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Clinicopathological study on meningioangiomatosis
Thursday, 10 July 1997
changes and microinfiltration in the surrounding tissues. The bone flaps were replaced during operation when there was no apparent skull hyperplasia or destruction. The wall of cystic meningiomas was difficult to remove completely, and the boundary of tumor was not clear. Tumors invading dural sinus, circle of Willis and important brain tissue are not easy to remove completely. A little part of tumor remained duringoperation, but was regarded as total resection by mistake.
I P-5-6021 Clinicopathological study on meningioangiomatosis S. Tsunoda 1, T. Sakaki 2 , T. Morimoto2 , T. Hoshida 2 , M. Nakamura2 , T. Tsuzuki j', H. Aoki 2 , K. Kobitsu -'. 1 Graduate School of Science, Osaka Prefecture University, Sakaj, Japan, 2 Dept of Neurosurgery, Nara Medical Unwersity, Kashihara, Japan Meningioangiomatosis is a rare malformative lesion of the central nervous system, which is microscopically characterized by two components: cortical meningovascular proliferation and leptomeningeal calcification. Recently, since the introduction of MR imaging, it has been recognized as an epileptogenic focus. We studied 3 cases of meningioangiomatosis not associated with von Recklinghausen's disease. Case 1 is 7-year-old female with an initial symptom of epilepsy. The tumor is located in the right occipital lobe. Case 2 is lo- year-old male with an initial symptom of epilepsy. The tumor is located in the right Sylvian fissure. Case3 is 21-year-old femalewith an initial symptom of epilepsy. The conclusions are summarized as follows. 1) MR images 01 meningioangiomatosis show the lesion as isointense on the Tl-weighted image, and hypointense on the T2-weighted image. A marked enhancement 01 the lesion is demonstrated after intravenous injection of Gd-DTPA. 2) The tumor cells are positive immunohistochemically for vimentin, glutathion s-transterase-» , but negative for epithelial membrane antigen (EMA). These findings indicate that the histogenesis 01 the tumor cells is probably an arachnoid cap cell. But, these tumor cells are not identical with meningioma cells because EMA is negative.
IP-5-6031 with Rapidly growing benign meningiomas: Correlation clinical features and histological diagnosis Ch. Kudoh 1.2, A. Detta2 , J. Yeh2 , A. Jackowski 2, E.R. Hitchcock 2, N. Yoshimizu 3, K. Sugiura 2 . 1 Department of Neurosurgery, University of Birmingham, England, 2 Tokyo Rohsai Hospital, Japan, 3 Yokohama General Hospifal, Kanagawa, Japan Introduction : Rapidlygrowing benign meningiomas were recently reported as a new type 01 unique growth pattern (Kudoh et aI., Neurosurg. 1995). Toclear the correlation of the clinical features and histological diagnosis of this type of meningiomas, we attempted to analyze its growth and survival rate and compared with that of conventional meningiomas. Methods: MIS 1 and PCNA immunostainings were performed in 712 meningiomasof benign, atypical and anaplastichistology and quantified the proliferating indices (PI) with a computerized Cell Analysis System (CAS) 200 image analyzer. DNA contentand immunoexpression of progesterone(PR)and estrogen receptors (EA) were also detected by the CAS. Resuhs: Themean MIS1and PCNA PI'sof 637totally resectedhistologically benign primary meningiomas were 1.2% and 1.4%, While those of 46 atypical and 29 anaplastic tumorswere 7.2%, 8.1%, and 17.2%, 19.4%, respectively. 26 histological benign meningiomas had a mean PI (MIS 1, 5.9%; PCNA, 6.4%) that failed to concur with their histological diagnosis. Clinical histories ot these 26 tumorsrevealedthatthey haddevelopedrapidly, reaching symptomatic sizes within 3.5 years; the mean tumor doubling time (Td) calculated lrom serial CT scans was 81 days. Concurrentanalysis of cellular DNA content revealed that these tumorswere aneuploid. Immunoexpression of PA and EA was negative. Thereweresignificant differences in survivaltime between theserapidlygrowing benign meningiomas and benign and anaplastic meningiomas (p < 0.01, P < 0.005, log-rank). Discussion and Conclusions: Theseresultsindicateda consistent correlation between PI and histological diagnosis. Whenthis relationship fails to concur the existence 01a rare histologically benign but rapidly growingmeningioma is revealed and appropriate clinical management of the tumor patient should be regarded.
