Pathology and genetics of meningiomas

This article constitutes a mini-review of the pathology and genetics of meningiomas. Meningiomas are the most common primary intracranial tumors. They are usually durally based and are often found adjacent to venous sinuses and dural infoldings. The majority of these tumors are WHO grade I, although a minority is WHO grade II, atypical, or WHO grade III, anaplastic. Grade II and III meningiomas show a greater tendency than Grade I tumors to recur and metastasize. The current WHO scheme recognizes 15 histologic subtypes of meningiomas. Nine of these are WHO grade I, three are grade II, and three are grade III. In addition to these histologic subtypes, meningiomas can also be graded on the basis of mitotic activity, evidence of brain invasion, growth pattern cellular density, nuclear atypia, and necrosis. Loss of the long arm of chromosome 22, which is usually associated with inactivation of the NF2 gene, is the most common genetic abnormality found in meningiomas. Other chromosomal abnormalities associated with tumorogenesis and increased gradeof meningiomas include loss of heterozygosity for chromosome 1p, loss of 14q, deletion of 9p21, abnormalities of chromosome 10 and 17q. Telomerase activity increases with meningiomas grade as well. The only proven environmental risk factor for meningiomas is ionizing radiation. Radiation-induced meningiomas are more often multiple and have higher recurrence rates than standard meningiomas.