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Clear Cell Meningioma: A Clinicopathologic Study of a Rare Meningioma Subtype in 35 Patients
Pranay Soni1, Samuel Li2, Soumya Sagar1
1Department of Neurosurgery, Neurological Institute, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, Ohio, USA.
Objective:
Clear cell meningioma (CCM) is a rare histologic variant, accounting for only 0.2%-0.8% of all meningiomas. Given their relative infrequency, few cases have been reported. We have presented one of the largest series of patients with intracranial CCM and reported the treatments and outcomes of these patients.
Methods:
Patients with histologically proven CCM from 2003 to 2018 were identified for inclusion in the present study. Relevant clinical and radiographic data were obtained via retrospective review and analyzed. Kaplan-Meier and Cox proportional hazards analyses were used to compare overall and progression-free survival.
Results:
A total of 35 patients had undergone surgical resection for CCM, including 18 women and 17 men, with a mean age of 59.3 years. Gross total resection was achieved in 22 patients (62.9%), and 11 patients (31.4%) had received adjuvant postoperative radiotherapy. Tumors recurred in 17 patients (48.6%), with a mean time to recurrence of 31.3 months. The mean postoperative follow-up was 66.3 months. On multivariable analysis, adjuvant radiotherapy and gross total tumor resection were both independently associated with prolonged progression-free survival (P < 0.033), although not with overall survival (P >0.274).
Conclusions:
The data from the present series of 35 patients with CCM have shown distinct contrasts to previous series, with an older mean age and a nearly 1:1 male/female ratio. Although gross total resection and adjuvant postoperative radiotherapy were both independently associated with longer progression-free survival for patients with CCM, tumor recurrence has remained a challenge in the treatment of these patients.
Insights
Clear cell meningioma (CCM) treatment outcomes show gross total resection and adjuvant radiotherapy improve progression-free survival. Despite these advances, tumor recurrence remains a significant challenge for patients with this rare brain tumor.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Clear cell meningioma (CCM) is a rare histologic subtype of meningioma, representing 0.2%-0.8% of all cases.
- Limited case reports exist due to its infrequency, hindering comprehensive understanding of treatment and outcomes.
Purpose of the Study:
- To present one of the largest patient series of intracranial CCM.
- To analyze treatment modalities and patient outcomes for CCM.
Main Methods:
- Retrospective review of clinical and radiographic data from 35 patients with histologically proven CCM (2003-2018).
- Kaplan-Meier and Cox proportional hazards analyses were employed to assess overall and progression-free survival.
Main Results:
- Gross total resection (GTR) was achieved in 62.9% of patients, and 31.4% received adjuvant radiotherapy.
- Tumor recurrence was observed in 48.6% of patients, with a mean time to recurrence of 31.3 months.
- Multivariable analysis indicated GTR and adjuvant radiotherapy were independently associated with prolonged progression-free survival (P < 0.033).
Conclusions:
- This series of 35 CCM patients contrasts with prior reports, showing an older mean age and a near 1:1 male/female ratio.
- While GTR and adjuvant radiotherapy correlate with improved progression-free survival, CCM recurrence continues to be a clinical challenge.
- Further research is needed to optimize management strategies for clear cell meningioma.
