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Intraorbital meningiomas: a pathologic review using current World Health Organization criteria
Deepali Jain1, Katayoon B Ebrahimi, Neil R Miller
1Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Context:
Meningiomas represent approximately 4% of all intraorbital tumors and can arise from the optic nerve or extend into the orbit from adjacent structures.
Objective:
To examine a cohort of intraorbital meningiomas and use the current World Health Organization (WHO) scheme to assess the effect of changes to the classification of tumors at this site.
Design:
The histopathology and clinical findings of intraorbital meningiomas resected between 1968 and 2008 at our institution were reviewed according to the WHO 2007 classification scheme.
Results:
A total of 51 intraorbital meningiomas were reviewed. The mean age at presentation was 45 years, but 5 tumors arose in children. Two patients were known to have neurofibromatosis type 2, and 1 had inherited retinoblastoma. Orbital meningiomas were more frequently encountered in women (30 cases) than in men (21 cases). In 21 patients, the tumor was associated with the optic nerve. The most common (25 of 51 tumors; 49%) histopathologic subtype was meningothelial. Most (47 of 51; 92%) of the tumors were WHO grade I. Four tumors (8%) were WHO grade II, with 4 or more mitotic figures per 10 high-power fields, brain invasion, chordoid histology, or a combination of these features.
Conclusions:
Intraorbital meningiomas were most frequently of the meningothelial or transitional subtypes and were WHO grade I. One relatively common intracranial subtype, fibrous meningioma, was not encountered. The percentage of WHO grade II tumors in the orbit (8%) is similar to that reported for intracranial tumors using the current grading scheme.
Insights
Intraorbital meningiomas are typically WHO grade I, most commonly meningothelial subtypes. A small percentage (8%) were WHO grade II, similar to intracranial tumors.
Area of Science:
- Ophthalmology
- Neurology
- Oncology
Background:
- Intraorbital meningiomas constitute about 4% of orbital tumors.
- These tumors can originate from the optic nerve or adjacent structures.
Purpose of the Study:
- To analyze a cohort of intraorbital meningiomas.
- To evaluate the impact of the World Health Organization (WHO) classification updates on these tumors.
Main Methods:
- Review of histopathology and clinical data for 51 intraorbital meningiomas.
- Tumors were classified using the WHO 2007 scheme.
Main Results:
- The most common subtype was meningothelial (49%).
- The majority (92%) were WHO grade I.
- 8% were WHO grade II, exhibiting features like high mitotic rates or brain invasion.
Conclusions:
- Intraorbital meningiomas are predominantly WHO grade I, with meningothelial and transitional subtypes being most common.
- Fibrous meningioma, a common intracranial subtype, was not observed.
- The incidence of WHO grade II tumors in the orbit mirrors that of intracranial tumors.
