Prognostic Significance of Proliferative Indices in Meningiomas

Dw, Hsu; Fs, Pardo; Jt, Efird; Rm, Linggood; Hedley‐Whyte, E. Tessa

doi:10.1097/00005072-199405000-00005

Cited by 67 publications

(41 citation statements)

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“…The cases that were immunoreactive tended to be strongly reactive, but only in a few nuclei. The overall proliferation index was unrelated to prognosis and therefore does not seem valuable in the workup of ear and temporal bone meningiomas (67)(68)(69).…”

Section: Discussionmentioning

confidence: 94%

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

et al. 2003

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"Primary" ear and temporal bone meningiomas are tumors that are frequently misdiagnosed and unrecognized, resulting in inappropriate clinical management. To date, a large clinicopathologic study of meningiomas in this anatomic site has not been reported. Thirty-six cases of ear and temporal bone meningiomas diagnosed between 1970 and 1996 were retrieved from our files. Histologic features were reviewed, immunohistochemical analysis was performed (n ‫؍‬ 19), and patient follow-up was obtained (n ‫؍‬ 35). The patients included 24 females and 12 males, aged 10 -80 years (mean, 49.6 years), with female patients presenting at an older age (mean, 52.0 years) than male patients (mean, 44.8 years). Patients presented clinically with hearing changes (n ‫؍‬ 20), otitis (n ‫؍‬ 7), pain (n ‫؍‬ 5), and/or dizziness/vertigo (n ‫؍‬ 3). Symptoms were present for an average of 24.6 months. The tumors affected the middle ear (n ‫؍‬ 25), external auditory canal (n ‫؍‬ 4), or a combination of temporal bone and middle ear (n ‫؍‬ 7). The tumors ranged in size from 0.5 to 4.5 cm in greatest dimension (mean, 1.2 cm). Radiographic studies demonstrated a central nervous system connection in 2 patients. Histologically, the tumors demonstrated features similar to those of intracranial meningiomas, including meningothelial (n ‫؍‬ 33), psammomatous (n ‫؍‬ 2), and atypical (n ‫؍‬ 1). An associated cholesteatoma was identified in 9 cases. Immunohistochemical studies confirmed the diagnosis of meningioma with positive reactions for epithelial membrane antigen (79%) and vimentin (100%). The differential diagnosis includes paraganglioma, schwannoma, carcinoma, melanoma, and middle ear adenoma. Surgical excision was used in all patients. Ten patients developed a recurrence from 5 months to 2 years later. Five patients died with recurrent disease (mean, 3.5 years), and the remaining 30 patients were alive (n ‫؍‬ 25, mean: 19.0 years) or had died (n ‫؍‬ 5, mean: 9.5 years) of unrelated causes without evidence of disease. We conclude that extracranial ear and temporal bone meningiomas are rare tumors histologically similar to their intracranial counterparts. They behave as slow-growing neoplasms with a good overall prognosis (raw 5-y survival, 83%). Extent of surgical excision is probably the most important factor in determining outlook because recurrences develop in 28% of cases.

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Section: Discussionmentioning

confidence: 94%

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

et al. 2003

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“…38 In line with our mRNA findings, immunohistochemical studies documented an increase in the fraction of PCNA and mitosinpositive tumor cells with advancing WHO grade of meningiomas. 39,40 …”

Section: Increased Expression Of Proliferation-associated Genes In Atmentioning

confidence: 99%

Microarray‐based gene expression profiling of benign, atypical and anaplastic meningiomas identifies novel genes associated with meningioma progression

Wrobel

Roerig

Kokocinski

et al. 2004

Intl Journal of Cancer

130

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To identify gene expression profiles associated with human meningiomas of different World Health Organization (WHO) malignancy grades, we analyzed 30 tumors (13 benign meningiomas, WHO grade I; 12 atypical meningiomas, WHO grade II; 5 anaplastic meningiomas, WHO grade III) for the expression of 2,600 genes using cDNA-microarray technology. Receiver operator curve (ROC) analysis with a cutoff value of 45% selection probability identified 37 genes with decreased and 27 genes with increased expression in atypical and anaplastic meningiomas, compared to benign meningiomas. Supervised classification of the tumors did not reveal specific expression patterns representative of each WHO grade. However, anaplastic meningiomas could be distinguished from benign meningiomas by differential expression of a distinct set of genes, including several ones associated with cell cycle regulation and proliferation. Investigation of potential correlations between microarray expression data and genomic aberrations, detected by comparative genomic hybridization (CGH), demonstrated that losses on chromosomes 10 and 14 were associated with distinct expression profiles, including increased expression of several genes related to the insulin-like growth factor (IGF) (IGF2, IGFBP3 and AKT3) or wingless (WNT) (CTNNB1, CDK5R1, ENC1 and CCND1) pathways. Taken together, our microarray-based expression profiling revealed interesting novel candidate genes and pathways that may contribute to meningioma progression.

