Meningioma classification: Difference between revisions

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Latest revision as of 20:51, 19 September 2019

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 has been classified into 3 groups by the WHO: benign classic meningioma (WHO grade 1), atypical meningioma (WHO grade 2), and anaplastic malignant meningioma (WHO grade 3). The WHO grade 1 group grow very slowly and consists of about 9 variants. About 3 variants correspond to WHO grade II, their association with malignancy is not clear but they grow faster than benign meningiomas. About 2 variants correspond to WHO grade III.

Classification

WHO has classified meningiomas into histological 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, and three in WHO grade III and are anaplastic malignant meningiomas.^[1]

The table below lists the subtypes of meningioma according to the WHO grades:^[1]^[2]


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. These are not clearly malignant, but grow faster than benign meningiomas 4 or more mitotic cells per hpf and/or 3 or more of the following features: small cells, increased cellularity, necrosis, prominent nucleoli, sheeting, &/or brain invasion in an otherwise Grade I tumor
Anaplastic malignant meningioma (WHO grade 3)	Rhabdoid, papillary, and anaplastic meningioma 20 or more mitoses per 10 hpf and/or possess cytological characteristics of an obvious malignancy such that the tumor cell resembles carcinoma, sarcoma, or melanoma.

Gallery

Meningothelial meningioma Source: Case courtesy of Dr Victor Yang, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.

Psammomatous meningioma Source: Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.

Papillary meningioma Source: Jensflorian-wikimedia commons

Alcian blue histologic slide showing chordoid meningioma Source: Jensflorian-wikimedia commons

References

↑ ^1.0 ^1.1 Harter, Patrick N.; Braun, Yannick; Plate, Karl H. (2017). "Classification of meningiomas—advances and controversies". Chinese Clinical Oncology. 6 (S1): S2–S2. doi:10.21037/cco.2017.05.02. ISSN 2304-3865.
↑ 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.

[HarterBraun2017-1] 1.0 ^1.1 Harter, Patrick N.; Braun, Yannick; Plate, Karl H. (2017). "Classification of meningiomas—advances and controversies". Chinese Clinical Oncology. 6 (S1): S2–S2. doi:10.21037/cco.2017.05.02. ISSN 2304-3865.

