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2.
BMJ Case Rep ; 14(11)2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34772682

RESUMO

We present a case of a 48-year-old man diagnosed with parasagittal atypical meningioma (AM) involving biparietal bones with intracranial and extracranial extension up to galea aponeurotica of the scalp. The patient underwent Simpson's grade 2 resection (GTR (gross total tumour resection) with coagulation of dural attachment). Currently, in AMs, the role of adjuvant radiotherapy is controversial after GTR. Here, through this case, we have discussed in detail issues related to tumour origin, that is, primary versus secondary extradural meningioma and controversial topics regarding the role of adjuvant radiotherapy in the management of AMs. We have presented our radiation treatment strategy addressing the high-risk zones related to tumour extension in this case.


Assuntos
Neoplasias Meníngeas , Meningioma , Humanos , Masculino , Neoplasias Meníngeas/radioterapia , Neoplasias Meníngeas/cirurgia , Meningioma/radioterapia , Meningioma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Procedimentos Neurocirúrgicos , Radioterapia Adjuvante , Estudos Retrospectivos
7.
Cir Cir ; 89(S1): 66-69, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762625

RESUMO

Meningiomas are the most frequent extra-axial tumors of the nervous system. Multiple meningiomas are defined as the presence of two or more lesions that appear simultaneously or not, in different intracranial location, without association to neurofibromatosis. Each lesion must be evaluated individually for treatment, which consists in microsurgical resection in most cases. A 59-year-old woman presented with neurological symptoms from different anatomical site. Two extra-axial tumors of different location, at right sphenoid wing and the other in the tuberculum sellae were identified. Microsurgical resection was decided in one-step surgery, using the same craniotomy for both lesions with complete resection.


Assuntos
Neoplasias Meníngeas , Meningioma , Craniotomia , Feminino , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Estudos Retrospectivos , Resultado do Tratamento
8.
Acta Neurochir (Wien) ; 163(12): 3417-3424, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34643803

RESUMO

PURPOSE: The patients' burden with asymptomatic meningiomas and patients with good clinical outcome after meningioma resection often remains neglected. In this study, we aimed to investigate the longitudinal changes of psychological distress and quality of life in these patient groups. METHODS: Patients with conservatively managed (CM) or operated (OM) meningiomas and excellent neurological status, who were screened for psychological distress during the follow-up visit (t1), were included. We performed a follow-up mail/telephone-based survey 3-6 months (t2) after t1. Distress was measured using Hospital Anxiety and Depression Scale (HADS), Distress Thermometer (DT), 36-item Short Form (SF-36), and Brief Fatigue Inventory (BFI). RESULTS: Sixty-two patients participated in t1 and 47 in t2. The number of patients reporting increased or borderline values remained high 3 months after initial presentation, with n = 25 (53%) of patients reporting increased anxiety symptom severity and n = 29 (62%) reporting increased depressive symptom severity values. The proportion of distressed patients according to a DT score remained similar after 3 months. Forty-four percent of patients reported significant distress in OM and 33% in CM group. The most common problems among distressed patients were fatigue (t2 75%) and worries (t2 50%), followed by pain, sleep disturbances, sadness, and nervousness. Tumor progress was associated with increased depression scores (OR 6.3 (1.1-36.7)). CONCLUSION: The level of psychological distress in asymptomatic meningiomas and postoperative meningiomas with excellent outcome is high. Further investigations are needed to identify and counsel the patients at risk.


Assuntos
Neoplasias Meníngeas , Meningioma , Ansiedade/etiologia , Depressão/etiologia , Humanos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Qualidade de Vida , Estresse Psicológico/etiologia , Inquéritos e Questionários
9.
J Clin Neurosci ; 93: 1-5, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34656230

