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{{Meningioma}}
{{Meningioma}}
{{CMG}} {{AE}}{{HL}}
{{CMG}} {{AE}} {{IO}} {{HL}}
==Overview==
==Overview==
Meningioma arises from the [[arachnoid]] "cap" cells, which are normally involved in the protection of the [[central nervous system]] by forming a thick envelope of meninges around the [[brain]] and [[spinal cord]].<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref><ref name="C">Meningioma. Canadian Cancer Society http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/meningioma/?region=mb September, 25th 2015</ref><ref name="radio">Meningeoma. Radiopaedia(2015)http://radiopaedia.org/articles/meningioma Accessed on September, 25th 2015</ref> The majority of meningiomas are [[benign]].<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref><ref name="C">Meningioma. Canadian Cancer Society http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/meningioma/?region=mb September, 25th 2015</ref><ref name="radio">Meningeoma. Radiopaedia(2015)http://radiopaedia.org/articles/meningioma Accessed on September, 25th 2015</ref> Development of meningioma is the result of multiple genetic mutations.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref> On gross pathology, a gray, well-circumscribed, dome-shaped mass is a characteristic finding of meningioma.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref> On microscopic [[histopathological]] analysis, whorled appearance, [[calcification]], and [[psammoma]] bodies are characteristic findings of meningioma.<ref name="liber">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview accessed on September, 25th 2015</ref>
Meningioma arises from the [[arachnoid]] "cap" cells, which are normally involved in the protection of the [[central nervous system]] by forming a thick envelope of [[meninges]] around the [[brain]] and [[spinal cord]]. The majority of meningiomas are [[benign]]. They can be found anywhere in the [[central nervous system]] but are most commonly seen in the parasagittal, convexity and turbeculum sellae areas. There may be [[genetic mutations]] involved in the development of a meningioma, some of the [[Gene|genes]] involved includes [[NF2 gene|NF2]], [[MEG3]], [[NDRG2]], and [[SMARCE1]]. [[Multiple endocrine neoplasia type 1|Multiple endocrine neoplasia 1]], [[cowden syndrome]], [[werner syndrome]] and [[Neurofibromatosis type II|neurofibromatosis 2]] are some of the conditions that may be associated with meningioma. On microscopic pathology, some of the characteristic findings of a meningioma include mitotic figures, [[necrosis]], interdigitating processes, and brain invasion. Most meningiomas are positive for [[vimentin]] and negative for [[cytokeratin]].


