Article
Recurring meningiomas
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Published: | May 30, 2008 |
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Outline
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Objective: The aims of our study are:
- to cut off a group of benign meningiomas recurring after total removal and to find out their incidence and clinical behaviour.
- to study their adhesion molecules expression: epithelial and neural cadherines. The aim is to find out if lower cohesion of the neoplastic cells causes themselves seeding in the CSF space. Actually, recurrence is supposed to be the growth of neoplastic elements near or far from the primitive tumor.
- to check recurrences surgical treatment effectiveness.
Methods: Pts. with a I or II surgical Simpson degree selected from 1386 consecutive pts. operated between 1980 and 1997. Average follow-up of 17 years.
Total removal was confirmed by postoperative CT or NMR.
E-cad and N-cad expression was studied with immunohistochemical (in 21 pts.) and Western-blot (in 5 pts) techniques (also in comparison with non-recurring meningiomas).
Ki-67 expression was assessed in 20 cases.
Genetic research was carried out in 2 pts.
Results: 26 meningiomas (3,5%) recurred after total removal (20 benign, 5 atypic, 1 anaplastic). The average Ki-67 positive cells was 3% in benign meningiomas, 7% in atypical meningiomas. N-cad was not expressed in any case (control-cases included).
E-cad was expressed in less than 70% of the cells of the 15 benign meningiomas studied, in 2 of the atypical meningiomas and in the anaplstic one. In comparison with non-recurring meningiomas, a lower intensity band was present in the Western-blot of 4 (benign) of the 5 pts. studied (absent in 1:atypical).
Both studied pts. presented normal karyotype.
16 of the 20 pts with benign meningiomas are alive after more than 11 years since the first operation. Four pts. dead respectively after 9, 16, 16 and18 years since the first operation (one due to non meningiomas-related causes). None underwent RT. Pts. underwent to 2-6 operations.
Conclusions: Recurrence in some benign meningiomas might be due to cellular adhesion molecules deficit. We think that in these peculiar meningiomas surgery alone remains the treatment of first choice for recurrences.