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[Atypical, aplastic, and unusual meningiomas. Morphology and incidence in 300 consecutive cases]
A M Buccoliero1, A Caldarella, A Taddei
1Dipartimento di Patologia Umana e Oncologia Università di Firenze, Viale G. B. Morgagni 85, 50134 Firenze. gl.taddei@unifi.it
Abstract:
We morphologically studied 300 consecutive and primitive meningiomas surgically treated between march 1997 and april 2002 in order to evaluate the incidence of atypical, anaplastic, and morphologically unusual meningiomas. Two hundred and fifty-five meningiomas (85%) were WHO I, 33 (11%) were WHO II, 9 (3%) were WHO III; the remaining 3 meningiomas (1%) showed clear and diffuse oncocytic differentiation without cytologic or architectural atypia (oncocytic meningiomas). Forty-five of 255 WHO I meningiomas (18%) were infrequent histological subtypes: 18 (7%) psammomatous, 9 (4%) metaplastic, 9 (4%) secretory, 6 (2%) angiomatous, and 3 (1%) microcystic. Thirty of 33 WHO II meningiomas (91%) were atypical, 2 (6%) were clear cell meningiomas, and 1 (3%) was chordoid meningioma. Seven of 9 WHO III meningiomas (78%) were anaplastic and 2 (22%) were papillary. We evidenced the high morphological variability and the discrete occurrence of WHO I and WHO II meningiomas.
Insights
This study analyzed 300 meningiomas, finding significant morphological variability. While most were benign (WHO I), a notable percentage included atypical (WHO II) and anaplastic (WHO III) tumors, highlighting diagnostic challenges.
Area of Science:
- Neuropathology
- Surgical Oncology
Context:
- Meningiomas represent a diverse group of primary central nervous system tumors.
- Accurate histological classification is crucial for patient management and prognosis.
- Understanding morphological variations aids in differentiating benign from malignant subtypes.
Purpose:
- To investigate the incidence of atypical, anaplastic, and morphologically unusual meningiomas.
- To evaluate the morphological spectrum of meningiomas within a consecutive surgical series.
- To correlate histological subtypes with World Health Organization (WHO) grading.
Summary:
- Analysis of 300 meningiomas revealed 85% were WHO Grade I, 11% WHO Grade II, and 3% WHO Grade III.
- Eighteen percent of WHO Grade I meningiomas presented as infrequent subtypes (psammomatous, metaplastic, secretory, angiomatous, microcystic).
- WHO Grade II meningiomas were predominantly atypical (91%), while WHO Grade III tumors were mostly anaplastic (78%).
Impact:
- Highlights the significant morphological variability within meningioma classifications.
- Underscores the importance of detailed histopathological examination for accurate grading.
- Provides data on the prevalence of rare and aggressive meningioma subtypes, informing clinical practice.