==Pathogenesis==
==Pathogenesis==
*Meningioma arises from the [[arachnoid]] "cap" cells, which are normally involved in the protection of the [[central nervous system]] by forming a thick envelope of meninges around the [[brain]] and [[spinal cord]].<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref>  
*Meningiomas are the most common [[benign tumors]] of the [[brain]]. They are also the most common [[nonglial]] brain [[Tumor|tumors]].<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
*The majority of meningiomas are [[benign]]; however, a minority of cases may develop a [[malignant]] nature.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref>  
*Meningioma arises from the [[arachnoid]] "cap" cells, which are normally involved in the protection of the [[central nervous system]] by forming a thick envelope of [[meninges]] around the [[brain]] and [[spinal cord]].<ref name="pmid20821343">Wiemels J, Wrensch M, Claus EB (2010) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20821343 Epidemiology and etiology of meningioma.] ''J Neurooncol'' 99 (3):307-14. [http://dx.doi.org/10.1007/s11060-010-0386-3 DOI:10.1007/s11060-010-0386-3] PMID: [https://pubmed.gov/20821343 20821343]</ref>
*The exact pathophysiology of meningioma depends on the histological subtype of the tumor.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref>
*Meningiomas are commonly found in the base of the [[skull]] and [[perivenous]] [[sinuses]] due to the abundance of [[arachnoid cap cells]] in these sites. They are usually non-infilterative.<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
*Meningioma may be located either intradural or extradural along the central nervous system.<ref name="Wiki">Meningioma diagnosi. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#History_and_nomenclature Accessed on September, 25th 2015</ref><ref name="L">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview Accessed on September, 25th 2015</ref>
*The majority of meningiomas are [[benign]] (90%), about 6% are atypical, and 2% are [[malignant]].<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
*Meningiomas are frequently found attached to the [[dura]] surrounding the brain tissue in several locations that include:<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref>
*Some meningiomas may be positive for [[progesterone]] [[receptors]] on histological examination. This can lead to increased [[tumor]] size and symptom burden during pregnancy and the [[luteal phase]] of the [[menstural cycle]].<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
:* Frontaparietal region
*Meningiomas may possess [[Receptor (biochemistry)|receptors]] for platelet derived growth factor, [[vascular endothelial growth factor]] (VEGF), [[glucocorticoid]], and [[epidermal growth factor]].<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
:* [[Brain]] convexity
*Meningiomas can be found anywhere in the [[central nervous system]], with its most frequent distribution as follows: parasagittal (20.8%), then convexity (15.2%), and tuberculum sellae (12.8%).<ref name="pmid30740161">{{cite journal| author=Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I| title=Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count. | journal=Open Access Maced J Med Sci | year= 2019 | volume= 7 | issue= 1 | pages= 56-64 | pmid=30740161 | doi=10.3889/oamjms.2018.503 | pmc=6352459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30740161  }} </ref>  
:* [[Sphenoid]] ridge
* The symptoms of meningioma can be flared by water retention, engorgement of [[Blood vessel|blood vessels]], and the presence of [[Sex hormones|sex hormone]] [[Receptor (biochemistry)|receptors]] on [[tumor]] cells.<ref name="pmid29492130">{{cite journal| author=Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF et al.| title=Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy. | journal=Asian J Neurosurg | year= 2018 | volume= 13 | issue= 1 | pages= 86-89 | pmid=29492130 | doi=10.4103/1793-5482.181115 | pmc=5820904 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492130  }} </ref>
:* [[Sella turcica]]
*A meningioma can be localized in the following areas: sphenoid ridge, olfactory groove, [[Falx cerebri|falx]], lateral ventriculi, [[Tentorium cerebelli|tentorium]], the middle fossa, the [[Orbit (anatomy)|orbit]], the spinal channel, the [[Sylvian fissure]], extracalvarial, multiple localization, the pontocerebral angle, the sphenoidal plane, and the [[foramen magnum]].<ref name="pmid30740161">{{cite journal| author=Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I| title=Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count. | journal=Open Access Maced J Med Sci | year= 2019 | volume= 7 | issue= 1 | pages= 56-64 | pmid=30740161 | doi=10.3889/oamjms.2018.503 | pmc=6352459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30740161  }} </ref>
:* [[Posterior fossa]]  
*The characteristics of a meningioma can be determined based on histopathological variables like [[tumor]] gradient, histological subtype, proliferative index, and invasiveness of a [[tumor]] to the [[brain]].<ref name="pmid30740161">{{cite journal| author=Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I| title=Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count. | journal=Open Access Maced J Med Sci | year= 2019 | volume= 7 | issue= 1 | pages= 56-64 | pmid=30740161 | doi=10.3889/oamjms.2018.503 | pmc=6352459 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30740161  }} </ref>
:* [[Olfactory]] groove  
* The characterization of a meningioma being [[malignant]] is based on one or more of the following criteria: brain invasion, frank [[anaplasia]], and distant [[metastasis]]<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref>
:* [[Meckel's cave]]  
:* [[Tentorium cerebelli]]
:* [[Cerebellopontine angle]]
:* [[Confluence of sinuses]]
:* Parafalcine region
*Meningiomas is commonly associated with [[neurofibromatosis type 2]] syndrome and [[gorlin syndrome]].<ref name="liber">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview accessed on September, 25th 2015</ref>
*Meningiomas demonstrate [[estrogen]] and [[progesterone]] sensitivity and may grow during pregnancy.<ref name="radio">Meningeoma. Radiopaedia(2015)http://radiopaedia.org/articles/meningioma Accessed on September, 25th 2015</ref><ref name="liber">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview accessed on September, 25th 2015</ref>


