Recurrent Anaplastic Meningioma Research Articles

Fluorescence and immune-cell infiltration of nonneoplastic, postbrachytherapy brain tissue in 5-ALA-guided resection of recurrent anaplastic meningioma: illustrative case.

5-Aminolevulinic acid (5-ALA) fluorescence-guided surgery is a well-established technique for resecting high-grade gliomas. However, its application in meningiomas, especially those previously treated with radiation therapy, remains under investigation. A 48-year-old female with recurrent anaplastic meningioma, World Health Organization grade 3, underwent a right-sided craniotomy using off-label 5-ALA as a surgical adjunct. The patient had previously undergone brachytherapy seed implantation (20 × cesium 131) for tumor management. During the surgery, a large fluorescent tumor mass adjacent to the brachytherapy-treated area was resected, and the prior brachytherapy seeds were removed. Interestingly, the surrounding brain tissue in the irradiated area showed robust 5-ALA fluorescence. Pathological examination confirmed that the fluorescent brain tissue was nonneoplastic and associated with lymphocyte and macrophage infiltration. This case report presents unique 5-ALA fluorescence in nonneoplastic tissue following brachytherapy, which was found during the resection of recurrent anaplastic meningioma. This phenomenon may reflect an intricate interplay among radiation therapy, immune cells, the tumor microenvironment, and 5-ALA metabolism. Given that false-positive findings in fluorescence-guided surgery can lead to unnecessary tissue resection and increased surgical morbidity, further research is warranted to elucidate the mechanisms underlying this phenomenon and its implications for meningioma surgery.

Recurrent Anaplastic Meningioma with Metastasis

Meningioma is the commonest primary intracranial tumor in adults, with the majority being benign. Malignant meningioma is exceedingly rare and carries a poor prognosis because of its tendency for local recurrence and distant metastasis. We present the case of a 53 years old male with anaplastic malignant meningioma, which recurred after excision and radiotherapy and later metastasised to pleura, bones and brain. Keywords: Metastatic meningioma, Anaplastic meningioma, Pleural metastasis, Intracranial tumor, Extracranial metastasis

Recurrent grade III anaplastic meningioma metastasising to the humerus: a case report

Meningiomas are usually slow growing neoplasms that follow a benign clinical course. However, atypical and anaplastic meningiomas can show more aggressive behaviour and have the potential to metastasise. The most common sites for metastases are lung, spine, soft tissue, liver and bone. Bone metastases are exceedingly rare. We report a case of a 70-year-old man with a previous history of recurrent anaplastic meningioma (WHO grade III) with a pathological fracture of the left humerus. Histopathology aided by immunohistochemistry revealed metastatic meningioma.

Survival Benefit of Prognostic Factors and Treatment in Adult Patients with Recurrent Anaplastic Meningioma: A Retrospective Case Series and Systematic Literature Review

Recurrence rates of anaplastic meningioma (AM) are high even after a complete resection with postoperative radiotherapy. This study aimed to evaluate predictors and treatment affecting survival of recurrent AM based on our series and a systematic literature review (SLR). Our single-institute (SI) data enrolled patients with first recurrent AM, treated in our hospital from 2012 to 2018. We retrieved eligible cases from SLR from 1966 to 2020. Our SI data and pooled data, integrating SI and SLR data, were subject to Cox proportional hazard regression analysis. Analysis from SI data (n= 38) showed that second recurrence-free survival (RFS) was associated with intervals (HR [hazard ratio], 0.263; P= 0.002), preoperative Karnofsky Performance Status (KPS) (HR, 0.450; P= 0.043), radiotherapy (HR, 0.395; P= 0.047), whereas overall survival(OS) was related to preoperative KPS (HR, 0.411; P= 0.037) and tumor size (HR, 3.429; P= 0.007). The pooled data (n= 60) indicated that short intervals (HR, 0.370; P= 0.002) and the use of radiotherapy (HR, 0.318; P= 0.003) improved second RFS and number of resections ≥3 (HR, 0.210; P= 0.002) and radiotherapy (HR, 0.209; P=0.002) prolonged OS. Furthermore, the overall second RFS (P= 0.024) and OS (P= 0.031) stratified by 4 treatment protocols differed significantly. Early managements of patients with AM, before presence of poor preoperative KPS and large tumor size, are critical for survival. For patients with recurrent AM, survival benefits could be obtained from radiotherapy and multiple resections.

