Adult Meningioma Research Articles

Association of methionine synthase rs1801394 and methionine synthase reductase rs1805087 polymorphisms with meningioma in adults: A meta-analysis.

Several epidemiological studies suggested that methionine synthase (MTRR) rs1801394 and methionine synthase reductase (MTR) rs1805087 polymorphisms may be involved in the risk of meningioma in adults; however, the results from different case-control studies have been inconsistent. Therefore, we performed a meta-analysis to investigate the association of MTRR and MTR polymorphisms with meningioma. PubMed, Web of Knowledge, China National Knowledge Infrastructure and Wanfang databases were searched up to October 30, 2013 and 3 publications, involving 7 case-control studies, were finally included. Following data extraction, a meta-analysis was conducted using Stata 12.0 software. The pooled results based on the fixed effects model demonstrated that the MTRR rs1801394 polymorphism was associated with an increased risk of meningioma [odds ratio (OR)=1.18, 95% confidence interval (CI): 1.05–1.32 for G vs. A; OR=1.41, 95% CI: 1.12–1.77 for GG vs. AA; OR=1.08, 95% CI: 0.94–1.33 for AG vs. AA; OR=1.19, 95% CI: 1.01–1.40 for (AG+GG) vs. AA; and OR=1.32, 95% CI: 1.07–1.63 for GG vs. (AG+AA)]; however, an association between the MTR rs1805087 polymorphism and the risk of meningioma was not identified [OR=0.99, 95% CI: 0.88–1.12 for G vs. A; OR=1.09, 95% CI: 0.80–1.48 for GG vs. AA; OR=0.95, 95% CI: 0.82–1.11 for AG vs. AA; OR=0.97, 95% CI: 0.84–1.13 for (AG+GG) vs. AA; and OR=1.09, 95% CI: 0.80–1.48 for GG vs. (AG+AA)]. Therefore, the currently available evidence suggests that the MTRR rs1801394 polymorphism may increase the risk of meningioma, whereas the MTRR rs1801394 polymorphism is not associated with meningioma.

Papillary tumor of the pineal region: Histopathological characterization and review of the literature

Background and purposeThe papillary tumor of the pineal region (PTPR) was described as a distinct new entity for the first time in 2003 by our team and has been included in the last 2007 WHO classification of tumors of the Central Nervous System. We describe the histopathological characterization of PTPR and present a review of the literature. MethodsThe description of the histological and immunological features of PTPR is based on the 2007 WHO classification. ResultsPTPR affects both children and adults, and mostly young adults in the third decade. PTPR is a neuroepithelial tumor occurring in the vicinity of the pineal gland, and characterized by its papillary architecture. The papillae are lined by multi-layered cuboidal to columnar epithelioid tumoral cells arranged in perivascular pseudorosettes. Immunohistochemistry shows strong reactivity for cytokeratins, particularly for cytokeratin 18. On electron microscopy, PTPR reveals ultrastructural features indicative of ependymal differentiation, including abundant microvilli at the apical cell pole. The differential diagnosis includes a variety of other papillary tumors, most notably papillary ependymoma, choroid plexus papilloma, papillary meningioma, and metastatic papillary carcinoma in adults. On the basis of ultrastructural and immunohistochemical features, it has been suggested that a PTPR arises from specialized cytokeratin-positive and nestin-positive ependymal cells that are derived from the subcommissural organ. Although the precise histological grading criteria of PTPR remain to be defined, its biological behavior may correspond to WHO grade II or III.

5,10-Methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MTRR), and methionine synthase reductase (MTR) gene polymorphisms and adult meningioma risk

The causes of meningiomas are not well understood. Folate metabolism gene polymorphisms have been shown to be associated with various human cancers. It is still controversial and ambiguous between the functional polymorphisms of folate metabolism genes 5,10-methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MTRR), and methionine synthase reductase (MTR) and risk of adult meningioma. A population-based case–control study involving 600 meningioma patients (World Health Organization [WHO] Grade I, 391 cases; WHO Grade II, 167 cases; WHO Grade III, 42 cases) and 600 controls was done for the MTHFR C677T and A1298C, MTRR A66G, and MTR A2756G variants in Chinese Han population. The folate metabolism gene polymorphisms were determined by using a polymerase chain reaction–restriction fragment length polymorphism assay. Meningioma cases had a significantly lower frequency of MTHFR 677 TT genotype [odds ratio (OR) = 0.49, 95 % confidence interval (CI) 0.33–0.74; P = 0.001] and T allele (OR = 0.80, 95 % CI 0.67–0.95; P = 0.01) than controls. A significant association between risk of meningioma and MTRR 66 GG (OR = 1.41, 95 % CI 1.02–1.96; P = 0.04) was also observed. When stratifying by the WHO grade of meningioma, no association was found. Our study suggested that MTHFR C677T and MTRR A66G variants may affect the risk of adult meningioma in Chinese Han population.