==Genetics==
==Genetics==
*Development of meningioma is the result of multiple [[genetic mutations]].<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref>
[[Gene|Genes]] involved in the pathogenesis of meningioma include:<ref name="pmid27624470">{{cite journal| author=Yuzawa S, Nishihara H, Tanaka S| title=Genetic landscape of meningioma. | journal=Brain Tumor Pathol | year= 2016 | volume= 33 | issue= 4 | pages= 237-247 | pmid=27624470 | doi=10.1007/s10014-016-0271-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27624470  }} </ref><ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref><ref name="pmid23307326">{{cite journal| author=Balik V, Srovnal J, Sulla I, Kalita O, Foltanova T, Vaverka M et al.| title=MEG3: a novel long noncoding potentially tumour-suppressing RNA in meningiomas. | journal=J Neurooncol | year= 2013 | volume= 112 | issue= 1 | pages= 1-8 | pmid=23307326 | doi=10.1007/s11060-012-1038-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23307326  }} </ref><ref name="pmid16103061">{{cite journal| author=Lusis EA, Watson MA, Chicoine MR, Lyman M, Roerig P, Reifenberger G et al.| title=Integrative genomic analysis identifies NDRG2 as a candidate tumor suppressor gene frequently inactivated in clinically aggressive meningioma. | journal=Cancer Res | year= 2005 | volume= 65 | issue= 16 | pages= 7121-6 | pmid=16103061 | doi=10.1158/0008-5472.CAN-05-0043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16103061  }} </ref><ref name="pmid20607352">{{cite journal| author=Skiriute D, Tamasauskas S, Asmoniene V, Saferis V, Skauminas K, Deltuva V et al.| title=Tumor grade-related NDRG2 gene expression in primary and recurrent intracranial meningiomas. | journal=J Neurooncol | year= 2011 | volume= 102 | issue= 1 | pages= 89-94 | pmid=20607352 | doi=10.1007/s11060-010-0291-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20607352  }} </ref><ref name="pmid23377182">{{cite journal| author=Smith MJ, O'Sullivan J, Bhaskar SS, Hadfield KD, Poke G, Caird J et al.| title=Loss-of-function mutations in SMARCE1 cause an inherited disorder of multiple spinal meningiomas. | journal=Nat Genet | year= 2013 | volume= 45 | issue= 3 | pages= 295-8 | pmid=23377182 | doi=10.1038/ng.2552 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23377182  }} </ref><ref name="pmid22038540">{{cite journal| author=van den Munckhof P, Christiaans I, Kenter SB, Baas F, Hulsebos TJ| title=Germline SMARCB1 mutation predisposes to multiple meningiomas and schwannomas with preferential location of cranial meningiomas at the falx cerebri. | journal=Neurogenetics | year= 2012 | volume= 13 | issue= 1 | pages= 1-7 | pmid=22038540 | doi=10.1007/s10048-011-0300-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22038540  }} </ref><ref name="pmid24261697">{{cite journal| author=Goutagny S, Nault JC, Mallet M, Henin D, Rossi JZ, Kalamarides M| title=High incidence of activating TERT promoter mutations in meningiomas undergoing malignant progression. | journal=Brain Pathol | year= 2014 | volume= 24 | issue= 2 | pages= 184-9 | pmid=24261697 | doi=10.1111/bpa.12110 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24261697  }} </ref>
*The majority of meningioma cases involve a deletion of the neurofibromatosis 2 gene located on [[chromosome 22]].<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref>
*[[Neurofibromatosis type II|Neurofibromatosis 2]] (NF2) gene on [[chromosome]] 22
*Other genes involved in the pathogenesis of meningioma include:<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref>
*[[MEG3]] (maternally expressed gene 3): Loss of expression, [[genomic]] [[DNA]] deletion, and promoter [[methylation]] on [[chromosome]] 14q32.
:*Protein kinase [[AKT1 gene]] located on human [[chromosome 14]]
*[[NDRG2]] (N-Myc downstream-regulated gene 2): Down regulation of this [[gene expression]] at the [[Messenger RNA|mRNA]] level is associated with the [[malignant]] progression and predisposition to recurrence of meningiomas.
:*Meningioma 1 MN1 gene located on human [[chromosome 22]]
*[[SMARCE1]] (SWI/SNF chromatin-remodeling complex subunit gene): [[Heterozygous]] loss-of-function [[mutation]]. Its is commonly seen in meningiomas with clear cell [[histology]] and those located in the [[spine]].
:*Phosphatase and tensin homolog [[PTEN gene]] located on both human chromosomes 10 and 19
*[[SMARCB1]]: Predisposes to multiple meningiomas preferentially in the [[falx cerebri]].
:*SMO gene located on human chromosome 6 and 7
*[[TERT]] promoter [[mutation]]: Seen in meningiomas undergoing [[malignant]] histological progression.
*TRAF7
*[[AKT1]]
*[[KLF4]]
*SMO
*PIK3CA
 
