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http://dx.doi.org/10.3340/jkns.2021.0114

Clinical Implications of the Mitotic Index as a Predictive Factor for Malignant Transformation of Atypical Meningiomas  

Kwon, Sae Min (Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine)
Kim, Jeong Hoon (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Kim, Young-Hoon (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Hong, Seok Ho (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Cho, Young Hyun (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Kim, Chang Jin (Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine)
Nam, Soo Jeong (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.65, no.2, 2022 , pp. 297-306 More about this Journal
Abstract
Objective : Intracranial atypical meningiomas have a poor prognosis and high rates of recurrence. Moreover, up to one-third of the recurrences undergo high-grade transformation into malignant meningiomas. We aimed to investigate the clinical factors that can predict the propensity of malignant transformation from atypical to anaplastic meningiomas. Methods : Between 2001 and 2018, all patients with atypical meningioma, in whom the tumors had undergone malignant transformation to anaplastic meningioma, were included. The patients' medical records documenting the diagnosis of atypical meningioma prior to malignant transformation were reviewed to identify the predictors of transformation. The control group comprised 56 patients with atypical meningiomas who were first diagnosed between January 2017 and December 2018 and had no malignant transformation. Results : Nine patients in whom the atypical meningiomas underwent malignant transformation were included. The median time interval from diagnosis of atypical meningioma to malignant transformation was 19 months (range, 7-78). The study group showed a significant difference in heterogeneous enhancement (77.8% vs. 33.9%), bone invasion (55.6% vs. 12.5%), mitotic index (MI; 14.8±4.9 vs. 3.5±3.9), and Ki-67 index (20.7±13.9 vs. 9.5±7.1) compared with the control group. In multivariate analysis, increased MI (odds ratio, 1.436; 95% confidence interval, 1.127-1.900; p=0.004) was the only significant factor for predicting malignant transformation. Conclusion : An increased MI within atypical meningiomas might be used as a predictor of malignant transformation. Tumors at high risk for malignant transformation might require more attentive surveillance and management than other atypical meningiomas.
Keywords
Mitotic index; Atypical meningioma; Malignant transformation;
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