RESUMO

OBJECTIVES: Meningiomas are the most common primary intracranial tumor. Hepatocyte growth factor (HGF) and its receptor, cMet, were shown to be involved in meningioma. This study was aimed to determine the concentration of HGF and soluble cMet (s-cMet) in the serum of patients with different grades of meningioma. METHODS: Ninety serum samples from different grades of meningioma patients (42 cases of grade I, 28 grade II, 20 grade III) and 51 controls were included in this study. The serum total protein concentration (TPC) was measured by a Bio-Rad protein assay and serum concentration of HGF and s-cMet by enzyme linked immunosorbent assay (ELISA). RESULTS: No significant change in the serum TPC of patients was seen as compared to controls. We also showed that serum HGF and s-cMet concentration in meningioma patients was higher than in controls. The results showed that starting from grades I to III meningioma, a significant increase in HGF and s-cMet serum concentration was observed (HGF; 380 ± 57.69, 430.27 ± 48.72, 596.36 ± 104.49 pg/ml, respectively, as compared to controls which was 327.72 ± 49.68 pg/ml and for s-cMet was 274.45 ± 45.05, 314.81 ± 38.71, 433.54 ± 51.81 ng/ml, respectively, as compared to controls which was 213.72 ± 29.13 ng/ml). The results showed that a high concentration of HGF and s-cMet is associated with advanced grades of meningioma. CONCLUSION: It is concluded that HGF and s-cMet serum levels increased in meningioma patients and their concentration was significantly higher in more advanced grades of the disease. It is also suggested that HGF/s-cMet might be involved in the progression of meningioma.


Assuntos
Neoplasias Encefálicas , Neoplasias Meníngeas , Meningioma , Criança , Ensaio de Imunoadsorção Enzimática , Fator de Crescimento de Hepatócito , Humanos
10.
J Clin Neurosci ; 93: 168-173, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34656242

RESUMO

A tumor-to-tumor metastasis inside a meningioma is a rare phenomenon. Malignant neoplasms of the breast and lung are the most common primary tumors. Other sites of origin include prostate, renal and gastric neoplasms. The included case files were retrieved from the medical records of the University Hospital of Crete, Greece. A review of the literature was conducted in March 2020 via PubMed. Relevant search results were few. We report a case of a 66-year-old female, with known Small Cell Lung Cancer, who presented with left-sided hemiparesis. The Magnetic Resonance Imaging scan revealed a right frontal extra-axial mass. The patient underwent a craniotomy and a gross total removal of the tumor. Histological examination of the excised mass revealed metastatic adenocarcinoma deposits inside a meningioma: tumor-to-tumor metastasis. Reviewing the available literature, it has been hypothesized that the following factors play a role in the pathophysiology of this phenomenon: progesterone and estrogen receptors, cell-to-cell adhesion molecules, rich vascularization, favorable metabolic, micro-and immunological environment. Meningiomas seem to be the most common type of intracranial neoplasm to host a metastasis. There is a difference between tumor-to-tumor metastasis and collision tumors. The former implies a recipient role of the host tumor, and the latter refers to a co-localization of two different tumors that grow into one another, both being in the same organ. Tumor-to-tumor brain metastasis is a well-described phenomenon but with unclear pathophysiology. Deeper knowledge could be beneficial for its management.


Assuntos
Adenocarcinoma , Neoplasias Encefálicas , Neoplasias Meníngeas , Meningioma , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia
11.
J Med Case Rep ; 15(1): 509, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34645501

RESUMO

INTRODUCTION: Meningiomas are the most commonly encountered intracranial tumors, usually showing indolent behavior. Extra-axial spreading and distant metastases are seldom detected in these tumors, and lung metastasis from a low-grade meningioma is a rare event. CASE PRESENTATION: This case report aimed to present the clinical, imaging, and pathological features of a 37-year-old Caucasian pregnant woman with bilateral lung metastases incidentally detected during preoperative workup ahead of surgery for a primary intracranial meningioma. The possible metastatic routes and risk factors of dissemination to the pulmonary circulation were discussed as well. CONCLUSION: Metastasis must be considered in patients with intracranial meningiomas accompanied by venous sinus invasion and extension through the calvarium. Thorough paraclinical investigations are suggested in such cases.