==Associated Conditions==
Conditions associated with meningioma include:<ref name="pmid29660026">{{cite journal| author=Kerr K, Qualmann K, Esquenazi Y, Hagan J, Kim DH| title=Familial Syndromes Involving Meningiomas Provide Mechanistic Insight Into Sporadic Disease. | journal=Neurosurgery | year= 2018 | volume= 83 | issue= 6 | pages= 1107-1118 | pmid=29660026 | doi=10.1093/neuros/nyy121 | pmc=6235681 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29660026  }} </ref>
 
*[[Neurofibromatosis type II|Neurofibromatosis type 2]]
*Nevoid basal cell carcinoma syndrome
*[[Multiple endocrine neoplasia|Multiple endocrine neoplasia 1]] (MEN1)
*[[Cowden syndrome]]
*[[Werner syndrome]]
*BAP1 tumor predisposition syndrome
*[[Rubinstein-Taybi syndrome]]
*Familial meningiomatosis


==Gross Pathology==
==Gross Pathology==
*On gross pathology, a gray, well-circumscribed, dome-shaped mass is a characteristic finding of meningioma.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25th 2015</ref>
*On gross pathology, a gray, well-circumscribed, dome-shaped mass is a characteristic finding of meningioma.<ref name="wiki">Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25 2015</ref>
 


[[File:Gross pathology meningioma.jpg|thumb|none|200px|Gross pathology meningioma<ref name=:"radiopaedia">Image courtesy of Dr Dharam Ramnani [http://www.radiopaedia.org Radiopaedia](original file [http://radiopaedia.org/images/7347737 "here"]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
[[File:Gross pathology meningioma.jpg |400px|thumb|left|Image showing gross pathology of a meningioma [https://radiopaedia.org/articles/meningioma?lang=us source:Case courtesy of Dr Dharam Ramnani, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. ]]]
<br style="clear:left" />


==Microscopic Pathology==
==Microscopic Pathology==
*On microscopic [[histopathological]] analysis, whorled appearance, [[calcification]], and [[psammoma]] bodies are characteristic findings of of meningioma.<ref name="liber">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview accessed on September, 25th 2015</ref>
* On microscopic pathology, characteristic findings of meningioma include:<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref><ref name="pmid25744347">{{cite journal| author=Shibuya M| title=Pathology and molecular genetics of meningioma: recent advances. | journal=Neurol Med Chir (Tokyo) | year= 2015 | volume= 55 | issue= 1 | pages= 14-27 | pmid=25744347 | doi=10.2176/nmc.ra.2014-0233 | pmc=4533397 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25744347  }} </ref>
*The table below differentiates between the three main groups of meningioma according to WHO histological classification:<ref name="C">Meningioma. Canadian Cancer Society http://www.cancer.ca/en/cancer-information/cancer-type/brain-spinal/brain-and-spinal-tumours/meningioma/?region=mb September, 25th 2015</ref><ref name="radio">Meningeoma. Radiopaedia(2015)http://radiopaedia.org/articles/meningioma Accessed on September, 25th 2015</ref><ref name="liber">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview accessed on September, 25th 2015</ref>
:* Interdigitating processes and intercellular junctions
:* Small foci of [[necrosis]] surrounded by pseudopalisading [[tumor]] cells in nonembolized atypical meningiomas
:* [[Necrosis]] occurring in large geographic areas with a quick line demarcating it from viable tissues in embolized menigiomas
:* Prominent macronucleoli in the perinecrotic areas in embolized meningiomas
:* Mitotic figures (low in [[benign]] cases and high in [[malignant]] and atypical cases)
:* Brain invasion histologically seen as a finger-like, a tongue-like, or a knobby protrusion into the tissue
:* Small cells with a high nuclear:cytoplasmic ratio
:* Prominent [[nucleoli]]
:* Uninterrupted patternless or sheet-like growth
:* Increased cellularity