Dosimetric comparison of Boron Neutron Capture Therapy, Proton Therapy and Volumetric Modulated Arc Therapy for Recurrent Anaplastic Meningioma

A patient with Recurrent Anaplastic Meningioma of the left temporal lobe was being planned for treatment. Using the same target volumes and organs-at-risk, we compared the treatment plans for Boron Neutron Capture Therapy, Proton Therapy and Volumetric Modulated Arc Therapy. The results showed that BNCT provides the best dosimetry amongst the three modalities.

TMOD-20. COMBINING TARGETED INHIBITOR AND RADIOTHERAPY IN TREATING ANAPLASTIC MENINGIOMA

Abstract BACKGROUND Anaplastic meningiomas pose a serious health concern due to their propensity for recurrence and brain invasion. Five-year overall survival of patients with anaplastic meningiomas is less than 10%, similar to that of glioblastoma patients. Standard treatment of recurrent anaplastic meningioma is radiotherapy (RT), but radioresistance is common. New therapeutic strategies, used singularly or in combination with RT, are urgently needed. Since deletion of the gene encoding the p16 cell cycle checkpoint protein is common in anaplastic meningioma, we hypothesized that such tumors would be sensitive to Palbociclib, a cdk4/6 inhibitor, and that Palbociclib could enhance RT efficacy. METHODS CH157 anaplastic meningioma cells were used in vitro for investigating tumor cell proliferation response to RT and Palbociclib, either alone or in combination, and as indicated by MTT assay results. CH157 cells were also used to establish intracranial xenografts in mice treated with RT or Palbociclib. Accuracy of RT dose was verified with calibrated MOSFET\OSLD dosimeters. Mice were monitored for intracranial tumor growth and response to treatment, as indicated by bioluminescence imaging. Length of survival data was collected and analyzed by log-rank test. RESULTS At two days post RT, the in vitro anti-proliferative effect of 2, 6, and 10 Gy radiation was significantly enhanced with concurrent 1mM Palbociclib (p < 0.001). Daily administration of Palbociclib (150 mg/kg) for 1 week significantly extended the survival of mice with intracranial CH157 xenografts (group mean value of 18.4 vs. 13.6 days with vehicle control, p < 0.001). A single dose of 10 Gy RT was superior to 6 Gy administered 1x and 2Gy/day administered on 5 consecutive days (group mean values of 37.4 vs. 24.0 vs. 24.6, respectively: p < 0.001). CONCLUSIONS These data support further investigation of RT + Palbociclib for treating p16-deficient anaplastic meningiomas.

An integrated genomic analysis of anaplastic meningioma identifies prognostic molecular signatures

Anaplastic meningioma is a rare and aggressive brain tumor characterised by intractable recurrences and dismal outcomes. Here, we present an integrated analysis of the whole genome, transcriptome and methylation profiles of primary and recurrent anaplastic meningioma. A key finding was the delineation of distinct molecular subgroups that were associated with diametrically opposed survival outcomes. Relative to lower grade meningiomas, anaplastic tumors harbored frequent driver mutations in SWI/SNF complex genes, which were confined to the poor prognosis subgroup. Aggressive disease was further characterised by transcriptional evidence of increased PRC2 activity, stemness and epithelial-to-mesenchymal transition. Our analyses discern biologically distinct variants of anaplastic meningioma with prognostic and therapeutic significance.

Extracranial metastases of anaplastic meningioma

Anaplastic meningioma is a World Health Organization (WHO) Class III lesion representing 2–3% of all meningiomas, with more aggressive spread, increased mortality and increased likelihood of recurrence. Metastases outside the blood–brain barrier are uncommon but can occur to the lungs, liver, bone and skin.Definitive diagnosis is obtained with pathological analysis. The World Health Organization classifies meningiomas into benign (Grade I), atypical (Grade II) and anaplastic/malignant (Grade III) based on histological findings including number of mitoses, cellularity, nucleus to cytoplasm etc. This case presents a 58-year-old female with history of treated anaplastic meningioma with new onset headache, nausea and vomiting. Workup demonstrated multiple new bilateral pulmonary nodules, which subsequent biopsy proved to be metastasis from recurrent anaplastic meningioma, with extensive intrathoracic involvement.