IP-5-6041 Cell kinetic study in benign, atypical and anaplastic meningiomas T. Arai, M. Aoyagi, K. Ohno, G. Nagashima, K. Hirakawa. Department of Neurosurgery, Tokyo Medicaland Dental University, Bunkyo-Ku, Tokyo, Japan Introduction: Meningioma is classified as benign, atypical and anaplastic accordingto the new grading system of WHO. We investigated growthkinetics of nonbeniqn meningiomas with various methodsand compared the results with clinical behaviors.
Tumours ofthe eNS - Meningiomas
5239
Methods: We examined 15tissues samples from 4 anaplastic meningiomas and 9 from 4 atypicalmeningiomas. Tumordoubling times (Td) were determined by calculating the tumor volumes on CT and MAL MIS-l staining indices were obtained using paraffin sections by immunohistochemistry. DNA histograms were plotted to estimate the DNA distribution. GoG" S, and G2M phases, with fluorocytometry. Cell cycletime was calculated with the followingequation: Tc '" Ts'l n2/1n [1 - CPls/(loo (2 - CPll)}] where Ts is durationof S-phase, andCPls and CPll (cumulative phase index of Sand G1) is the population of Sand Gl phase. Results: The mean Td in anaplastic meningiomas was 78.08 ± 56.2 and 396 ± 492.8 days (mean ± SD), in atypical meningioma. The Td decreased with subsequent recurrences in anaplastic meningiomas. The growth kinetic data varied among anaplastic, atypical and benign meningioma: MIS-l index, 13.6±4.2, 4.7 ± l .4and2.1 ± 0.7%; Tc: 13.1 ± 10.7, 17.3 ± 10.8 and 44.4 ± 29.7; Growth Indices (Gl's): 8.5 ± 5.5, 6.5 ± 5.7 and 4.6 ± 3.9%, respectively. MIS-l indices showed the strongest positive correlation with Td, while Tc and GI showed only weak positive correlation. Discussion and Conclusions: Our datajustify the grading system of WHO in meningiomas and also indicate that evaluation of growth kinetics are of great use in estimatingthe biological behaviorof meningiomas.
[ P-5-60S j MIB-1 lmmunostalnlnq in high-grade meningiomas and hemanqloperlcytoma Tadashi Abe, Takayuki Hara, Yubuhito Mochizuki, Manabu Sugita, Jun Sashida, Shunsuke Kawamoto, KazuyaNagata. Departmentof Neurosurgery, ShowaGeneral Hospital, Tokyo, Japan Introduction: Meningiomas are considered to be benign tumors, except high grade meningiomas (atypical, papillary and anaplastic meningiomas) that are aboutapproximately 1% of meningiomas. MIS-I was investigated in high grade meningiomas and hemangiopericytoma. The authors compared high grade meningiomas with low grademeningioma. Materials and Methods: Setween 1984 and 1996, 88 meningiomas were treated in our institution. The authors investigated 3 cases with high grade meningiomas and 1 case with hemangiopericytoma by MIS-l immunohistochemically. Results: Case 1 is atypical meningioma. The patient was a 78-year'old man whonoticedswelling of the headafter trauma. CT scan showed a posttraumatic meningioma. MIS-l score was 4%. Case 2 is also atypical meningioma. The patientwas a 78-year-old man who began to complain of gait disturbance. CT showed a cerebello-pontine angle meningioma. MIS-l was 2.2%. Case 3 is anaplastic meningioma.The patient was a 50-year-old man who complained of headache and right hemiparesis. CT scan showed a lalx meningioma. MIS-l was 22.4%. Case 4 is hemangiopericytoma with recurrence. MIS-l was 0.7%. MIS-l staining index for the 84 cases in low grade meningioma was 1.3%. MIS-1 staining index for high grade meningiomas was more than the index of low grademeningiomas. Conclusion: The MIS-l staining index appears to be a useful method for predicting the biologicalbehaviour of meningiomas.