{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px"
* The following immunohistochemistry profile can be used to support the diagnosis of meningioma:<ref name="ComminsAtkinson2007">{{cite journal|last1=Commins|first1=Deborah L.|last2=Atkinson|first2=Roscoe D.|last3=Burnett|first3=Margaret E.|title=Review of meningioma histopathology|journal=Neurosurgical Focus|volume=23|issue=4|year=2007|pages=E3|issn=1092-0684|doi=10.3171/FOC-07/10/E3}}</ref>
|valign=top|
:* Positive for [[vimentin]]  
|+
:* Negative for [[cytokeratin]]
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Grade  }}
:* Weak or negative staining for S 100 protein
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Histologic features}}
:* Focal membranous positivity for EMA
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Image}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''[[Benign]] (Grade I) meningioma'''
| style="padding: 5px 5px; background: #F5F5F5;" |
Less then 4 [[mitosis]]/10 HPF, no [[atypia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
[[File:Grade 1 Meningioma.jpg|thumb|none|300px|Grade 1 Meningioma]]
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'''Atypical (Grade II) meningioma'''
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Brain invasion, 4 or more mitosis/10 HPF, [[necrosis]], increased cell count, high [[nucleus]]:[[cytoplasm]] ratio, increased [[nucleoli]] size, presence of sheeting
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[[File:Grade 2 menigioma.jpg|thumb|none|300px|Grade 2 menigioma]]
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'''[[Anaplastic]] (Grade III) meningioma'''
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20 or more mitoses/10 HPF, histology may be similar to [[carcinoma]] or [[sarcoma]]
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[[File:Grade 3 menigioma.jpg|thumb|none|300px|Grade 3 menigioma]]
|}


 
[[File:Prominent mitosis meningioma.jpg|400px|thumb|left|Histology slide showing meningioma with prominent mitosis [https://commons.wikimedia.org/wiki/File:Prominent_mitosis_meningioma.jpg source:Jensflorian-wikimedia commons ]]]
*Demonstrated below is a series of microscopic smears which feature specific findings observed in each subtype of meningioma:<ref name="liber">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview accessed on September, 25th 2015</ref>
<br style="clear:left" />
 
[[File:Secretory meningioma 1.jpg|400px|thumb|left|Histology slide showing secretory meningioma [https://commons.wikimedia.org/wiki/File:Neuropathology_case_III_-_04.jpg source:Jensflorian-wikimedia commons ]]]
<gallery>
<br style="clear:left" />
Image:Meningeotheliomatous meningeoma 1.jpg|Meningothelial meningioma with syncytial appearance and whorl formation
[[File:Meningioma histology.jpg|400px|thumb|left|Histology showing meningioma [https://radiopaedia.org/articles/meningioma?lang=us source:Case courtesy of Dr Dharam Ramnani, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. ]]]
Image:Meningothelial Meningioma showing 2.jpg|Meningothelial meningioma with [[psammoma]] body
<br style="clear:left" />
Image:Meningothelioal Meningioma 3.jpg|Meningothelial meningioma with onion bulb formation
Image:Meningothelial Meningioma 4.jpg|Meningothelial meningioma on [[HPS stain]]
Image:Meningioma fibromatous variant.jpg|[[Fibrous]] meningioma with [[spindle cell]]s in parallel bundles
Image:Meningiom fibrous variant2.JPG|Fibrous meingioma on EMA stain
Image:Miningioma (2) transitional type.jpg|Transitional meningioma with coexisting [[lobular]] and fasicular growth patterns
Image:Psammomatous meningioma.jpg|Psammomatous meningioma with numerous psammoma bodies
Image:Angiomatous meningioma.jpg|Angiomatous meningioma with hyalinized [[vessel]]s
Image:Microcystic meningeoma.jpg|Microcystic meningioma with [[cystic]] appearance and increased [[pleomorphism]] of the elongated cells
Image:Secretory meningioma.jpg|Secretory meningioma with secretory [[granule]]s
Image:Secretory meningioma PAS.jpg|Secretory meningioma with [[PAS stain]] positive secretory granules
Image:Chordoid meningoma.jpg|Chordoid meningioma with myxoid appearance
Image:Papillary meningioma.jpg|[[Papillary]] meningioma with discohesive [[tumor]] cells located around a fibrovascular core and perivascular pseudo- rosettes
Image:Rhabdoid meningioma.jpg| Rhabdoid meningioma with abundant [[cytoplasm]] and cross-striations
</gallery>