Assuntos
Neoplasias Encefálicas , Neoplasias Pulmonares , Neoplasias Meníngeas , Meningioma , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Período Pós-Parto
12.
Artigo em Inglês | MEDLINE | ID: mdl-34639256

RESUMO

BACKGROUND: This report discusses the utility of a wearable augmented reality platform in neurosurgery for parasagittal and convexity en plaque meningiomas with bone flap removal and custom-made cranioplasty. METHODS: A real patient with en plaque cranial vault meningioma with diffuse and extensive dural involvement, extracranial extension into the calvarium, and homogeneous contrast enhancement on gadolinium-enhanced T1-weighted MRI, was selected for this case study. A patient-specific manikin was designed starting with the segmentation of the patient's preoperative MRI images to simulate a craniotomy procedure. Surgical planning was performed according to the segmented anatomy, and customized bone flaps were designed accordingly. During the surgical simulation stage, the VOSTARS head-mounted display was used to accurately display the planned craniotomy trajectory over the manikin skull. The precision of the craniotomy was assessed based on the evaluation of previously prepared custom-made bone flaps. RESULTS: A bone flap with a radius 0.5 mm smaller than the radius of an ideal craniotomy fitted perfectly over the performed craniotomy, demonstrating an error of less than ±1 mm in the task execution. The results of this laboratory-based experiment suggest that the proposed augmented reality platform helps in simulating convexity en plaque meningioma resection and custom-made cranioplasty, as carefully planned in the preoperative phase. CONCLUSIONS: Augmented reality head-mounted displays have the potential to be a useful adjunct in tumor surgical resection, cranial vault lesion craniotomy and also skull base surgery, but more study with large series is needed.


Assuntos
Realidade Aumentada , Neoplasias Meníngeas , Meningioma , Craniotomia , Humanos , Laboratórios , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia
13.
BMJ Case Rep ; 14(10)2021 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-34667042

RESUMO

Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.


Assuntos
Delírio de Parasitose , Neoplasias Meníngeas , Meningioma , Delírio de Parasitose/diagnóstico , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Recidiva Local de Neoplasia , Neuroimagem
14.
Int J Mol Sci ; 22(19)2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34638590

RESUMO

Meningiomas represent a phenotypically and genetically diverse group of tumors which often behave in ways that are not simply explained by their pathologic grade. The genetic landscape of meningiomas has become a target of investigation as tumor genomics have been found to impact tumor location, recurrence risk, and malignant potential. Additionally, targeted therapies are being developed that in the future may provide patients with personalized chemotherapy based on the genetic aberrations within their tumor. This review focuses on the most common genetic mutations found in meningiomas of all grades, with an emphasis on the impact on tumor location and clinically relevant tumor characteristics. NF-2 and the non-NF-2 family of genetic mutations are summarized in the context of low-grade and high-grade tumors, followed by a comprehensive discussion regarding the genetic and embryologic basis for meningioma location and phenotypic heterogeneity. Finally, targeted therapies based on tumor genomics currently in use and under investigation are reviewed and future avenues for research are suggested. The field of meningioma genomics has broad implications on the way meningiomas will be treated in the future, and is gradually shifting the way clinicians approach this diverse group of tumors.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias Meníngeas/genética , Meningioma/genética , Animais , Heterogeneidade Genética , Genômica , Humanos , Neoplasias Meníngeas/tratamento farmacológico , Neoplasias Meníngeas/embriologia , Meningioma/tratamento farmacológico , Meningioma/embriologia , Terapia de Alvo Molecular/métodos
15.
In Vivo ; 35(6): 3031-3037, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697134

RESUMO

Lipomatous meningioma (LM) is a form of metaplasia, originating from intracellular lipid bodies accumulation due to metabolic alterations. A comprehensive literature review was performed introducing further elements of evaluation. The parameters utilized were age, sex, location, clinical presentation, imaging features, treatment, and recurrences. Seizure and headache are the primary onsets of symptoms. Further LM clinical features, such as visual disturbances and visual epileptic seizures were examined. Symptoms may occur ten years prior to LM finding and it can resolve completely with the indicated surgery. LM computed tomography imaging analysis reveals hypodense regions due to the presence of fat content. On magnetic resonance imaging, the lesion displays hyperintense signal in T1-T2 with signal loss in the fat-suppression sequences. Immunohistochemically, lipidized meningioma cells are positive for Epithelial-Membrane Antigen, Vimentin, CD99, S-100 protein, and progesterone receptor. The recurrence risk rate of LM is estimated to be around 17%. Precise immune-histological findings have been correlated with imaging features to help with early diagnosis. A defined diagnosis of LM is a crucial factor in the choice of treatment.


