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Cell kinetics of the malignant evolution of meningothelial meningioma
T Iwaki1, I Takeshita, M Fukui
1Department of Neuropathology, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
Abstract:
A meningotheliomatous meningioma occurred in the right parietal parasagittal region of a 43-year-old woman. A total excision was carried out. Three years and 9 months later, one parasagittal and two falx tumors in close proximity recurred and were excised. The falx tumors showed the features of an anaplastic transitional meningioma with increased mitoses. The falx meningioma recurred locally and repeatedly, despite radiation therapy and chemoimmunotherapy. She died 7 years and 8 months after the onset. At autopsy, the tumor was found to have metastasized via the cerebrospinal fluid to the spinal cord and pituitary stalk. Extracranial metastases were not evident. At the fourth craniotomy, bromodeoxyuridine (BrdU) was administered intravenously to label tumor cells in the S phase of the cell cycle. The BrdU-labeled cells accounted for 9.0%; they are usually less than 1% in benign meningiomas. Meningothelial meningiomas with a high labeling index recur rapidly, even after Simpson's grade 2 removal, and treatment for a malignant meningioma should be instituted.
Insights
A rare aggressive meningioma recurred and spread through cerebrospinal fluid. High cell proliferation, indicated by bromodeoxyuridine labeling, predicts rapid growth and suggests malignant meningioma treatment is needed.
Area of Science:
- Neuro-oncology
- Pathology
Background:
- Meningiomas are typically benign tumors arising from the meninges.
- Meningotheliomatous meningioma is a subtype that can occasionally exhibit aggressive behavior.
Observation:
- A 43-year-old woman developed a meningotheliomatous meningioma in the right parietal region.
- Tumor recurrence occurred 3 years and 9 months post-excision, with anaplastic features and increased mitoses in falx tumors.
- The recurrent tumor showed widespread metastasis via cerebrospinal fluid to the spinal cord and pituitary stalk.
Findings:
- Bromodeoxyuridine (BrdU) labeling revealed 9.0% of tumor cells in the S phase, significantly higher than the <1% typically seen in benign meningiomas.
- High BrdU labeling index correlates with rapid tumor recurrence and aggressive behavior.
- Despite surgical removal and adjuvant therapies, the anaplastic meningioma exhibited local and widespread dissemination.
Implications:
- Meningothelial meningiomas with a high proliferation index warrant aggressive management, similar to malignant meningiomas.
- Early identification of high-risk features like elevated BrdU labeling is crucial for treatment planning.
- This case highlights the potential for meningiomas, even initially classified as benign, to develop aggressive and metastatic characteristics.