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Intracranial Papillary Meningioma: A Clinicopathologic Study of 30 Cases at a Single Institution

Wang, Xiao-Qiang MD, PhD*,‡; Chen, Hong MD*,§; Zhao, Lin MD; Li, Shi-Ting MD, PhD; Hu, Jie MD; Mei, Guang-Hai MD; Jiang, Cheng-Chuan MD

doi: 10.1227/NEU.0000000000000133
Research-Human-Clinical Studies

BACKGROUND: Papillary meningioma (PM) is an uncommon meningioma subtype, and the clinical characteristics remain unclear.

OBJECTIVE: To determine the clinical characteristics and prognosis of PM.

METHODS: The clinical data of 30 PM patients were collected, the samples were reexamined, and the patients' prognoses were based on clinical observations and calculated according to the Kaplan-Meier method.

RESULTS: The 30 patients included 16 males and 14 females (median: 34.0 years upon initial diagnosis). Of the 48 intracranial operations in the 30 patients, total removal was attained in 34 surgeries, and subtotal removal in 14 surgeries. Radiotherapy was provided in 20 patients. In 40 specimens with follow-up, 29 attained the positive aggressive factors. Six tumors showed positive progestogen receptor (PR) combined with negative Bcl-2. The median follow-up period was 39.0 months. Tumor recurrence occurred in 18 patients (median: 17.0 months); the recurrence rates following total removal and subtotal removal were 57.1% and 100%, respectively. Fourteen patients died of the recurrence. In the univariate analyses, positive aggressive factors (P = .021), positive PR combined with negative Bcl-2 immunoreactivity (P = .011), the extent of resection (P = .001), and radiotherapy (P = .002) were significantly related to progression-free survival. The MIB-1 labeling index was not significantly related to progression-free survival (P = .88).

CONCLUSION: PM is a rare subtype of meningioma with a tendency of recurrence. The extent of resection is an important prognosis factor. The presence of positive histopathological index increases the recurrence risk. Positive PR combined with negative Bcl-2 immunoreaction might predict a good prognosis. Postoperative radiotherapy may play a vital role in prolonging the time to tumor recurrence.

ABBREVIATIONS: EGFR, epidermal growth factor receptor

EMA, epithelial membrane antigen

ER, estrogen receptor

GFAP, glial fibrillary acidic protein

GTR, gross total resection

HPF, high-power field

MIB-1 LI, MIB-1 labeling index

PM, papillary meningioma

PR, progestogen receptor

STR, subtotal resection

WHO, World Health Organization

Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China;

§Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai, China;

Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

Correspondence: Cheng-Chuan Jiang, No.12 Middle Wulumuqi Rd, Shanghai 200040, China. E-mail: jiangcc2000@163.com, and Shi-Ting Li, No. 1665 Kongjiang Rd, Shanghai 200092, China. E-mail: lishiting12@126.com

* These authors have contributed equally to this article.

Received September 29, 2012

Accepted August 01, 2013

Copyright © by the Congress of Neurological Surgeons