The effect of weight in the outcomes of meningioma patients.

Background:Meningiomas are more prevalent in women and mostly benign in nature. Our aim was to evaluate the association of weight and outcomes of meningioma patients undergoing craniotomy.Methods:A retrospective analysis of meningioma patients discharged postcraniotomy between 1998 and 2007 was conducted. Univariate and multivariate analysis evaluated in-hospital mortality, complications, length of stay (LOS), and cost.Results:According to the nationwide inpatient sample (NIS) database, an estimated 72,257 adult meningioma patients underwent a craniotomy in US hospitals during the study period. Female and male weight loss rates were 0.7% and 1.2%, respectively; obesity rates were 5.2% and 3.7%. Males had higher rates of malignant tumors than females (6.2% vs. 3.5%, P < 0.0001), and malignant tumors were more common in patients with weight loss (6.4% vs. 4.3%, P = 0.03). Weight loss was associated with higher mortality in men (OR 6.66, P < 0.0001) and women (OR 3.92, P = 0.04) as well as higher rates of postoperative complications in both men (OR 6.13, P < 0.0001) and women (OR 8.37, P < 0.0001). Furthermore, patients suffering weight loss had longer LOS and higher overall hospital cost when compared with all patients. In contrast, obesity seemed to reduce mortality (OR 0.47, P = 0.0006) and complications (OR 0.8, P = 0.0007) among women.Conclusions:In summary, weight loss seems to be the single most critical factor present in patients experiencing higher mortality, complications, hospital charges, and longer LOS. However, further studies aimed to assess the inter-relation of potential preexisting comorbidities and weight loss are needed to establish causation.

Urinary tract infections in meningioma patients: analysis of risk factors and outcomes

Urinary tract infections (UTIs) account for about 35% of all nosocomial infections and 75% are associated with the use of urethral catheters. The goal of this study was to evaluate preoperative factors associated with the risk of UTI and to estimate the impact of UTIs on patient outcome and resource utilization. Adult meningioma patients treated with craniotomy in US hospitals between 2002 and 2007 were queried from the Nationwide Inpatient Sample (NIS) database. Univariate and multivariate analyses that correct for sample survey design data were used to study the association of perioperative UTIs and outcomes. In all, 46,344 patients were included. Women comprised the majority (70.0%), had lower mortality (1.2% vs 2.0%), shorter in-hospital stay (6.7 vs 7.5 days), lower hospital charges (US$76,682 vs 87,220) and higher UTI rates (6.3% vs 3.9%) than men. In multivariate analysis, female gender (odds ratio: 2.2; P<0.0001), older age (1.4; P<0.001), emergency room admissions (1.8; P<0.0001), total length of stay (1.08; P<0.0001), comorbidity score (1.04; P=0.0147), postoperative fluid abnormalities (1.96; P<0.0001) and pulmonary complications (1.3; P<0.0011) were associated with UTI. UTI was associated with an additional 2.3 days of hospital stay and an incremental US$18,920 in hospital charges. Perioperative UTIs are associated with specific comorbidities and postoperative complications. They significantly increase in-hospital length of stay and costs. Our data emphasize the need to support national efforts that are underway to reduce hospital-acquired UTIs within the neurosurgical population.

Occupational exposure to chlorinated solvents and risks of glioma and meningioma in adults

ObjectivesChlorinated solvents are classified as probable or possible carcinogens. It is unknown whether exposure to these agents increases the risk of malignant or benign brain tumours. Our objective was to...

The relationship between urinary bisphenol A levels and meningioma in Chinese adults

Estrogen has been implicated as a risk factor for meningioma. Bisphenol A (BPA), a widely used synthetic xenoestrogen, has already been reported to be associated with several estrogen-sensitive tumors. An exploratory association study of 243 meningioma cases and 258 frequency-matched healthy controls was conducted, using subjects from a hospital-based study to demonstrate the association of urine BPA concentration and the risk of meningioma. The specimens and data of patients were collected at Union Hospital, Wuhan, China, from 2009 to 2010. A positive association between increasing levels of urinary BPA and meningioma was observed, independent of confounding factors such as gender, age, race, body mass index, HRT use, BMI, and family history of cancer. Compared to quartile 1 (referent), the multivariate-adjusted odds ratio of meningioma associated with quartile 4 was 1.45 (95 % CI, 1.02-1.98) (P trend = 0.03). In this case-control study from China, a clear association between urinary BPA concentrations and diagnosis of meningioma was detected.

