Radiation-induced Meningiomas Research Articles

RADIATION-INDUCED MENINGIOMA CONCEALED BY SHUNT VALVE ARTIFACT

Ventricular shunting is a common neurosurgical procedure. Metal-containing shunt components can cause artifacts on magnetic resonance imaging (MRI), obscuring visualization of the surrounding tissue. We present the case of a radiation-induced meningioma growing around a ventricular catheter that was not noted at an early stage as a result of artifact from an overlying shunt. We present the case of a 27-year-old survivor of a childhood medulloblastoma who required ventriculoperitoneal shunting as a consequence of her treatment. As a result of radiation-induced meningiomas that developed in adolescence, the patient was screened biennially via contrasted MRI. Her most recent imaging revealed a new meningioma at the edge of the MRI artifact associated with the shunt valve. A contrasted computed tomographic scan demonstrated a large meningioma with mass effect on the surrounding brain. Complete surgical resection of the meningioma was obtained. The ventricular catheter was preserved and the shunt valve replaced with a newer system that is reported to generate less magnetic artifact. Artifact from shunt valves or other implanted metallic devices obscures the surrounding tissues on MRI. Patients with significant artifact who are at higher risk for development of intracranial pathology may benefit from periodic imaging through alternate modalities that are not susceptible to magnetic artifact.

Orbital Meningioma After Cranial Radiation for Acute Lymphocytic Leukemia

Purpose: To describe the ophthalmic findings of cranial radiation-induced orbital meningioma after acute lymphocytic leukemia therapy. Methods: This is a prospective clinical report. Results: We describe two patients recently evaluated with orbital meningiomas many years after cranial radiation for acute lymphocytic leukemia. Conclusions: There will probably be more of these cases in the next several years. Unlike primary meningiomas, these neoplasms have a tendency to be more diffuse, multiple, and may undergo malignant degeneration.

Meningiomas in Children

Objective: Pediatric meningioma is a rare diagnosis. This retrospective review seeks to elucidate pertinent characteristics of pediatric patients presenting with meningioma. Methods: The Seattle Children’s Hospital and Regional Medical Center brain tumor database was surveyed from 1940 through 2004. Twenty patients were identified. Results: The median age of the 20 patients was 13 years. Five patients had radiation-induced meningiomas. Five patients had neurofibromatosis type 2. Ten patients had spontaneously arising meningiomas, 2 of which were malignant. Conclusion: Patients with spontaneously arising meningiomas were younger than those with identified risk factors. There was no recurrence in patients with radiation-induced meningiomas. The only death occurred in a patient with a malignant meningioma.

MOLECULAR GENETICS OF MENINGIOMAS

To review our current understanding of the molecular pathogenesis of meningiomas, to suggest topics for future investigations, and to present perspectives for clinical application. Significant progress has been made in recent years in delineating the molecular mechanisms involved in meningioma formation, growth, and malignant progression. However, many questions remain unanswered. Mutations in the NF2 gene probably account for the formation of more than half of all meningiomas. On the other hand, the molecular events underlying the initiation of meningiomas without NF2 mutations have yet to be identified. Investigating hereditary conditions associated with an increased meningioma incidence and the mechanisms underlying the development of radiation-induced meningiomas could potentially yield relevant insights. Meningioma growth is sustained by the dysregulated expression of steroid hormones, growth factors, their receptors, and activation of signal transduction cascades. The underlying genetic causes are unknown. Malignant progression of meningiomas probably involves the inactivation of tumor suppressor genes on chromosomes 1p, 9p, 10q, and 14q. However, with the possible exception of INK4A/INK4B, the actual targets of these chromosomal losses have remained largely elusive. Cell cycle dysregulation and telomerase activation have been recognized as important steps in meningioma progression. Telomere dynamics, cell cycle control, and the mechanisms responsible for deoxyribonucleic acid damage control are tightly interwoven. Investigating genes involved in the maintenance of genomic integrity might significantly deepen the understanding of meningioma progression. An area that has received relatively little attention thus far is the genetic background of meningioma spread and invasion. Possible clinical applications of the molecular data available may include a meningioma grading system based on genetic alterations, as well as therapeutic strategies for refractory meningiomas aimed at interfering with signal transduction pathways.