Assuntos
Lipoma , Neoplasias Meníngeas , Meningioma , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
16.
Clin Nucl Med ; 46(11): e553-e555, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34606488

RESUMO

ABSTRACT: Meningiomas are typically benign and the most common primary brain tumors. They are usually diagnosed based on their characteristic appearance on both MRI and CT. Meningiomas can easily be misdiagnosed as metastasis of prostate cancer due to their high 68Ga-PSMA uptake on 68Ga-PSMA PET/CT. We present a case of a metastatic prostate adenocarcinoma with PSMA-avid lesion in the right frontal lobe on 68Ga-PSMA PET/CT. Later, MRI confirmed the brain lesion as meningioma.


Assuntos
Neoplasias Meníngeas , Meningioma , Neoplasias da Próstata , Ácido Edético , Isótopos de Gálio , Radioisótopos de Gálio , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata/diagnóstico por imagem
17.
Acta Neurochir (Wien) ; 163(11): 3201-3207, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34518903

RESUMO

BACKGROUND: The management of craniopharyngiomas is challenging, usually requiring multidisciplinary care. We evaluated the long-term clinical and radiologic outcomes of Gamma Knife radiosurgery (GKRS) for craniopharyngiomas. METHODS: This retrospective study involved patients managed with GKRS for a craniopharyngioma during the period of 1989 to 2019. Patient clinical and radiologic data, tumor characteristics, and procedural details were analyzed. RESULTS: Thirty-eight consecutive patients (24 males; mean patient age at GKRS = 30.82 years [SD ± 20.45 years]) were treated with GKRS for craniopharyngioma. Overall survival rates at 5 and 10 years were 84.1% and 80.1%, respectively. Progression-free survival at 5 years was 48.1%, and, at 10 years, it was 29.8%. Risk factors for post-GKRS clinical deterioration were increasing number of isocenters used (p = 0.04 (HR1.32, CI 1-1.73)), increasing margin dose [p = 0.02 (HR1.52, CI 1.31-1.84)], and maximum dose > 35 Gy [p = 0.002 (HR1.35, CI 1.11-1.63)]. CONCLUSION: Stereotactic radiosurgery (SRS) appears a safe and effective management option in selected craniopharyngioma patients. Increasing margin dose and maximum dose > 35 Gy are associated with an increased risk for post-SRS neurologic deficit. Further, well-designed studies are necessary to determine the optimal timing and SRS parameters and to identify which patients with craniopharyngioma will benefit the most from SRS.


Assuntos
Craniofaringioma , Neoplasias Meníngeas , Meningioma , Neoplasias Hipofisárias , Radiocirurgia , Craniofaringioma/radioterapia , Craniofaringioma/cirurgia , Seguimentos , Humanos , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Neoplasias Hipofisárias/radioterapia , Neoplasias Hipofisárias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
18.
N Engl J Med ; 385(11): 996, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34496175

RESUMO

BACKGROUND: Cerebral cavernous malformations (CCMs) are common sporadic and inherited vascular malformations of the central nervous system. Although familial CCMs are linked to loss-of-function mutations in KRIT1 (CCM1), CCM2, or PDCD10 (CCM3), the genetic cause of sporadic CCMs, representing 80% of cases, remains incompletely understood. METHODS: We developed two mouse models harboring mutations identified in human meningiomas with the use of the prostaglandin D2 synthase (PGDS) promoter. We performed targeted DNA sequencing of surgically resected CCMs from patients and confirmed our findings by droplet digital polymerase-chain-reaction analysis. RESULTS: We found that in mice expressing one of two common genetic drivers of meningioma - Pik3ca H1047R or AKT1 E17K - in PGDS-positive cells, a spectrum of typical CCMs develops (in 22% and 11% of the mice, respectively) instead of meningiomas, which prompted us to analyze tissue samples from sporadic CCMs from 88 patients. We detected somatic activating PIK3CA and AKT1 mutations in 39% and 1%, respectively, of lesion tissue from the patients. Only 10% of lesions harbored mutations in the CCM genes. We analyzed lesions induced by the activating mutations Pik3ca H1074R and AKT1 E17K in mice and identified the PGDS-expressing pericyte as the probable cell of origin. CONCLUSIONS: In tissue samples from sporadic CCMs, mutations in PIK3CA were represented to a greater extent than mutations in any other gene. The contribution of somatic mutations in the genes that cause familial CCMs was comparatively small. (Funded by the Fondation ARC pour la Recherche contre le Cancer and others.).


