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Histopathological features to define atypical meningioma: What does really matter for prognosis?

Valeria Barresi1, Simona Lionti2, Samuel Caliri2

  • 1Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva "G. Barresi", AOU Policlinico G. Martino, Pad D, University of Messina, Via Consolare Valeria, 98125, Messina, Italy. vbarresi@unime.it.

Brain Tumor Pathology
|April 20, 2018
PubMed

Insights

Atypical meningiomas with only minor atypical features have low recurrence risk. Brain invasion and high mitotic index with sheeting are key predictors of recurrence, aiding in identifying high-risk cases for adjuvant treatment.

Area of Science:

  • Neurosurgery
  • Pathology
  • Oncology

Background:

  • Atypical meningiomas exhibit heterogeneous behavior, leading to controversial post-surgical treatment strategies.
  • Current diagnostic criteria include minor atypical features, high mitotic index, and brain invasion.

Purpose of the Study:

  • To investigate the predictive ability of histopathological features for atypical meningioma recurrence risk.
  • To identify specific features that can guide adjuvant treatment decisions.

Main Methods:

  • Retrospective analysis of histopathological features in atypical meningiomas.
  • Correlation of features such as brain invasion, mitotic index, and sheeting with disease-free survival (DFS).

Main Results:

  • Meningiomas classified as atypical solely on minor criteria demonstrated a low recurrence risk.
  • Brain invasion, high mitotic index, and sheeting were significantly associated with shorter DFS.
  • Brain invasion and the combination of sheeting and high mitotic index were highly effective in identifying recurrent meningiomas (90.9% sensitivity, 86.7% specificity).

Conclusions:

  • Reconsideration of classifying meningiomas as atypical based only on minor criteria is suggested.
  • Brain invasion and the co-occurrence of sheeting and high mitotic count can identify high-risk atypical meningiomas.
  • Adjuvant treatments may benefit patients identified as high-risk based on these histopathological features.
Keywords:
Atypical meningiomaBrain invasionGradingMitotic indexSheeting

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