==References==
==References==
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Latest revision as of 14:29, 10 September 2019

Meningioma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Odukwe, M.D. [2] Haytham Allaham, M.D. [3]

Overview

Meningioma arises from the arachnoid "cap" cells, which are normally involved in the protection of the central nervous system by forming a thick envelope of meninges around the brain and spinal cord. The majority of meningiomas are benign. They can be found anywhere in the central nervous system but are most commonly seen in the parasagittal, convexity and turbeculum sellae areas. There may be genetic mutations involved in the development of a meningioma, some of the genes involved includes NF2, MEG3, NDRG2, and SMARCE1. Multiple endocrine neoplasia 1, cowden syndrome, werner syndrome and neurofibromatosis 2 are some of the conditions that may be associated with meningioma. On microscopic pathology, some of the characteristic findings of a meningioma include mitotic figures, necrosis, interdigitating processes, and brain invasion. Most meningiomas are positive for vimentin and negative for cytokeratin.

Pathogenesis

Genetics

Genes involved in the pathogenesis of meningioma include:[5][4][6][7][8][9][10][11]

Associated Conditions

Conditions associated with meningioma include:[12]

Gross Pathology

  • On gross pathology, a gray, well-circumscribed, dome-shaped mass is a characteristic finding of meningioma.[13]
Image showing gross pathology of a meningioma source:Case courtesy of Dr Dharam Ramnani, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.


Microscopic Pathology

  • On microscopic pathology, characteristic findings of meningioma include:[4][14]
  • Interdigitating processes and intercellular junctions
  • Small foci of necrosis surrounded by pseudopalisading tumor cells in nonembolized atypical meningiomas
  • Necrosis occurring in large geographic areas with a quick line demarcating it from viable tissues in embolized menigiomas
  • Prominent macronucleoli in the perinecrotic areas in embolized meningiomas
  • Mitotic figures (low in benign cases and high in malignant and atypical cases)
  • Brain invasion histologically seen as a finger-like, a tongue-like, or a knobby protrusion into the tissue
  • Small cells with a high nuclear:cytoplasmic ratio
  • Prominent nucleoli
  • Uninterrupted patternless or sheet-like growth
  • Increased cellularity
  • The following immunohistochemistry profile can be used to support the diagnosis of meningioma:[4]
  • Positive for vimentin
  • Negative for cytokeratin
  • Weak or negative staining for S 100 protein
  • Focal membranous positivity for EMA
Histology slide showing meningioma with prominent mitosis source:Jensflorian-wikimedia commons


Histology slide showing secretory meningioma source:Jensflorian-wikimedia commons


Histology showing meningioma source:Case courtesy of Dr Dharam Ramnani, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.