Assuntos
Classe I de Fosfatidilinositol 3-Quinases/genética , Malformações Arteriovenosas Intracranianas/genética , Mutação , Proteínas Proto-Oncogênicas c-akt/genética , Animais , Modelos Animais de Doenças , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/patologia , Proteína KRIT1/genética , Masculino , Meningioma/genética , Camundongos , Camundongos Endogâmicos
19.
Neurol Med Chir (Tokyo) ; 61(11): 647-651, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34470989

RESUMO

The significance of atypical histological features (AHF) as risk factors for recurrence in benign meningioma is not well understood. This study examined risk factors of World Health Organization (WHO) Grade I meningioma (GIM) recurrence, focusing on AHF. We investigated 150 consecutive newly diagnosed GIM patients who had more than one year of follow-up after resection in our hospital between January 2007 and March 2018. The following factors were reviewed retrospectively: age, sex, tumor location, extent of resection, MIB-1 index, mitotic figures, number and distribution of AHF, and recurrence. The patients were grouped according to the presence or absence of recurrence and comparatively examined. Recurrence was observed in 10 cases (6.7%). Univariate analysis showed that patients with recurrence had a significantly higher MIB-1 index (2.0 vs. 4.3; p = 0.006) and a significantly higher proportion of male patients (21.4% vs. 70.0%; p = 0.002) and patients with sheet-like growth (6.42% vs. 30.0%; p = 0.04). In multivariate analysis, skull base location (odds ratio [OR] 31.424; 95% confidence interval [CI] 1.74-569), gross total resection (OR 0.130; 95% CI 0.0189-0.897), and MIB-1 index (OR 1.939; 95% CI 1.19-3.15) were significantly associated with recurrence. Our study revealed that skull base location, subtotal resection, and high MIB-1 index were independent risk factors for recurrence. Only the presence of sheet-like growth had a significantly higher incidence in patients with recurrence in univariate analysis of AHF. Multivariate analysis found no significant association. Sheet-like growth may be involved in malignancy and recurrence of benign meningioma.


Assuntos
Neoplasias Meníngeas , Meningioma , Criança , Humanos , Masculino , Neoplasias Meníngeas/epidemiologia , Neoplasias Meníngeas/cirurgia , Meningioma/epidemiologia , Meningioma/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Organização Mundial da Saúde
20.
PLoS One ; 16(9): e0255133, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34582442

RESUMO

Meningioma is the second most common type of intracranial brain tumor. Immunohistochemical techniques have shown prodigious results in the role of epidermal growth factor receptor variant III (EGFR vIII) in glioma and other cancers. However, the role of EGFR vIII in meningioma is still in question. This study attempt the confer searches for the position attained by EGFR vIII in progression and expression of meningioma. Immunohistochemistry technique showed that EGFR vIII is highly expressed in benign tumors as compared to the atypical meningioma with a highly significant p-value (p<0.05). Further analysis by flow cytometry results supported these findings thus presented high intensity of EGFR vIII in low grades of meningioma. The study revealed that the significant Ki 67 values, to predictor marker for survival and prognosis of the patients. Higher expression of EGFR vIII in low grades meningiomas as compared to high-grade tumors indicate towards its oncogenic properties. To our knowledge, limited studies reported in literature expressing the EGFR vIII in meningioma tumors. Hence, Opinions regarding the role that EGFR vIII in tumorigenesis and tumor progression are clearly conflicting and, therefore, it is crucial not only to find out its mechanism of action, but also to definitely identify its role in meningioma.


Assuntos
Biomarcadores Tumorais/metabolismo , Receptores ErbB/metabolismo , Variação Genética , Neoplasias Meníngeas/patologia , Meningioma/patologia , Biomarcadores Tumorais/genética , Receptores ErbB/genética , Humanos , Neoplasias Meníngeas/genética , Neoplasias Meníngeas/metabolismo , Meningioma/genética , Meningioma/metabolismo , Pessoa de Meia-Idade , Gradação de Tumores
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