Meningioma Diagnosis and Prognosis

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Questions and Answers

What is the primary brain tumor in adults?

Meningioma (correct)

Astrocytoma

Medulloblastoma

Glioblastoma

What is the incidence of meningioma in the USA?

5.5 cases per 100,000 population

8.58 cases per 100,000 population (correct)

12.8 cases per 100,000 population

10.5 cases per 100,000 population

What is the median age at diagnosis for meningioma?

60 years

66 years (correct)

56 years

70 years

What is the incidence of metastases from all meningiomas?

0.67% Signup and view all the answers

What is the risk differential of grade 1 meningioma in women compared to men before menopause?

3.28 Signup and view all the answers

What is the percentage of CNS tumors that meningioma accounts for?

37.6% Signup and view all the answers

What is the primary established environmental risk factor for meningioma?

Ionizing radiation Signup and view all the answers

What is the incidence of meningioma in Black people compared to White people?

Higher in Black people Signup and view all the answers

What is the association between hormone exposure and meningioma risk?

A modest association Signup and view all the answers

What is the effect of breastfeeding on meningioma risk?

Decreases the risk Signup and view all the answers

What is the association between CT scans in childhood and meningioma risk?

A modest association Signup and view all the answers

What is the genetic aspect of meningioma risk after exposure to ionizing radiation?

Modest genetic susceptibility Signup and view all the answers

What is the recurrence rate of cases with a proliferation index > 4% similar to?

CNS WHO grade 2 (atypical) meningiomas Signup and view all the answers

What is the purpose of staining for the mitosis marker phosphohistone H3?

To stratify meningiomas into three risk groups Signup and view all the answers

What is the characteristic arrangement of meningothelial meningioma cells?

In syncytia-like lobules Signup and view all the answers

What are the nuclei of meningothelial meningioma cells like?

Round to oval with internal empty spaces Signup and view all the answers

What is the significance of the similarity between meningothelial meningioma cells and arachnoid cap cells?

It warrants caution when encountering small fragments Signup and view all the answers

What is rare in meningothelial meningiomas compared to other subtypes?

Whorls Signup and view all the answers

What do most rhabdoid meningiomas have in common?

High rates of recurrence and death Signup and view all the answers

What percentage of rhabdoid meningiomas have CNS WHO grade 1 features?

50% Signup and view all the answers

What is the impact of atypical features on CNS WHO grade 1 meningiomas?

They increase the risk of subsequent progression/recurrence Signup and view all the answers

What is a key factor in determining patient outcome for rhabdoid meningiomas?

CNS WHO grade Signup and view all the answers

What is a characteristic feature of some rhabdoid meningiomas?

Cells with rhabdoid cytomorphology in a papillary architecture Signup and view all the answers

What is the association between malignant histological features and survival times?

Malignant histological features are associated with shorter survival times Signup and view all the answers

What is a genetic characteristic of some patients with rhabdoid and/or papillary meningiomas?

Germline mutations in the BAP1 gene Signup and view all the answers

What is the median survival time for anaplastic meningioma?

5 years Signup and view all the answers

What is a condition associated with some rhabdoid and/or papillary meningiomas?

BAP1 tumour predisposition syndrome Signup and view all the answers

What is the difference in outcome between de novo anaplastic meningiomas and secondary anaplastic meningiomas?

De novo anaplastic meningiomas have a better outcome Signup and view all the answers

What is the impact of high mitotic counts on overall survival in meningiomas?

High mitotic counts are associated with shorter overall survival Signup and view all the answers

What is the significance of molecular features in meningiomas?

Molecular features have prognostic significance Signup and view all the answers

Study Notes

Neuroimaging Features

Neuroimaging features are not always specific for the diagnosis of meningioma or for estimating prognosis.
However, quantitative and qualitative imaging features from gadolinium-enhanced MRI can suggest the histological grade of meningiomas and predict more likely patient outcomes.

Spread

Meningiomas commonly invade adjacent anatomical structures (especially the dura).
The rate and extent of local spread are often greater in more aggressive subtypes.
Extracranial metastases (e.g., to lung, pleura, bone, and/or liver) are rare and most often associated with CNS WHO grade 3 meningiomas.

Epidemiology

The incidence of meningioma in the USA is 8.58 cases per 100,000 population, accounting for 37.6% of CNS tumors.
Meningioma is the most common primary brain tumor in adults (estimated to occur in up to 1% of the population).
The least common in children aged 0-19 years.

Age, Sex, and Race Distribution

The risk of meningioma increases with age; the median age at diagnosis is 66 years.
The incidence of grade 1 meningioma is 2.32 times greater in women than in men, with the greatest risk differential (3.28) seen before menopause and decreasing thereafter.
The incidence is significantly higher in Black people than in White people (9.25 vs 7.88 cases per 100,000 person-years).

Etiology

Exposure to ionizing radiation is the primary established environmental risk factor for meningioma.
Lower doses of ionizing radiation also increase the risk of meningioma, including exposure to CT in childhood or adolescence.
Genetic susceptibility to the development of meningioma after exposure to ionizing radiation is suggested by the Tinea capitis cohort study.

Meningothelial Meningioma

Epithelioid cells form syncytia-like lobules, with some nuclei appearing to have nuclear holes and pseudoinclusions.
The cells resemble the morphology of arachnoid cap cells and are largely monomorphic, with abundant eosinophilic cytoplasm, and are arranged in lobules that can be demarcated by fine collagen septa.

Rhabdoid Meningioma

Rhabdoid meningiomas are highly proliferative and have other histological features of malignancy.
Most rhabdoid meningiomas have CNS WHO grade 1 or 2 features.
Patient outcome is strongly correlated with CNS WHO grade, independent of the rhabdoid features.

Molecular Features

Higher-grade meningiomas are associated with more complex copy-number changes and chromosomal abnormalities.

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Description

Learn about the role of neuroimaging features in diagnosing meningioma and predicting patient outcomes. Discover how MRI scans can help estimate prognosis and suggest histological grades.