Cytogenetic and Molecular gene array analyses of radiation-induced meningiomas

Cytogenetic and Molecular gene array analyses of radiation-induced meningiomas

Multistaged Surgical Strategy Combined Frontotemporal Approach with Transnasal Approach Using Endscopy: A Case of Radiation-Induced Meningioma

Background: Suprasellar or sphenoid ridge meningioma often invade cavernous sinus, internal carotid artery, and extracranial regions such as the paranasal sinus. Of course the principle for treatment of meningioma is complete resection, but we are rarely able to remove tumors perfectly by the frontotemporal approach alone because of the neurovascular anatomical complexity of this area. We consider that combining a frontotemporal approach with the transnasal approach gives us an expanded capability to treat these tumors.

Multistaged Surgical Strategy Combined Frontotemporal Approach with Transnasal Approach Using Endscopy: A Case of Radiation-Induced Meningioma

Multistaged Surgical Strategy Combined Frontotemporal Approach with Transnasal Approach Using Endscopy: A Case of Radiation-Induced Meningioma

Meningeoma pós-radioterapia

Meningiomas are neoplasms derived from arachnoid cells with their origin linked to idiopathic genetic abnormalities (deletion of the long arm of chromosome 22), predisposing diseases and radiotherapy induction. We report the case of a 50 years-old man radiation-induced meningioma 20 years after the diagnosis, surgical and radiation treatment of an oligodendroglioma. The supporting diagnostic criteria of radiation-induced meningiomas are discussed and the pertinent literature of the theme is revised.

High-dose radiation-induced meningioma in children. Case report and critical review of the literature

Object High-dose radiation-induced meningiomas in children are a rare occurrence. We discuss the clinical data and the differences of these rare tumors from those of spontaneous counterpart and radiation-induced meningiomas of the adult population. Case report We report a case of meningothelial meningioma, which occurred in a 9-year-old boy who underwent radiotherapy for a parieto-occipital cutaneous angioma. In addition, we collected 18 cases of high-dose radiation-induced meningiomas in children from a literature review with Medline. Results Radiation-induced meningiomas in children show a female predominance, a short latency period that seems to be related to the age at irradiation, and an aggressive behaviour. Conclusion Exposure to the potentially carcinogenic effects of radiotherapy should be reserved only for tumors that demonstrate subsequent progression. A meticulous follow-up of patients treated with radiation therapy is mandatory.

Radiation-Induced Meningiomas: Clinical, Pathological, Cytokinetic, and Cytogenetic Characteristics

Radiation-Induced Meningiomas: Clinical, Pathological, Cytokinetic, and Cytogenetic Characteristics

Intracranial Meningiomas in Children: Report of 27 New Cases and Critical Analysis of 440 Cases Reported in the Literature

We accumulated 440 cases of intracranial meningiomas in patients under 16 years of age, and another 27 personal. This review confirms the existence of specific clinical features of spontaneous and radiation-induced meningioma in children. In addition, we discuss various points that suggest a more aggressive behavior of meningiomas in children than in adults. (J Child Neurol 2006;21:31-36).

Radiation induced meningioma with a short latent period following high dose cranial irradiation – Case report and literature review

Radiation induced meningiomas (RIM) are rare late complications in patients who have received high dose irradiation for brain tumors. The mean latency period for induction of RIM in most of the series is 18.7+/-10.2 years. There are only 9 reported cases of RIM following high dose cranial irradiation with unusually short latency periods of less than 5 years. Herein, we report a child diagnosed with RIM with an unusually short latency period of 14 months. An 11-year old male child underwent gross total resection of medulloblastoma. Following surgery he received high dose craniospinal irradiation. Postoperative computed tomography scan (CT scan) after 1 month did not show features of any residual tumor, recurrence or tumor at a new site. The child was asymptomatic for 14 months and then presented with complaints of headache and vomiting. CT scan head showed multiple solid homogenously enhancing lesions in bilateral basifrontal and right basitemporal region. Histopathology of the lesions turned out to be atypical meningioma.