IP-5-6061 trauma: Hemangiopericytoma of brain in children after head Report of two cases M. Mehrazin, N. Kamalian. Department of Neurosurgery and Pathology, Or ShariatiHospital, Tehran Universityof Medical Sciences, Tehran, Iran A11hough the role of head trauma in the induction of meningioma has been emphasized by many physicians, in a review of the literature we have n01 encountered any reportof a history 01 head trauma in childrenwith hemangiopericytoma. This has encouraged us to report two cases of hemangiopericytoma with a prior history of head trauma few months back. Age, sex, clinical presentation, surgery, and radiotherapy after surgery as adjuvent therapy will be discussed.
IP-5-607j Angiogenesis in meningioma J. de Vries, E. Sakheet, P. Wesseling, J. van der Laak, J. van Overbeeke. Departments 01 Neurosurgery and Pathology, University of Nijmegen, The Netherlands Introduction : Although meningiomas generally are slow-growing benign tumors, recurrences are not uncommon. Angiogenesis is considered a prerequisite for the continued growth of solid tumor. Meningiomas with prominent neovascularization are thought to recur more often. Methods: To quantify the histological aspects of microvascular proliferation in meningioma a feasible and reproducible method was developed for computer-assisted imageanalysis of the visualized microvasculature in meningioma tissue. This method was used to compare several vascular parameters in histological tumor sections of 51 opera1ed meningioma.
changes and microinfiltration in the surrounding tissues. The bone flaps were replaced during operation when there was no apparent skull hyperplasia or destruction. The wall of cystic meningiomas was difficult to remove completely, and the boundary of tumor was not clear. Tumors invading dural sinus, circle of Willis and important brain tissue are not easy to remove completely. A little part of tumor remained duringoperation, but was regarded as total resection by mistake.
I P-5-6021 Clinicopathological study on meningioangiomatosis S. Tsunoda 1, T. Sakaki 2 , T. Morimoto2 , T. Hoshida 2 , M. Nakamura2 , T. Tsuzuki j', H. Aoki 2 , K. Kobitsu -'. 1 Graduate School of Science, Osaka Prefecture University, Sakaj, Japan, 2 Dept of Neurosurgery, Nara Medical Unwersity, Kashihara, Japan Meningioangiomatosis is a rare malformative lesion of the central nervous system, which is microscopically characterized by two components: cortical meningovascular proliferation and leptomeningeal calcification. Recently, since the introduction of MR imaging, it has been recognized as an epileptogenic focus. We studied 3 cases of meningioangiomatosis not associated with von Recklinghausen's disease. Case 1 is 7-year-old female with an initial symptom of epilepsy. The tumor is located in the right occipital lobe. Case 2 is lo- year-old male with an initial symptom of epilepsy. The tumor is located in the right Sylvian fissure. Case3 is 21-year-old femalewith an initial symptom of epilepsy. The conclusions are summarized as follows. 1) MR images 01 meningioangiomatosis show the lesion as isointense on the Tl-weighted image, and hypointense on the T2-weighted image. A marked enhancement 01 the lesion is demonstrated after intravenous injection of Gd-DTPA. 2) The tumor cells are positive immunohistochemically for vimentin, glutathion s-transterase-» , but negative for epithelial membrane antigen (EMA). These findings indicate that the histogenesis 01 the tumor cells is probably an arachnoid cap cell. But, these tumor cells are not identical with meningioma cells because EMA is negative.
