lancet Neurol. 2006; 5:1045–1054.
Tamimi AF, Tamimi I, Abdelaziz M, Saleh Q, Obeidat F, Al-Husseini M, Haddadin W, Tamimi F: Epidemiology of malignant and non-malignant primary brain tumors in Jordan. Neuroepidemiol. 2015; 45:100-108.
Baldi I, Engelhardt J, Bonnet C, Bauchet L, Berteaud E, Grüber A, Loiseau H: Epidemiology of meningiomas. Neurochirurgie. 2018; 64:5-14.
Champeaux C, Weller J, Katsahian, S: Epidemiology of meningiomas. A nationwide study of surgically treated tumours on French medico-administrative data. Cancer Epidemiol. 2019; 58:63-70.
Kaguri SK: Anatomical and histological spectra of intracranial meningiomas seen in KNH; a retrospecctive and prospective study (Doctoral dissertation, University of Nairobi, Kenya). 2011.
Black P, Morokoff A, Zauberman J, Claus E, Carroll R: Meningiomas: science and surgery. Clinical Neurosurg. 2007; 54:91.
Meningiomas. Their classification, regional behaviour, life history, and surgical end results. By Harvey Cushing, M.D., with the collaboration of Louise Eisenhardt, M.D. 10 × 6 3/4 in. Pp. 785 + xiv, with 685 illustrations. 1938. Springfield, Ill., and Baltimore, Md.: Charles C. Thomas. $15.00, British Journal of Surgery, Volume 26, Issue 104, April 1939, Page 957, https://doi.org/10.1002/bjs.18002610438.
Awori NW, Otsyula BK: Intracranial meningiomas as seen at KNH. M.Med.Surg.Thesis.
Korshunov A, Shishkina L, Golanov A: Immunohistochemical analysis of p16INK4a, p14ARF, p18INK4c, p21CIP1, p27KIP1 and p73 expression in 271 meningiomas correlation with tumor grade and clinical outcome. Int J Cancer. 2003; 104:728-734.
Maier H, Ofner D, Hittmair A, Kitz K, Budka H: Classic, atypical, and anaplastic meningioma: three histopathological subtypes of clinical relevance. J Neurosurg. 1992; 77:616-623.
Perry A, Stafford SL, Scheithauer BW, Suman VJ, Lohse CM: Meningioma grading: an analysis of histologic parameters. Am J Surg Pathol. 1997; 21:1455-1465.
Olar A, Wani KM, Sulman EP, Mansouri A, Zadeh G, Wilson CD, DeMonte F, Fuller GN, Aldape KD: Mitotic index is an independent predictor of recurrence-free survival in meningioma. Brain Pathol. 2015; 25:266-275.
Kwon SM, Kim JH, Kim YH, Hong SH, Cho YH, Kim CJ, Nam SJ: Clinical Implications of the Mitotic Index as a Predictive Factor for Malignant Transformation of Atypical Meningiomas. J Korean Neurosurg Soc. 2022; 65:297-306.
Vranic A, Popovic M, Cör A, Prestor B, Pizem J: Mitotic count, brain invasion, and location are independent predictors of recurrence-free survival in primary atypical and malignant meningiomas: a study of 86 patients. Neurosurgery. 2010; 67:1124-1132.
Lee KD, DePowell JJ, Air EL, Dwivedi AK, Kendler A, McPherson CM: Atypical meningiomas: is postoperative radiotherapy indicated? Neurosurg Focus. 2013; 35:E15.
Miller DC: Predicting recurrence of intracranial meningiomas: A multivariate clinicopathologic model—Interim report of the New York University Medical Center Meningioma Project. Neurosurg Clin N Am. 1994; 5:193-200.
Ong T, Bharatha A, Alsufayan R, Das S, Lin AW: MRI predictors for brain invasion in meningiomas. Neuroradiol J. 2021; 34:3-7.
Ildan F, Erman T, Göçer AI, Tuna M, Bag᷃datog᷃lu H, Cetinalp E, Burgut R: Predicting the probability of meningioma recurrence in the preoperative and early postoperative period: a multivariate analysis in the midterm follow-up. Skull Base. 2007; 17:157-171.
Nakasu S, Nakasu Y, Nakajima M, Matsuda M, Handa J: Preoperative identification of meningiomas that are highly likely to recur. J Neurosurg. 1999; 90:455-462.
McCarthy BJ, Davis FG, Freels S, Surawicz TS, Damek DM, Grutsch J, Mench HR, Laws Jr ER: Factors associated with survival in patients with meningioma. J Neurosurg. 1998; 88:831-839.
Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL: Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg. 1985; 62:18–24.
King AT, Sharr MM, Gullan RW, Bartlett JR: Spinal meningiomas: a 20-year review. Br J Neurosurg. 1998; 12:521–526.
Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, Pluchino F: Spinal meningiomas: review of 174 operated cases. Neurosurg. 1989; 25:153–160.
Levy WJ Jr, Bay J, Dohn D: Spinal cord meningioma. J Neurosurg. 1982; 57:804–812.
Klekamp J, Samii M: Surgical results for spinal meningiomas. Surg Neurol. 1999; 52:552–562.
Maiti TK, Bir SC, Patra DP, Kalakoti P, Guthikonda B, Nanda A: Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome. Neurosurg Focus. 2016; 41:E6.
Perry A: Meningiomas, in McLendon RE, Rosenblum MK, Bigner DD. ( eds): Russel and Rubinstein's Pathology of Tumors of the Nervous System, ed 7 London, Hodder Arnold, 2006, pp 427– 474.
Korhonen K, Salminen T, Raitanen J, Auvinen A, Isola J, Haapasalo HJ: Female predominance in meningiomas cannot be explained by differences in progesterone, estrogen, or androgen receptor expression. Neurooncol. 2006; 80:1– 7.
Behling F, Fodi C, Skardelly M, Paulsen F, Tabatabai G, Honegger J, Tatagiba M, Schittenhelm J: The prognostic role of the immunohistochemical expression of S100 in meningiomas. J Cancer Res Clin Oncol. 2023; 149:2975-2985.
