Meningioma classification

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

Overview

Meningioma may be classified according to the histological criteria of the WHO into 3 groups: benign classic meningioma (WHO grade 1), atypical meningioma (WHO grade 2), and anaplastic malignant meningioma (WHO grade 3). Meningioma may also be classified according to the tumor location into 2 main subtypes: intradural and extradural meningioma.

Classification

• WHO has classified meningiomas into 15 histo- and cytomorphological variants. Nine variants correspond to WHO grade I which are the benign classic meningiomas, three correspond to WHO grade II which are atypical meningiomas, the other three are in WHO grade III and are anaplastic malignant meningiomas.

• WHO grade I: They are low-grade tumors that grow very slowly and rarely invade the surrounding tissues.
• WHO grade II: These are not clearly malignant, but grow faster than benign meningiomas. They have increased mitosis and can invade the brain. They could possess increased cellularity, small cells with high nuclear-to-cytoplasmic ratio, prominent nucleoli, sheeting, foci of spontaneous necrosis (at least three of these features).
• WHO grade III: Markedly increased mitosis with and overtly malignant cytology.

• The table below lists the subtypes of meningioma according to the WHO grades:

WHO grade	Subtypes
Benign classic meningioma (WHO grade 1)	Meningothelial, fibrous, transitional, psammomatous, angiomatous, micrcystic, secretory, lymphoplasmacyte-rich, and metaplastic meningioma They are low-grade tumors that grow very slowly and rarely invade the surrounding tissues
Atypical meningioma (WHO grade 2)	Chordoid, clear cell, and atypical meningioma. clear cell meningioma These are not clearly malignant, but grow faster than benign meningiomas They have increased mitosis and can invade the brain They could possess increased cellularity, small cells with high nuclear-to-cytoplasmic ratio, prominent nucleoli, sheeting, foci of spontaneous necrosis (at least three of these features).
Anaplastic malignant meningioma (WHO grade 3)	Rhabdoid, papillary, and anaplastic meningioma

• Meningioma may also be classified according to the tumor location into 2 main subtypes: intradural and extradural meningioma.