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Meningioma Prognostic Tool Based on Correlation of Histopathological Grading and Immunohistochemistry
Mahak Shafat1, Nayil Khursheed1, Nazia Walvir1
1Department of Pathology and Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India.
Objectives:
Meningiomas are slow-growing brain neoplasms classified into three grades based on morphological criteria. While these grades are simple, they do not always correlate with patient outcomes. This study aimed to evaluate the status of estrogen receptor (ER), progesterone receptor (PR), and proliferation marker Ki-67/molecular immunology borstel-1 (MIB-1) in the three grades of meningioma.
Methods:
We evaluated the data of meningioma patients who were seen in our tertiary center over 10 years-8.5 years retrospectively and 1.5 years prospectively. Their archival hematoxylin and eosin stained slides were reviewed and re-graded according to the World Health Organization 2021 criteria. Immunohistochemical analysis for ER, PR, and Ki-67 was performed on all grade 2 and grade 3 meningiomas and 30 cases of grade 1 formalin-fixed, paraffin-embedded samples.
Results:
Of the 276 cases included in the study, there were 231 (83.7%) cases of grade 1 meningioma, 34 (12.3%) cases of grade 2, and 11 (4.0%) cases of grade 3. ER was positive in 26.0% of grade 1 tumors, 5.8% of grade 2, and 0.0% of grade 3. PR was positive in 70.0% of grade 1 tumors, 20.0% of grade 2, and 18.0% of grade 3. The Ki-67/MIB-1 labeling index (LI) was 2.1 in grade 1, 6.3 in grade 2, and 13.4 in grade 3 tumors. For both PR and Ki-67, the differences between grades 1, 2, and 3 tumors were significant (p < 0.001). There was a significant inverse relationship between mean Ki-67 LI and PR status, with increasing grade of tumor.
Conclusions:
Ki-67/MIB-1 LI has significant positive correlations with meningioma grade and its recurrence, which makes it a useful auxiliary method for the routine assessment of meningiomas, especially in patients with borderline atypia. The expression of PR, on the other hand, is a positive prognostic indicator and has a substantial correlation with histological grade. In cases of subtotal resection, high proliferative/recurrence rates, and borderline histopathology, the PR status in combination with the MIB-1 LI can offer insights into the behavior and the recurrence probability of a meningioma.
Insights
Estrogen receptor (ER), progesterone receptor (PR), and Ki-67/MIB-1 levels vary significantly across meningioma grades. PR expression is a positive prognostic indicator, while Ki-67/MIB-1 correlates with tumor grade and recurrence risk.
Area of Science:
- Neuro-oncology
- Pathology
- Molecular Biology
Background:
- Meningiomas are graded I-III, but grade alone doesn't predict patient outcomes.
- Estrogen receptor (ER), progesterone receptor (PR), and Ki-67/MIB-1 are key markers in meningioma research.
- Understanding these markers' expression across grades is crucial for prognosis.
Purpose of the Study:
- To evaluate ER, PR, and Ki-67/MIB-1 status in different grades of meningioma.
- To correlate these markers with meningioma grade and potential patient outcomes.
Main Methods:
- Retrospective and prospective analysis of 276 meningioma cases over 10 years.
- Re-grading of tumors using WHO 2021 criteria.
- Immunohistochemical analysis for ER, PR, and Ki-67/MIB-1 in all grades.
Main Results:
- ER positivity decreased from grade 1 (26.0%) to grade 3 (0.0%).
- PR positivity decreased from grade 1 (70.0%) to grade 2 (5.8%), but was similar in grade 3 (18.0%).
- Ki-67/MIB-1 labeling index significantly increased with tumor grade (Grade 1: 2.1, Grade 2: 6.3, Grade 3: 13.4).
Conclusions:
- Ki-67/MIB-1 is a valuable marker for assessing meningioma grade and recurrence risk.
- PR expression is a positive prognostic indicator and correlates with histological grade.
- Combining PR status and MIB-1 LI aids in predicting meningioma behavior and recurrence probability, especially in challenging cases.
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