[ComminsAtkinson2007-2] 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.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Meningioma}}
-{{CMG}} {{AE}}{{HL}}
+{{CMG}} {{AE}} {{IO}} {{HL}}
 ==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.<ref name="Wiki">Meningioma diagnosis. Wikipedia (2015) https://en.wikipedia.org/wiki/Meningioma#History_and_nomenclature Accessed on September, 25 2015</ref><ref name="L">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview Accessed on September, 25 2015</ref>
+Meningioma has been [[Classification|classified]] into 3 groups by the [[World Health Organization|WHO]]: [[benign]] classic meningioma ([[WHO]] grade 1), atypical meningioma ([[World Health Organization|WHO]] grade 2), and [[anaplastic]] [[malignant]] meningioma ([[World Health Organization|WHO]] grade 3). The [[World Health Organization|WHO]] grade 1 group grow very slowly and consists of about 9 variants. About 3 variants correspond to [[World Health Organization|WHO]] grade II, their association with [[Cancer|malignancy]] is not clear but they grow faster than [[benign]] meningiomas. About 2 variants correspond to [[World Health Organization|WHO]] grade III.
 ==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.<ref name="HarterBraun2017">{{cite journal|last1=Harter|first1=Patrick N.|last2=Braun|first2=Yannick |last3=Plate|first3=Karl H. |title=Classification of meningiomas—advances and controversies|journal=Chinese Clinical Oncology|volume=6|issue=S1|year=2017|pages=S2–S2|issn=23043865|doi=10.21037/cco.2017.05.02}}</ref>
+*[[World Health Organization|WHO]] has [[Classification|classified]] meningiomas into [[Histology|histological]] and cytomorphological variants. Nine variants correspond to [[World Health Organization|WHO]] grade I which are the [[benign]] classic meningiomas, three correspond to [[World Health Organization|WHO]] grade II which are atypical meningiomas, and three in [[World Health Organization|WHO]] grade III and are [[anaplastic]] [[malignant]] meningiomas.<ref name="HarterBraun2017">{{cite journal|last1=Harter|first1=Patrick N.|last2=Braun|first2=Yannick |last3=Plate|first3=Karl H. |title=Classification of meningiomas—advances and controversies|journal=Chinese Clinical Oncology|volume=6|issue=S1|year=2017|pages=S2–S2|issn=23043865|doi=10.21037/cco.2017.05.02}}</ref>
-:*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:<ref name="HarterBraun2017">{{cite journal|last1=Harter|first1=Patrick N.|last2=Braun|first2=Yannick |last3=Plate|first3=Karl H. |title=Classification of meningiomas—advances and controversies|journal=Chinese Clinical Oncology|volume=6|issue=S1|year=2017|pages=S2–S2|issn=23043865|doi=10.21037/cco.2017.05.02}}</ref>
+*The table below lists the subtypes of meningioma according to the [[World Health Organization|WHO]] grades:<ref name="HarterBraun2017">{{cite journal|last1=Harter|first1=Patrick N.|last2=Braun|first2=Yannick |last3=Plate|first3=Karl H. |title=Classification of meningiomas—advances and controversies|journal=Chinese Clinical Oncology|volume=6|issue=S1|year=2017|pages=S2–S2|issn=23043865|doi=10.21037/cco.2017.05.02}}</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>
 {| style="border: 0px solid #DCDCDC; font-size: 90%; width: 60%;"
-|valign=top|
+| valign="top" |
+|
 |+
-! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|WHO grade  }}
+! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|WHO Grade  }}
 ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Subtypes}}
 |-
@@ Line 26: / Line 21: @@
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Meningothelial, fibrous, [[transitional]], psammomatous,<br> angiomatous, micrcystic, secretory, lymphoplasmacyte-rich, and metaplastic meningioma
-*They are low-grade tumors that grow very slowly and rarely invade the surrounding [[tissues]]
+*They are low-grade [[Tumor|tumors]] that grow very slowly and rarely invade the surrounding [[tissues]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
 Atypical meningioma<br> (WHO grade 2)
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Chordoid, clear cell, and atypical meningioma. [[clear cell]] meningioma
+*Chordoid, clear cell, and atypical meningioma.
-*These are not clearly [[malignant]], but grow faster than benign meningiomas
+*These are not clearly [[malignant]], but grow faster than [[benign]] meningiomas
-*They have increased mitosis and can invade the brain
+*4 or more mitotic cells per hpf and/or 3 or more of the following features: small cells, increased cellularity, [[necrosis]], prominent [[nucleoli]], sheeting, &/or brain invasion in an otherwise Grade I [[tumor]]
-*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).
 |-
 | style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
 Anaplastic malignant meningioma<br> (WHO grade 3)
 | style="padding: 5px 5px; background: #F5F5F5;" |
-Rhabdoid, papillary, and anaplastic meningioma
+*Rhabdoid, papillary, and anaplastic meningioma
+*20 or more mitoses per 10 hpf and/or possess cytological characteristics of an obvious [[malignancy]] such that the [[tumor]] cell resembles [[carcinoma]], [[sarcoma]], or [[melanoma]].
 |}
-*Meningioma may also be classified according to the [[tumor]] location into 2 main subtypes: intradural and extradural meningioma.<ref name="Wiki">Meningioma diagnosi. Wikipedia(2015) https://en.wikipedia.org/wiki/Meningioma#History_and_nomenclature Accessed on September, 25 2015</ref><ref name="L">Meningioma. Liberpathology(2015) http://librepathology.org/wiki/index.php/Meningioma#Quick_overview Accessed on September, 25 2015</ref>
+==Gallery==
+[[File:Meningioma-histopathology-1.jpg|400px|thumb|left|Meningothelial meningioma [https://radiopaedia.org/articles/meningioma?lang=us Source: Case courtesy of Dr Victor Yang, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.]]]
+<br style="clear:left" />
+[[File:Psammomatous meningioma histopathology.jpg|400px|thumb|left|Psammomatous meningioma [https://radiopaedia.org/articles/meningioma?lang=us Source: Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.]]]
+<br style="clear:left" />
+[[File:Papillary meningioma HE.jpg|400px|thumb|left|Papillary meningioma [https://commons.wikimedia.org/wiki/File:Papillary_meningioma_HE.jpg Source: Jensflorian-wikimedia commons]]]
+<br style="clear:left" />
+[[File:Chordoid meningioma.jpg|400px|thumb|left|Alcian blue histologic slide showing chordoid meningioma [https://commons.wikimedia.org/wiki/File:Alcian_blue_chordoid_meningioma.jpg Source: Jensflorian-wikimedia commons]]]
+<br style="clear:left" />
 ==References==
 {{Reflist|2}}
 [[Category:Disease]]