Molecular genetics of meningiomas

In this article the authors provide a brief description of the current understanding of meningioma genetics. Chromosome 22 abnormalities, especially in the Neurofibromatosis Type 2 (NF2) gene, have been associated with meningioma development. Loss of heterozygosity of chromosome 22 occurs in approximately 60% of meningiomas; however, loss of NF2 gene function occurs in only one third of these lesions. This discrepancy supports the theory that a second tumor suppressor gene exists on chromosome 22, and the authors introduce several possible gene candidates, including BAM22, LARGE, INI1, and MN1 genes. Deletions of 1p have also been shown to correlate with meningioma progression. The genetic similarities and differences among sporadic, NF2-associated, pediatric, and radiation-induced meningiomas are discussed, with the observation that the nonsporadic meningiomas have a higher incidence of multiple chromosomal abnormalities at presentation. Ultimately, a better understanding of the molecular pathways of meningioma tumorigenesis will lead to new, successful treatments.

Meningiomas after medulloblastoma irradiation treatment in a patient with basal cell nevus syndrome

A 23-year-old woman with basal cell nevus syndrome (BCNS), or Gorlin's syndrome, was given the diagnosis at age 2 years of a medulloblastoma that was resected and treated postoperatively with craniospinal irradiation. Multiple basal cell carcinomas developed at the craniospinal irradiation port site 8 years later. She subsequently developed multiple meningiomas within the area of irradiation at age 20 years. This case reviews early presentation of BCNS, newly described differences between medulloblastomas in patients with BCNS and nonsyndromic medulloblastomas, and global assessment of patients by the treating dermatologist of this patient population. This is the first report in the dermatologic literature, to our knowledge, of radiation-induced meningiomas in a patient with BCNS.

Growth Retardation and Bilateral Cataracts Followed by Anaplastic Meningioma 23 Years after High-Dose Cranial and Whole-Body Irradiation for Acute Lymphoblastic Leukemia: Case Report and Review of the Literature

We report a case of meningioma diagnosed 23 years after high-dose cranial and whole-body irradiation for the treatment of acute lymphocytic leukemia (ALL). Radiotherapy in this case also caused early radiation injury to the lenses and the pituitary gland, with growth retardation and mineralizing angiopathy. Radiation-induced meningiomas are more commonly malignant, more commonly multiple, and more likely to recur after resection than non-radiation-induced meningiomas. Survivors of childhood ALL treated with high-dose cranial irradiation are at risk both for early radiation injury in radiosensitive organs, such as the lens and pituitary gland, and for the later development of a radiation-induced meningioma.

Gamma knife radiosurgery of radiation-induced intracranial tumors: Local control, outcomes, and complications

To determine local control (LC) and complication rates for patients who underwent radiosurgery for radiation-induced intracranial tumors. Review of a prospectively maintained database (2,714 patients) identified 16 patients (20 tumors) with radiation-induced tumors treated with radiosurgery between 1990 and 2004. Tumor types included typical meningioma (n=17), atypical meningioma (n=2), and schwannoma (n=1). Median patient age at radiosurgery was 47.5 years (range, 27-70 years). The median tumor margin dose was 16 Gy (range, 12-20 Gy). Median follow-up was 40.2 months (range, 10.8-146.2 months). Time-to-event outcomes were calculated with Kaplan-Meier estimates. Three-year and 5-year LC rates were 100%. Three-year and 5-year overall survival rates were 92% and 80%, respectively. Cause-specific survival rates at 3 and 5 years were 100%. Three patients died: 1 had in-field progression 65.1 months after radiosurgery and later died of the tumor, 1 died of progression of a preexisting brain malignancy, and 1 died of an unrelated cause. One patient had increased seizure activity that correlated with development of edema seen on neuroimaging. LC, survival, and complication rates in our series are comparable to those in previous reports of radiosurgery for intracranial meningiomas. Also, LC rates with radiosurgery are at least comparable to those of surgical series for radiation-induced meningiomas. Radiosurgery is a safe and effective treatment option for radiation-induced intracranial tumors, most of which are typical meningiomas.

