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Histopathologic features and MIB-1 labeling indices in recurrent and nonrecurrent meningiomas
1Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Background:
Predicting the behavior of meningiomas based on histopathologic features alone has remained problematic.
Design:
This study retrospectively compared several histopathologic features and MIB-1 labeling indices (LIs) in recurrent meningiomas with those of nonrecurrent meningiomas. Six histopathologic features, including mitoses, necrosis, loss of architectural pattern, hypervascularity/hemosiderin deposition, prominent nucleoli, and nuclear pleomorphism, were compared between 32 recurrent and 27 nonrecurrent meningiomas using Fisher exact tests. MIB-1 LIs (% positive tumor cell nuclei) were compared using the Wilcoxon rank sum test.
Results:
The patients in the recurrent group included 26 women (mean age, 55 years), who developed 1 to 5 recurrences. Time intervals to the first recurrence ranged from 5 to 183 months (mean, 55 months). The nonrecurrent group included 21 women (mean age, 56 years), with follow-up ranging from 88 to 124 months (mean, 109 months). Of the histopathologic features evaluated, statistically significant differences between the recurrent and nonrecurrent groups were found only with respect to prominent nucleoli (P =.024) and nuclear pleomorphism (P <.001), both of which were more common in the recurrent group. In the recurrent group, 9 tumors were considered malignant (defined by brain invasion or metastasis) versus 2 of the nonrecurrent meningiomas. Nineteen percent of nonrecurrent tumors versus 41% of recurrent tumors had 2 or more of the 6 histopathologic features. MIB-1 LIs in the nonrecurrent group ranged from 0 to 8.3 (mean, 1.5) and were generally lower than those in the recurrent group (range, 0-32.5; mean, 5.4); no statistical difference was identified between these groups. No statistically significant difference with regard to histology or MIB-1 LIs was noted between the initially excised recurrent tumor and the most recently resected recurrence.
Conclusions:
Of the histopathologic features examined, only prominent nucleoli and nuclear pleomorphism were found to be statistically more common in recurrent than nonrecurrent meningiomas. The mean MIB-1 LI was higher in the recurrent than in the nonrecurrent group, although there was no statistical difference between means and there was clear overlap with regard to MIB-1 LI ranges.
Insights
Predicting meningioma behavior is challenging. Prominent nucleoli and nuclear pleomorphism are key indicators of recurrence, though MIB-1 labeling indices show overlap.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Predicting meningioma behavior solely on histopathology is difficult.
- Meningiomas are tumors of the meninges, with varying grades and recurrence rates.
Purpose of the Study:
- To compare histopathologic features and MIB-1 labeling indices (LIs) in recurrent versus nonrecurrent meningiomas.
- To identify histopathologic predictors of meningioma recurrence.
Main Methods:
- Retrospective comparison of 32 recurrent and 27 nonrecurrent meningiomas.
- Evaluation of six histopathologic features and MIB-1 LIs.
- Statistical analysis using Fisher exact tests and Wilcoxon rank sum test.
Main Results:
- Prominent nucleoli (P=.024) and nuclear pleomorphism (P<.001) were significantly more common in recurrent meningiomas.
- Recurrent meningiomas showed a higher mean MIB-1 LI (5.4) compared to nonrecurrent ones (1.5), but with no statistical difference.
- Malignant features were observed in 9 recurrent and 2 nonrecurrent tumors.
Conclusions:
- Prominent nucleoli and nuclear pleomorphism are significant histopathologic indicators of meningioma recurrence.
- While mean MIB-1 LI is higher in recurrent cases, its overlap limits its predictive value.
- Histopathological assessment remains crucial for predicting meningioma behavior.