Pediatric meningioma: current approaches and future direction

With improvement in leukemia therapy, central nervous system (CNS) tumors are the leading cause of cancer mortality in children and the most expensive of all human neoplasms to treat. Meningiomas are rare intracranial tumors in childhood and adolescence arising from arachnoid cell clonal outgrowth in the meninges. There have been no collaborative prospective therapeutic trials for pediatric meningioma because of its rarity, and the best evidence for management comes from retrospective case analyses and extrapolation from the treatment of adult meningioma. However this may not be ideal, because the underlying biology of adult and pediatric meningiomas seems to be different, as is the case for other CNS tumors. In addition, treatment of pediatric brain tumors requires consideration of long-term quality of life. This review reflects on what is currently known about pediatric meningiomas and opportunities for future directions.

Intracranial meningioma in children: Different from adult forms? A series of 21 cases

Objective Intracranial meningiomas are very rare in children, comprising only 0.4 to 4.1% of pediatric tumors and only 1.5 to 1.8% to all intracranial meningiomas. The goal of this study of pediatric meningiomas was to establish their epidemiological profile as well as their clinical and radiological features, to assess the long-term outcome, and compare this result with adult meningioma. Patient and methods We conducted a retrospective study from June 1983 to June 2007; during this period 521 patients underwent surgery for primary meningioma at the Rabat Hospital, Department of Neurosurgery. Twenty-one patients were under 16 years of age (4%). The clinical charts and imaging data were reviewed. Results The mean age was 10.3 years (range: 2 to 16 years), with 13 boys and eight girls. In one patient a neurofibromatosis was associated. The mean delay to diagnosis was 4.6 months (range: 1 to 12 months). The most common clinical sign was raised intracranial pressure (90%). Of the meningiomas diagnosed, 47% were convexity meningiomas while 24% were parasagittal and 19% were skull-base meningiomas; in two cases (9.5%) the location was intraventricular. The mean tumor diameter was 6.6 cm (range: 3 to 10 cm). A large cystic component was found in 24% of the cases. Surgery achieved a Simpson grade I resection in 47%; 62% of the tumors were grade I and 24% were grade II based on World Health Organization pathological classification. The mean follow-up period was 33 months (range: 6 to 120 months). The recurrence rate was 33%. Conclusion Pediatric meningiomas are larger than those found in the adult population; there is a male predominance with high incidence of a cystic component and high-grade meningiomas, thus explaining the increased recurrence rate despite the multimodal treatment.

DNA repair gene polymorphisms and risk of adult meningioma, glioma, and acoustic neuroma

Although the etiology of primary brain tumors is largely unknown, prior studies suggest that DNA repair polymorphisms may influence risk of glioma. Altered DNA repair is also likely to affect the risk of meningioma and acoustic neuroma, but these tumors have not been well studied. We estimated the risk of glioma (n = 362), meningioma (n = 134), and acoustic neuroma (n = 69) in non-Hispanic whites with respect to 36 single nucleotide polymorphisms from 26 genes involved in DNA repair in a hospital-based, case-control study conducted by the National Cancer Institute. We observed significantly increased risk of meningioma with the T variant of GLTSCR1 rs1035938 (OR(CT/TT) = 3.5; 95% confidence interval: 1.8-6.9; P(trend) .0006), which persisted after controlling for multiple comparisons (P = .019). Significantly increased meningioma risk was also observed for the minor allele variants of ERCC4 rs1800067 (P(trend) .01); MUTYH rs3219466 (P(trend) .02), and PCNA rs25406 (P(trend) .03). The NBN rs1805794 minor allele variant was associated with decreased meningioma risk (P(trend) .006). Risk of acoustic neuroma was increased for the ERCC2 rs1799793 (P(trend) .03) and ERCC5 rs17655 (P(trend) .05) variants and decreased for the PARP1 rs1136410 (P(trend) .03). Decreased glioma risk was observed with the XRCC1 rs1799782 variant (P(trend) .04). Our results suggest that common DNA repair variants may affect the risk of adult brain tumors, especially meningioma.