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“…[2,4,6,9,12,13,[15][16][17]23,24,26,34,39,41] Particular problems in this context are the meningiomas with limited signs of histological anaplasia, termed "atypical" and recently introduced into the WHO classification. This category is intended to constitute an intermediate group between benign and malignant meningiomas, with a supposedly intermediate prognosis.…”

Section: Prognosis and Histology: The Problem Of Atypical Meningiomasmentioning

confidence: 99%

“…A review of the literature indicates that the atypical meningioma group is still poorly defined and that we are still far from being able to assess a priori the real prognostic influence of limited histological atypia in individual cases. [2,4,6,9,12,13,16,17,23,24,26,34,39,41] In considering the problem of the influence of malignant histological features on meningioma recurrences, many authors have failed to differentiate atypical from anaplastic (malignant) forms or have grouped them together to analyze histological elements common to both. [4,9,11,13,17,25,26,38] Zülch and Mennel [41] formulated the four-step grading scheme for meningiomas later adopted as the WHO classification, but grouped Grade II and III tumors together, stating that the prognostic significance of differentiating the two subgroups did not seem to be sufficiently established.…”

Section: Prognosis and Histology: The Problem Of Atypical Meningiomasmentioning

confidence: 99%

“…In particular, the clinical behavior of atypical meningiomas, regarded as less severe than malignant tumors and intermediate between benign and malignant forms, must still be precisely defined by further clinicopathological studies. [2,6,12,[14][15][16]23,24,39,41] Moreover, the prognostic influence of radical surgery on outcome has not been discussed as thoroughly for atypical and malignant meningiomas [2,5,16,24,30,34,39] as for benign meningiomas. [1,14,25,27,31,33] The radicality of surgical excision, in turn, depends mainly on the meningioma site and was graded objectively by Simpson [33] in his well-known paper, in which he pointed out that total removal was sometimes only subjectively assessed by the surgeon and that this gave rise to reports of a 9% recurrence rate after so-called "complete excision" of benign meningiomas.…”

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confidence: 99%

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Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases

Palma¹,

Celli²,

Franco³

et al. 1997

FOC

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To contribute to a better understanding of the prognostic differences between atypical and malignant meningiomas as defined by the World Health Organization (WHO) and the influence of the grade of initial surgical excision on postoperative course, 42 cases of atypical and 29 of malignant meningioma were studied, along with long-term follow up. The two groups were compared with respect to long-term survival, recurrence-free survival, and median time to recurrence. The prognostic significance of the Simpson grade of surgical resection and tumor location was also considered. Survival at 5 and 10 years was recorded in 95% and 79%, respectively, of patients with atypical meningioma and in 64.3% and 34.5% of patients with malignant meningioma (p = 0.001). Recurrence-free survival and median time to recurrence were also significantly longer in patients with atypical than in those with malignant meningiomas: 11.9 versus 2 years (p = 0.001) and 5 versus 2 years (p < 0.0041), respectively. Six (26%) of the 23 recurring atypical meningiomas became malignant. Simpson Grade I resection and location in the cerebral convexity, which were closely related, were found to be associated with a significantly better clinical course in the entire series (p ¾ 0.0016). Patients with atypical meningiomas fared better than those with malignant meningiomas after incomplete surgical excision (Simpson Grades II-III), but the difference was not statistically significant. Multivariate analysis using the Cox model indicated that radical extirpation (Simpson Grade I vs. II-III) and histological findings (atypical meningioma vs. malignant meningioma) were significantly related to prolonged survival (p < 0.0003 and p < 0.0388, respectively). In conclusion, the current study shows that for most patients with atypical meningioma the prognosis was less severe than for those with malignant meningioma, but the risk of a downhill course resulting from malignancy after incomplete resection and recurrence was not negligible (26%). In addition, the WHO classification was found to be inadequate for a minority of the atypical meningioma cases, which currently have the same unfavorable course as cases of malignant meningioma. The results also indicate that objective Simpson Grade I extirpation of convexity meningiomas can be successful despite histological findings of malignancy.

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Prognostic Significance of Proliferative Indices in Meningiomas

Cited by 67 publications

References 0 publications

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

Primary Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

Microarray‐based gene expression profiling of benign, atypical and anaplastic meningiomas identifies novel genes associated with meningioma progression

Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases

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