Disseminated extracranial metastatic meningioma

Meningiomas are usually low-grade, solitary lesions that rarely metastasize. In this group of central nervous system tumours, the higher grade subtypes are notorious for resistance to conventional chemo-radiation therapies. Recent studies have shown efficacy in the use of bevacizumab in patients with recurrent and, or progressive anaplastic meningioma. The authors report a case of a young patient with recurrent anaplastic meningioma who despite being treated with bevacizumab, progressed with disease dissemination to multiple extracranial sites. Although the majority of meningiomas are amendable to treatment, the higher grade subtypes remain therapeutically challenging. The unexpected resistance to anti-angiogenic therapy in this patient adds another layer of complexity to an elusive subset of a supposedly benign disease. This patient report reflects the need for in-depth studies, molecular characterization and overall, better disease understanding in order to improve prognosis for affected patients.

Recurrent anaplastic meningioma treated by sunitinib based on results from quantitative proteomics

Figure S1. Immunohistochemical staining with anti-PDGFRβ and anti-phospho-PDGFR antibody. Paraffin sections were immunostained with monoclonal antibody against PDGFR (left panels) and phospho-PDGFR (right panels). The specimens were from the second surgery (upper panels) and the third surgery (lower panels). Note the selective immunostaining in meningioma cells. Scale bar = 50 μm. Table S1. Peptide sequences and selected ions for quantification of each membrane protein. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Novel chromosomal aberrations in a recurrent malignant meningioma

The molecular basis of tumorigenesis and tumor progression in meningiomas is not fully understood. Here we present results of conventional cytogenetic, fluorescence in situ hybridization (FISH), and comparative genetic hybridization (CGH) analyses in a patient with recurrent anaplastic meningioma. We found complex aberrant karyotype alterations previously described in anaplastic meningiomas, such as 1p, 14q aberration, and a possibly tetraploid karyotype. Loss of chromosome 22q was detected by conventional cytogenetic analysis. Additional chromosomal aberrations not previously reported included a near-triploid karyotype and alterations such as 4p+, 5p−, 7p+, 8q+, and gain of chromosome 19. FISH with LSI 9p21, CEP9, LSI PML/RARA, and CGH confirmed the karyotype complexity in this case. Our findings of several previously unreported cytogenetic alterations suggest that complex karyotype alterations are a characteristic feature in anaplastic meningiomas. High chromosomal complexity might be associated with a highly aggressive meningioma phenotype.

Myelin basic protein in the cerebrospinal fluid of patients with brain tumors.

We measured the level of myelin basic protein (MBP) in the cerebrospinal fluid (CSF) of patients with various kinds of tumors, including malignant tumors, using radioimmunoassay. The CSF had been obtained by lumbar puncture through an Ommaya reservoir or a shunt device placed in the lateral ventricle. The level of MBP was high (> 4 ng/ml) in the patients with meningeal dissemination of malignant tumors, but in those who showed a good response to chemotherapy and/or radiation, it decreased or returned to the normal level, with improvement on the computed tomography and magnetic resonance imaging, cytological, general CSF, and neurological findings. Of seven malignant gliomas without CSF dissemination, six showed an elevated level of MBP before selective intra-arterial chemotherapy with a combination of etoposide and cisplatin administered via a microcatheter placed at A1, M1, P1-P2, and the basilar top. All CSF specimens obtained during the period of the intra-arterial chemotherapy showed an abnormally high (> 4 ng/ml) level of MBP that exceeded the prechemotherapy level. The MBP level decreased or returned to normal in the patients with a good response to chemotherapy after intra-arterial chemotherapy. In some patients with multiple metastatic brain tumors, the MBP level was elevated before treatment and returned to normal after treatment (surgical removal, chemotherapy, and/or irradiation) in all except one. Thus, there was a clear correlation between the timing of treatment and changes in imaging studies and MBP levels.(ABSTRACT TRUNCATED AT 250 WORDS)