Posterior Cranial Fossa Tumors in Young Adults

This retrospective study presents our experience on the posterior cranial fossa tumors in young adults during the past 15 years. From 1991 to 2005, 16 (0.8%) of 2,091 young adults (range, 16-29 years) with dizziness/vertigo, hearing loss, or tinnitus were diagnosed with posterior fossa tumor. Each patient underwent a battery of audiovestibular tests and image study. Audiometry revealed sensorineural hearing loss in 12 patients (75%). Spontaneous nystagmus was disclosed in eight patients (50%), consisting of bilateral gaze nystagmus in five, unilateral gaze nystagmus in two, and downbeat nystagmus in one. Electronystagmographic examination displayed abnormal eye tracking test in 75% and abnormal optokinetic nystagmus test in 81% of cases. Magnetic resonance imaging scan demonstrated space-occupying lesions at the cerebellopontine angle in 11, cerebellum in two, brainstem in two, and jugular fossa in one. Diagnoses consisted of vestibular schwannoma and neurofibromatosis II in eight patients (50%), glial neoplasm (including astrocytoma, ependymoma, glioma) in four patients (25%), epidermoid cyst in three patients, and glomus jugulare tumor in one patient. At study close, excluding one lost patient, three patients died as a result of recurrent or residual tumor at the primary site. Restated, 12 of 15 (80%) patients were alive. Unlike predominant medulloblastoma in children, the most frequent posterior fossa tumor in young adults is vestibular schwannoma and neurofibroma. However, the second most frequent one in young adults is glial neoplasm as opposed to meningioma in adults.

Méningiome de l'enfant : un nouveau cas sans attache durale

We report a new case of aggressive meningioma without dural attachment occurring in a three-year-old girl. We emphasize the rarity of meningiomas in children and the absence of the female predominance associated whit meningioma in adults and we describe their pathological and radiological features.

Predisposing conditions and risk factors for development of symptomatic meningioma in adults

Background: Risk factors and predisposing factors for the development of symptomatic meningioma during adult life are not well known. Methods: Data from 306 consecutive patients with primary meningioma were collected retrospectively in a hypothesis-generating study. Factors studied included localisation of tumours, blood group typing, and risk factors, such as diabetes mellitus, coronary arterial disease, hypertension, rheumatoid arthritis, bronchial asthma, smoking, obesity, and second primary tumour. Case-control analysis of putative risk factors was carried out using a control data set from the German East–West Health Survey ( n = 7466, age range 25–69 years). Patients and controls were matched for age, gender, geographic area, and time of data collection. Results: Rh(D) positive cases were significantly less frequent in the patient group compared to controls ( p = 0.01). Pre-existing diabetes was associated with meningioma in middle-aged (40–69 years) patients (odds ratio, OR 13.94–4.30, p = 0.001–0.05). In female patients, arterial hypertension was significantly associated with occurrence of meningioma in the age group 60–69 years (OR = 2.23, p = 0.041). Rheumatoid arthritis had a negative association with meningioma in both males and females in the age groups above 50 years (OR 0.19–0.27, p = 0.02–0.034). Bronchial asthma, smoking, and obesity were not significantly associated with meningioma. A second primary tumour was present in 12 cases. The most frequent combination was meningioma and breast cancer (5/12). Conclusions: This study shows statistically significant association of some co-morbidities with symptomatic meningioma in adults. Areas of interest have been identified where further research would be necessary.

Meningioma and schwannoma risk in adults in relation to family history of cancer

Relatively little is known about factors that contribute to the development of meningioma and vestibular schwannoma, two intracranial nervous system tumors. We evaluated the risk of these tumors in relation to family history of malignant or benign tumors. Incident cases of meningioma (n = 197) or schwannoma (n = 96) were identified at three U. S. referral hospitals between June 1994 and August 1998. Controls (n = 799) admitted to the same hospitals for nonmalignant conditions were matched to cases on age, sex, race/ethnicity, hospital, and proximity of residence to hospital. We found that risk of meningioma was increased among persons reporting a family history of a benign brain tumor (odds ratio [OR], 4.5; 95% confidence interval [CI], 1.0-21.0; n = 5) or melanoma (OR, 4.2; 95% CI, 1.2-15.0; n 5). A family history of breast cancer was associated with an elevated meningioma risk among participants aged 18 to 49 years (OR, 3.9; 95% CI, 1.4-11.0; n = 8) but a reduced risk among older respondents (OR, 0.2; 95% CI, 0.1-0.7; n = 3). Family history of cancer did not differ between schwannoma cases and controls, although the statistical power to detect associations was limited. Some relative risk estimates were based on a small number of observations and may have arisen by chance. Inheritance of predisposing genes, shared environmental factors, or both within families with a history of benign brain tumors, melanoma, or possibly breast cancer may be related to altered meningioma risk.