IP-5-6031 with Rapidly growing benign meningiomas: Correlation clinical features and histological diagnosis Ch. Kudoh 1.2, A. Detta2 , J. Yeh2 , A. Jackowski 2, E.R. Hitchcock 2, N. Yoshimizu 3, K. Sugiura 2 . 1 Department of Neurosurgery, University of Birmingham, England, 2 Tokyo Rohsai Hospital, Japan, 3 Yokohama General Hospifal, Kanagawa, Japan Introduction : Rapidlygrowing benign meningiomas were recently reported as a new type 01 unique growth pattern (Kudoh et aI., Neurosurg. 1995). Toclear the correlation of the clinical features and histological diagnosis of this type of meningiomas, we attempted to analyze its growth and survival rate and compared with that of conventional meningiomas. Methods: MIS 1 and PCNA immunostainings were performed in 712 meningiomasof benign, atypical and anaplastichistology and quantified the proliferating indices (PI) with a computerized Cell Analysis System (CAS) 200 image analyzer. DNA contentand immunoexpression of progesterone(PR)and estrogen receptors (EA) were also detected by the CAS. Resuhs: Themean MIS1and PCNA PI'sof 637totally resectedhistologically benign primary meningiomas were 1.2% and 1.4%, While those of 46 atypical and 29 anaplastic tumorswere 7.2%, 8.1%, and 17.2%, 19.4%, respectively. 26 histological benign meningiomas had a mean PI (MIS 1, 5.9%; PCNA, 6.4%) that failed to concur with their histological diagnosis. Clinical histories ot these 26 tumorsrevealedthatthey haddevelopedrapidly, reaching symptomatic sizes within 3.5 years; the mean tumor doubling time (Td) calculated lrom serial CT scans was 81 days. Concurrentanalysis of cellular DNA content revealed that these tumorswere aneuploid. Immunoexpression of PA and EA was negative. Thereweresignificant differences in survivaltime between theserapidlygrowing benign meningiomas and benign and anaplastic meningiomas (p < 0.01, P < 0.005, log-rank). Discussion and Conclusions: Theseresultsindicateda consistent correlation between PI and histological diagnosis. Whenthis relationship fails to concur the existence 01a rare histologically benign but rapidly growingmeningioma is revealed and appropriate clinical management of the tumor patient should be regarded.
IP-5-6041 Cell kinetic study in benign, atypical and anaplastic meningiomas T. Arai, M. Aoyagi, K. Ohno, G. Nagashima, K. Hirakawa. Department of Neurosurgery, Tokyo Medicaland Dental University, Bunkyo-Ku, Tokyo, Japan Introduction: Meningioma is classified as benign, atypical and anaplastic accordingto the new grading system of WHO. We investigated growthkinetics of nonbeniqn meningiomas with various methodsand compared the results with clinical behaviors.
Tumours ofthe eNS - Meningiomas
5239
Methods: We examined 15tissues samples from 4 anaplastic meningiomas and 9 from 4 atypicalmeningiomas. Tumordoubling times (Td) were determined by calculating the tumor volumes on CT and MAL MIS-l staining indices were obtained using paraffin sections by immunohistochemistry. DNA histograms were plotted to estimate the DNA distribution. GoG" S, and G2M phases, with fluorocytometry. Cell cycletime was calculated with the followingequation: Tc '" Ts'l n2/1n [1 - CPls/(loo (2 - CPll)}] where Ts is durationof S-phase, andCPls and CPll (cumulative phase index of Sand G1) is the population of Sand Gl phase. Results: The mean Td in anaplastic meningiomas was 78.08 ± 56.2 and 396 ± 492.8 days (mean ± SD), in atypical meningioma. The Td decreased with subsequent recurrences in anaplastic meningiomas. The growth kinetic data varied among anaplastic, atypical and benign meningioma: MIS-l index, 13.6±4.2, 4.7 ± l .4and2.1 ± 0.7%; Tc: 13.1 ± 10.7, 17.3 ± 10.8 and 44.4 ± 29.7; Growth Indices (Gl's): 8.5 ± 5.5, 6.5 ± 5.7 and 4.6 ± 3.9%, respectively. MIS-l indices showed the strongest positive correlation with Td, while Tc and GI showed only weak positive correlation. Discussion and Conclusions: Our datajustify the grading system of WHO in meningiomas and also indicate that evaluation of growth kinetics are of great use in estimatingthe biological behaviorof meningiomas.
