Aggressive meningeal tumors: review of a series

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✓ A series of 25 patients with aggressive meningeal tumors was studied to determine the efficacy of various management options. The median age of the patients was 52 years, with a range of 13 to 73 years. A marked male preponderance (64%) was noted. Twenty of 25 patients experienced recurrence during a median follow-up time of 47 months. Survival and freedom from recurrence varied with histological diagnosis. Recurrence was noted sooner in patients who had received partial resections on first presentation of tumor than in those who had received total resections at first presentation. Survival time was also shorter for patients who underwent partial resections at first presentation than for patients who underwent total resections.

Patients' prognoses did not improve as a result of either chemotherapy or radiotherapy. Of six patients with extracranial metastases, the median time to metastasis was 102 months, with a 5-year metastasis-free rate of 85%. The most common sites of metastasis in these six patients were lung and bone. In each tumor type, histological features used in diagnosis and radiological features studied from computerized tomography and magnetic resonance imaging were evaluated, compared, and discussed. Of eight patients studied with an in vivo bromodeoxyuridine (BUdR) labeling index (LI), seven showed an LI of 1% or more. The authors support the incorporation of the BUdR LI into the diagnostic process to provide a better estimate of the potential for tumor recurrence.

Article Information

Address reprint requests to: Raymond Sawaya, M.D., Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe, Box 064, Houston, Texas 77027.

© AANS, except where prohibited by US copyright law.

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Figures

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    Event chart showing histories of all patients in the series. Lines that end without a † indicate that the patient was alive at last follow-up review. Note the histological progressions of tumors in Cases 9, 15, 16, and 24; metastases (Mets) in Cases 1, 2, 6, 8, 15, and 17; and malignancies (Malig) in Cases 15, 16, and 24. In Case 23, treatment did not begin until more than 1 year after tumor was first noted. The bromodeoxyuridine labeling index (LI) (when available) is printed on the line just to the right of the respective presentations. The * indicates that Case 16 had an LI = 5.8% at first presentation.

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    Left: Photomicrograph of an atypical meningioma with aggressive features, showing sheeting growth pattern. Many nuclei show prominent nucleoli (arrows). Right: Photomicrograph of an atypical meningioma with aggressive histological features showing peripheral area of high cellularity. In the center there is some preservation of poorly formed whorls (arrows) and many nuclei with prominent nucleoli (arrowheads). H & E, original magnification, × 250.

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    Photomicrographs illustrating histological features of three types of lesions. H & E. Left: Malignant meningioma showing invasion of brain (arrows) and areas of tumor necrosis (N). Mitotic activity cannot be seen at this low magnification. Original magnification, × 125. Center: Meningeal sarcoma showing highly cellular spindle areas with interlacing fascicles of neoplastic cells. Mitotic figures are abundant (arrows). No residual meningioma-like areas are present. Original magnification, × 500. Right: Hemangiopericytoma of meninges showing prominent gaping vascular channels (V) surrounded by small bland tumor cells. The histological growth pattern shows no whorls or other features of meningioma. Original magnification, × 500.

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    Case 19. Axial postcontrast T1-weighted magnetic resonance image of a malignant meningioma revealing dural-based enhancement with indistinct margins and fingerlike extensions into the cerebral parenchyma.

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    Case 4. Coronal T1-weighted magnetic resonance image revealing a massive lesion of the right hemisphere. The neoplasm has numerous large flow voids in its deeper and lateral aspects, no brain edema, and a superomedial contrast-enhancing nodule. Pathological diagnosis was a hemangiopericytoma.

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    Case 24. Postcontrast infusion axial computerized tomography scan of this malignant meningioma revealing the tomographic finding known as “mushrooming.” There is a contrast-enhancing tumor seen along most of the right cerebral convexity.

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    Case 5. Skull x-ray film revealing a well-demarcated focal area of osteolysis. An underlying malignant meningioma was removed at surgery.

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    Diagrams showing follow-up studies of a series of 25 patients with aggressive meningeal tumors. A: Patient survival by tumor groups (p = 0.056). B: Freedom from recurrence by tumor groups (p = 0.061). C: Survival for all patients by degree of initial surgical resection (p = 0.095). D: Freedom from recurrence by degree of initial surgical resection (p = 0.029). E: Survival according to whether radiotherapy (XRT) was received (p = 0.21). F: Freedom from recurrence according to whether XRT was received (p = 0.65).

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