Stereotactic radiosurgery provides equivalent tumor control to Simpson Grade 1 resection for patients with small- to medium-size meningiomas

Purpose: To compare tumor control rates after surgical resection or stereotactic radiosurgery for patients with small- to medium-size intracranial meningiomas. Methods and materials: Between 1990 and 1997, 198 adult meningioma patients treated at our center underwent either surgical resection ( n = 136) or radiosurgery ( n = 62) as primary management for benign meningiomas <35 mm in average diameter. Tumor recurrence or progression rates were calculated by the Kaplan-Meier method according to an independent radiographic review. The mean follow-up was 64 months. Results: The tumor resections were Simpson Grade 1 in 57 (42%), Grade 2 in 57 (42%), and Grade 3–4 in 22 (16%). The mean margin and maximal radiation dose at radiosurgery was 17.7 Gy and 34.9 Gy, respectively. Tumor recurrence/progression was more frequent in the surgical resection group (12%) than in the radiosurgical group (2%; p = 0.04). No statistically significant difference was detected in the 3- and 7-year actuarial progression-free survival (PFS) rate between patients with Simpson Grade 1 resections (100% and 96%, respectively) and patients who underwent radiosurgery (100% and 95%, respectively; p = 0.94). Radiosurgery provided a higher PFS rate compared with patients with Simpson Grade 2 (3- and 7-year PFS rate, 91% and 82%, respectively; p <0.05) and Grade 3–4 (3- and 7-year PFS rate, 68% and 34%, respectively; p <0.001) resections. Subsequent tumor treatments were more common after surgical resection (15% vs. 3%, p = 0.02). Complications occurred in 10% of patients after radiosurgery compared with 22% of patients after surgical resection ( p = 0.06). Conclusion: The PFS rate after radiosurgery was equivalent to that after resection of a Simpson Grade 1 tumor and was superior to Grade 2 and 3-4 resections in our study. If long-term follow-up confirms the high tumor control rate and low morbidity of radiosurgery, this technique will likely become the preferred treatment for most patients with small- to moderate-size meningiomas without symptomatic mass effect.

Risk factors for meningioma in adults: a case-control study in northeast China.

A hospital case-control study of meningioma was conducted in Heilongjiang Province in northeast China between September 1989 and December 1996. It included 183 cases of newly diagnosed primary meningioma and 366 individually matched hospital controls with non-neoplastic and non-neurological disease selected from six major hospitals. Cases and controls were matched by sex, age and area of residence and interviewed in the hospital wards to obtain information on medical history, occupation and lifestyle. No association with liquor or beer consumption was apparent. Cigarette smoking was positively associated with meningioma risk in women but not in men. In women, compared with non-smokers, the adjusted OR for pack-years of smoking above the median (124) was 6.2 (CI 2.04-18.87). Both of these observations contrast with the results of a study of glioma in the same population, using similar methods. The risk of meningioma was positively associated with reported occupational exposure to lead, tin, cadmium and ionising radiation in both genders.

Risk factors for meningioma in adults: A case‐control study in northeast China

A hospital case-control study of meningioma was conducted in Heilongjiang Province in northeast China between September 1989 and December 1996. It included 183 cases of newly diagnosed primary meningioma and 366 individually matched hospital controls with non-neoplastic and non-neurological disease selected from six major hospitals. Cases and controls were matched by sex, age and area of residence and interviewed in the hospital wards to obtain information on medical history, occupation and lifestyle. No association with liquor or beer consumption was apparent. Cigarette smoking was positively associated with meningioma risk in women but not in men. In women, compared with non-smokers, the adjusted OR for pack-years of smoking above the median (124) was 6.2 (CI 2.04–18.87). Both of these observations contrast with the results of a study of glioma in the same population, using similar methods. The risk of meningioma was positively associated with reported occupational exposure to lead, tin, cadmium and ionising radiation in both genders. Int. J. Cancer 83:299–304, 1999. © 1999 Wiley-Liss, Inc.