Clinicopathological features, imaging characteristics and surgical management in a novel tumour entity - aggressive meningiomas

 

G. Popescu (1,2), Francesca Paslaru (1), A.C. Paslaru (3,4), M. Apostol (1), M.C. Zaharia (1), T. Corneliu (3,5), M. Mitrica (6), M. Popescu (7), R.M. Gorgan (1,3)

 

1. 4th Neurosurgical Department, “Bagdasar Arseni” Clinical Emergency Hospital, Bucharest, ROMANIA
2. PhD Student, “Carol Davila” University of Medicine and Pharmacy, Bucharest, ROMANIA
3. “Carol Davila” University of Medicine and Pharmacy, Bucharest, ROMANIA
4. Department of Genetics,“Dr. Victor Gomoiu” Children’s Clinical Hospital, Bucharest, ROMANIA
5. Department of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, Bucharest, ROMANIA
6. Department of Neurosurgery, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, ROMANIA
7. Department of Neurosurgery, Pitesti Emergency Hospital, University of Pitesti, ROMANIA

 

ABSTRACT: Meningiomas are common neoplasms of the central nervous system, comprising between 24 and 30% of primary intracranial tumors, most commonly affecting females in their middle age or later adult life [1] [2].
Meningiomas are classified as benign, atypical or anaplastic meningiomas depending mostly on histopathological criteria known to be associated with worse prognosis in terms of tumor progression, recurrence risk after surgery and overall survival. The 2016 edition of World Health Organization (WHO) classification of Central Nervous System (CNS) tumors recognizes brain invasion as an independent criterion for diagnosing an atypical grade II meningioma [3]. Meningioma grading based on the WHO classification of CNS tumors thoroughly impacts therapeutic management and tumor prognosis.
Aggressive meningiomas, a different phenotype of tumors, characterized by rapid growth and involvement of adjacent brain tissue, blood vessels and bone, was not previously listed as an independent entity in the WHO classification of meningothelial-cell tumors.
Regarding the increasing importance of tumor grading in meningioma treatment strategies, the authors here provide an overview of clinicopathological and radiographic features, surgical management and long-term prognosis of this novel meningothelial tumor entity, the aggressive meningioma. In particular, we aimed to describe pre-, intra- and postoperative methods for recognizing aggressive meningiomas and explore the implications of this diagnosis on both surgical strategies and adjuvant therapy.

Keywords: aggressive meningiomas, clinicopathological features, imaging characteristics, surgical management

 

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Imaging characteristics, histopathological features and surgical considerations regarding aggressive meningiomas. Case series and review of the literature

 

G. Popescu (1,2), Francesca Paslaru (1), A.C. Paslaru (3,4), M. Apostol (1), M.C. Zaharia (1), T. Corneliu (3,5), M. Mitrica (6), M. Popescu (7), R.M. Gorgan (1,3)

 
1. 4th Neurosurgical Department, “Bagdasar Arseni” Clinical Emergency Hospital, Bucharest, ROMANIA
2. PhD Student, “Carol Davila” University of Medicine and Pharmacy, Bucharest, ROMANIA
3. “Carol Davila” University of Medicine and Pharmacy, Bucharest, ROMANIA
4. Department of Genetics,“Dr. Victor Gomoiu” Children’s Clinical Hospital, Bucharest, ROMANIA
5. Department of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, Bucharest, ROMANIA
6. Department of Neurosurgery, "Dr. Carol Davila" Central Military Emergency Hospital, Bucharest, ROMANIA
7. Department of Neurosurgery, Pitesti Emergency Hospital, University of Pitesti, ROMANIA

 

ABSTRACT: Meningiomas are tumors of the meninges that arise primarily from arachnoidal cap cells, but they can also occur rarely as primary tumors in other localizations, such as within the ventricles. They stand for 24-30% of primary intracranial tumors and affect mostly women in their middle age or later adult life [1, 2]. Meningiomas can be classified, according to World Health Organization (WHO) classification of Central Nervous System (CNS) tumors, as benign (grade I, most frequently encountered type), atypical (grade II) or anaplastic (grade III), based mostly on histopathological criteria known to be associated with tumor progression, recurrence risk and survival. Since meningioma grading based on the WHO classification is the most important factor determining therapeutic management and tumor prognosis, there has been an increasing interest in adding new criteria for better characterization of these tumors. Thus, the 2016 edition of WHO classification recognized brain invasion as an independent criterion for atypical (grade II) meningioma diagnosis [3]. However, meningiomas that display aggressive features such as rapid growth and higher recurrence rate, can also involve blood vessels and bone. Hence, the authors aim to describe a different entity, aggressive meningiomas, not previously listed as a tumor phenotype in the WHO classification of meningothelial-cell tumors, with regard to pre-, intra- and postoperative methods for diagnosis and explore the implications on surgical strategies and adjuvant therapy.

Keywords: aggressive meningiomas, clinicopathological features, imaging characteristics, surgical management

 

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