[ P-5-60S j MIB-1 lmmunostalnlnq in high-grade meningiomas and hemanqloperlcytoma Tadashi Abe, Takayuki Hara, Yubuhito Mochizuki, Manabu Sugita, Jun Sashida, Shunsuke Kawamoto, KazuyaNagata. Departmentof Neurosurgery, ShowaGeneral Hospital, Tokyo, Japan Introduction: Meningiomas are considered to be benign tumors, except high grade meningiomas (atypical, papillary and anaplastic meningiomas) that are aboutapproximately 1% of meningiomas. MIS-I was investigated in high grade meningiomas and hemangiopericytoma. The authors compared high grade meningiomas with low grademeningioma. Materials and Methods: Setween 1984 and 1996, 88 meningiomas were treated in our institution. The authors investigated 3 cases with high grade meningiomas and 1 case with hemangiopericytoma by MIS-l immunohistochemically. Results: Case 1 is atypical meningioma. The patient was a 78-year'old man whonoticedswelling of the headafter trauma. CT scan showed a posttraumatic meningioma. MIS-l score was 4%. Case 2 is also atypical meningioma. The patientwas a 78-year-old man who began to complain of gait disturbance. CT showed a cerebello-pontine angle meningioma. MIS-l was 2.2%. Case 3 is anaplastic meningioma.The patient was a 50-year-old man who complained of headache and right hemiparesis. CT scan showed a lalx meningioma. MIS-l was 22.4%. Case 4 is hemangiopericytoma with recurrence. MIS-l was 0.7%. MIS-l staining index for the 84 cases in low grade meningioma was 1.3%. MIS-1 staining index for high grade meningiomas was more than the index of low grademeningiomas. Conclusion: The MIS-l staining index appears to be a useful method for predicting the biologicalbehaviour of meningiomas.
IP-5-6061 trauma: Hemangiopericytoma of brain in children after head Report of two cases M. Mehrazin, N. Kamalian. Department of Neurosurgery and Pathology, Or ShariatiHospital, Tehran Universityof Medical Sciences, Tehran, Iran A11hough the role of head trauma in the induction of meningioma has been emphasized by many physicians, in a review of the literature we have n01 encountered any reportof a history 01 head trauma in childrenwith hemangiopericytoma. This has encouraged us to report two cases of hemangiopericytoma with a prior history of head trauma few months back. Age, sex, clinical presentation, surgery, and radiotherapy after surgery as adjuvent therapy will be discussed.
IP-5-607j Angiogenesis in meningioma J. de Vries, E. Sakheet, P. Wesseling, J. van der Laak, J. van Overbeeke. Departments 01 Neurosurgery and Pathology, University of Nijmegen, The Netherlands Introduction : Although meningiomas generally are slow-growing benign tumors, recurrences are not uncommon. Angiogenesis is considered a prerequisite for the continued growth of solid tumor. Meningiomas with prominent neovascularization are thought to recur more often. Methods: To quantify the histological aspects of microvascular proliferation in meningioma a feasible and reproducible method was developed for computer-assisted imageanalysis of the visualized microvasculature in meningioma tissue. This method was used to compare several vascular parameters in histological tumor sections of 51 opera1ed meningioma.