References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Gurcay AG, Bozkurt I, Senturk S, Kazanci A, Gurcan O, Turkoglu OF; et al. (2018). "Diagnosis, Treatment, and Management Strategy of Meningioma during Pregnancy". Asian J Neurosurg. 13 (1): 86–89. doi:10.4103/1793-5482.181115. PMC 5820904. PMID 29492130.
  2. ↑ Wiemels J, Wrensch M, Claus EB (2010) Epidemiology and etiology of meningioma. J Neurooncol 99 (3):307-14. DOI:10.1007/s11060-010-0386-3 PMID: 20821343
  3. ↑ 3.0 3.1 3.2 Sumkovski R, Micunovic M, Kocevski I, Ilievski B, Petrov I (2019). "Surgical Treatment of Meningiomas - Outcome Associated With Type of Resection, Recurrence, Karnofsky Performance Score, Mitotic Count". Open Access Maced J Med Sci. 7 (1): 56–64. doi:10.3889/oamjms.2018.503. PMC 6352459. PMID 30740161.
  4. ↑ 4.0 4.1 4.2 4.3 Commins, Deborah L.; Atkinson, Roscoe D.; Burnett, Margaret E. (2007). "Review of meningioma histopathology". Neurosurgical Focus. 23 (4): E3. doi:10.3171/FOC-07/10/E3. ISSN 1092-0684.
  5. ↑ Yuzawa S, Nishihara H, Tanaka S (2016). "Genetic landscape of meningioma". Brain Tumor Pathol. 33 (4): 237–247. doi:10.1007/s10014-016-0271-7. PMID 27624470.
  6. ↑ Balik V, Srovnal J, Sulla I, Kalita O, Foltanova T, Vaverka M; et al. (2013). "MEG3: a novel long noncoding potentially tumour-suppressing RNA in meningiomas". J Neurooncol. 112 (1): 1–8. doi:10.1007/s11060-012-1038-6. PMID 23307326.
  7. ↑ Lusis EA, Watson MA, Chicoine MR, Lyman M, Roerig P, Reifenberger G; et al. (2005). "Integrative genomic analysis identifies NDRG2 as a candidate tumor suppressor gene frequently inactivated in clinically aggressive meningioma". Cancer Res. 65 (16): 7121–6. doi:10.1158/0008-5472.CAN-05-0043. PMID 16103061.
  8. ↑ Skiriute D, Tamasauskas S, Asmoniene V, Saferis V, Skauminas K, Deltuva V; et al. (2011). "Tumor grade-related NDRG2 gene expression in primary and recurrent intracranial meningiomas". J Neurooncol. 102 (1): 89–94. doi:10.1007/s11060-010-0291-9. PMID 20607352.
  9. ↑ Smith MJ, O'Sullivan J, Bhaskar SS, Hadfield KD, Poke G, Caird J; et al. (2013). "Loss-of-function mutations in SMARCE1 cause an inherited disorder of multiple spinal meningiomas". Nat Genet. 45 (3): 295–8. doi:10.1038/ng.2552. PMID 23377182.
  10. ↑ van den Munckhof P, Christiaans I, Kenter SB, Baas F, Hulsebos TJ (2012). "Germline SMARCB1 mutation predisposes to multiple meningiomas and schwannomas with preferential location of cranial meningiomas at the falx cerebri". Neurogenetics. 13 (1): 1–7. doi:10.1007/s10048-011-0300-y. PMID 22038540.
  11. ↑ Goutagny S, Nault JC, Mallet M, Henin D, Rossi JZ, Kalamarides M (2014). "High incidence of activating TERT promoter mutations in meningiomas undergoing malignant progression". Brain Pathol. 24 (2): 184–9. doi:10.1111/bpa.12110. PMID 24261697.
  12. ↑ Kerr K, Qualmann K, Esquenazi Y, Hagan J, Kim DH (2018). "Familial Syndromes Involving Meningiomas Provide Mechanistic Insight Into Sporadic Disease". Neurosurgery. 83 (6): 1107–1118. doi:10.1093/neuros/nyy121. PMC 6235681. PMID 29660026.
  13. ↑ Meningioma. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#cite_note-pmid7731706-9 Accessed on September, 25 2015
  14. ↑ Shibuya M (2015). "Pathology and molecular genetics of meningioma: recent advances". Neurol Med Chir (Tokyo). 55 (1): 14–27. doi:10.2176/nmc.ra.2014-0233. PMC 4533397. PMID 25744347.


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