High-Dose Radiation-Induced Meningioma in Children

High-dose radiation-induced meningiomas in children are a rare occurrence. We discuss the clinical data and the differences of these rare tumors from those of spontaneous counterpart and radiation-induced meningiomas of the adult population. We report a case of meningothelial meningioma, which occurred in a 9-year-old boy who underwent radiotherapy for a parieto-occipital cutaneous angioma. In addition, we collected 18 cases of high-dose radiation-induced meningiomas in children from a literature review with Medline. Radiation-induced meningiomas in children show a female predominance, a short latency period that seems to be related to the age at irradiation, and an aggressive behaviour. Exposure to the potentially carcinogenic effects of radiotherapy should be reserved only for tumors that demonstrate subsequent progression. A meticulous follow-up of patients treated with radiation therapy is mandatory.

Meningiomas after radiation-therapy for benign astrocytomas

A 4.5 year-old-girl was submitted to subtotal removal of a benign astrocytoma of the left temporal lobe with basal ganglia extension and given radiotherapy. At age 27, she was found to harbor a right posterior frontal meningioma that was totally removed. A recurrence of the right convexity meningioma was again excised after a 4-year interval. The authors report this case to illustrate the possibility of the appearance of radiation-induced meningiomas after an interval of 22 years and briefly discuss 16 previous reports on this occurrence in benign astrocytomas.

Radiation-induced meningiomas: clinical, pathological, cytokinetic, and cytogenetic characteristics.

Radiation-induced meningiomas are known to occur after high- and low-dose cranial radiation therapy. The goal of this study was to discern the distinguishing findings and characteristics of radiation-induced meningiomas. The records of 16 patients (seven men and nine women) who fulfilled the criteria for radiation-induced meningiomas were retrospectively reviewed. Clinical, histopathological, cytokinetic, and cytogenetic findings as well as the patients' outcome were analyzed. The mean age of the patients was 38.8 years and the mean tumor latency was 26.5 years. Five patients had multiple meningiomas in the irradiated field. The recurrence rate was 100% after the initial resection; 62% of patients had a second recurrence and 17% had a third recurrence. Thirty-eight percent of patients had atypical or malignant histopathological findings. The presence of progesterone receptors and low proliferation indices in these patients did not correlate with benign tumor behavior. Cytogenetic analysis showed multiple clonal aberrations in all tumors studied. The most frequent aberrations were found on chromosomes 1p, 6q, and 22. Derivative, lost, or additional chromosome 1p was found in 89% of cases and loss or deletion on chromosome 6 was found in 67%. The age of patients at presentation with meningioma and the latency period of radiation-induced meningiomas are dose related. These tumors are more aggressive and are certain to recur, have a higher histopathological grade, and are associated with complex cytogenetic aberrations particularly involving 1p and 6q.

High dose radiation induced meningioma

Radiation therapy has played an important integral part in the management of various intracranial tumours. However, radiation has been implicated in the development of intracranial tumours. We describe three cases of radiation-induced meningiomas following high dose cranial irradiation. All these patients developed tumours within the previous radiation field and satisfied the criteria used for the definition of radiation-induced neoplasm. The interval between the irradiation and the onset of meningioma was significantly less in the younger patient. All the cases had several unique features of radiation-induced meningioma including features of atypical meningioma. Two patients developed multiple site meningiomas and one patient developed early recurrence of the tumour. This report confirms that patients exposed to cranial irradiation are at lifelong risk of developing radiation-induced tumours such as meningiomas. Hence these patients require long-term clinical and radiological surveillance to detect occurrence as early as possible.