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Multiple meningiomas of different variants in a single patient: illustrative cases
Jeffrey Olson1, Deven Reddy2, Dan X Cai1
1Department of Pathology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
Background:
Meningiomas are the most common primary intracranial tumors, accounting for approximately one-third of all primary brain neoplasms, typically characterized by a single histological variant. Multiple meningiomas are a relatively rare occurrence in a single patient, particularly when exhibiting different histopathological variants.
Observations:
The authors present the cases of three patients, each with two separate intracranial meningiomas of different variants. One patient had secretory and angiomatous meningiomas, while two patients had transitional and psammomatous meningiomas.
Lessons:
Studies of multiple meningiomas, especially cases like those in this report with different subtypes, will highlight how genetic mutations correlate with tumor location, histology, and possible clonal origins. Certain mutations, such as TRAF7 and KLF4, are linked to secretory meningiomas, while others like neurofibromatosis type 2 are associated with specific locations and fibrous histology. The presence of mutually exclusive mutations suggests that different meningiomas can either arise independently or share a common progenitor cell with divergent mutations. Comparing genetic profiles of multiple meningiomas in a single patient can clarify tumor pathogenesis and support the development of targeted therapies, aiding in personalized treatment strategies and improving outcomes. https://thejns.org/doi/10.3171/CASE24359.
Insights
Multiple meningiomas with distinct histologies in single patients are rare. Studying these cases helps link genetic mutations to tumor characteristics, aiding personalized treatment for brain tumors.
Area of Science:
- Neurosurgery
- Oncology
- Genetics
Background:
- Meningiomas are the most common primary intracranial tumors, representing about one-third of all brain neoplasms.
- Multiple meningiomas in a single patient are rare, especially with differing histopathological variants.
Purpose of the Study:
- To investigate the relationship between genetic mutations, tumor location, histology, and clonal origins in rare cases of multiple meningiomas with distinct subtypes.
- To explore the potential for targeted therapies and personalized treatment strategies based on the genetic profiles of co-occurring meningiomas.
Main Methods:
- Case report of three patients, each presenting with two distinct intracranial meningiomas.
- Detailed histopathological analysis of the different meningioma subtypes within each patient.
- Review of existing literature on genetic mutations associated with specific meningioma subtypes and their implications.
Main Results:
- One patient had secretory and angiomatous meningiomas.
- Two patients had transitional and psammomatous meningiomas.
- Identified specific mutations (e.g., TRAF7, KLF4) linked to secretory meningiomas and neurofibromatosis type 2 associated with fibrous histology.
Conclusions:
- Comparing genetic profiles of multiple meningiomas clarifies tumor pathogenesis and supports targeted therapy development.
- Mutually exclusive mutations suggest independent origins or divergent evolution from a common progenitor.
- This research aids in developing personalized treatment strategies for improved patient outcomes in complex meningioma cases.
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