Chordoid meningiomas: Incidence and clinicopathological features of a case series over 18 years

Abstract

Chordoid meningioma (CM) is a rare subtype of meningioma, classified as grade II, which exhibits a high rate of recurrence following subtotal resection. We retrospectively examined nine cases of chordoid meningioma over a case series of 1743 meningiomas (0.52%) operated upon at our institution from 1995 to 2013. All the reported clinicopathological findings were analyzed. Two hundred and twenty-one CM cases have been published to date worldwide and few single-center large case series have been issued. Seventy-five percent of the cases that underwent subtotal resection at our institution had recurrence within 1 year. Total resection of the tumor should be the major objective of surgery to reduce the possibility of tumor recurrence. The percentage of chordoid features within the tumor specimen could assist in predicting the pathogenesis of the lesion. The correlation of the index of proliferation to recurrence rate is still controversial. Much debate exists with regard to the role of adjuvant radiotherapy in CM cases. Immunohistochemical, cytological and ultrastructural studies should be used in combination to assure a correct diagnosis of CM. Owing to the rare occurrence of this meningioma subtype, larger case series are required to assist in providing a reference for diagnosis and to improve the therapeutic management of CM.

Predictors of recurrence in the management of chordoid meningioma

“…However, differences were not statistically significant. [7] While some case studies have advocated for the role of RT [9, 15, 25, 26], our multivariate analysis did not demonstrate a benefit with adjuvant RT. The rarity of this entity has limited the accumulation of experience in the literature, and larger prospective studies will be needed to further delineate the role of RT, including timing and modality.…”

“…Six patients died shortly following surgery from postoperative complications from initial tumor resection. [6-9] Nine patients died from progression of disease and continued recurrence. [2, 7, 8, 10-15] The remaining 3 patients died from causes unrelated to disease.…”

“…Adjuvant RT for atypical meningiomas has mainly been utilized in the management of residual disease following subtotal resection[9, 21-23]. Given the increased rates of tumor recurrence compared to benign meningiomas, some authors have advocated the use of postoperative RT regardless of EOR to minimize risk of recurrence.…”

“…Presently, the role of RT should depend on factors including extent of resection, MIB-1 proliferation, and both patient and physician preference. [9, 27]…”

“…[7] Di Ieva et al reported a mean MIB-LI of 2.3% in 9 patients, with a range of 0.6-6.5%, and found no correlation with recurrence. [9] Recently, Jee et al reported a mean MIB in 11.56% in 16 patients, ranging from 1-26.6%, without correlation to clinical outcomes. [12] Our data reflect the high variability reported in literature, with a mean MIB-LI of 4.4 and a wide range of 0.1-26.6%.…”