case_images: PMC10702344_01
case_images: Time course and clinical findings of the progressive meningioma. (A) The diagram shows the time course of treatment and tumor progression. Preoperative magnetic resonance imaging (MRI) using gadolinium-enhanced T1 imaging (Gd-T1WI) of the parasagittal sinus meningioma at the second (B) and third (C) surgeries. Pathological features of the tumor at the third surgery indicate overt anaplasia by malignant progression with hematoxylin and eosin (H&E) staining (D) and high mitotic features in Ki-67 staining (E) under x400 magnification (scale bar = 50 mum). Preoperative Gd-T1WI before the fourth tumor removal (F). H&E staining (G) and Ki67 staining (H) at the fourth surgery (original magnification, x400; scale bar = 50 mum). Postoperative follow-up imaging using Gd-T1WI shows tumor progression in the posterior cavity (I).
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case_images: Health Organization (WHO) grade 1, at another hospital (Figure 1A). He had no significant medical history or family history of meningioma. After gamma knife radiosurgery for recurrence at the age of 61 years, a second resection had been performed at 65 years of age due to progressive tumor growth with histological transformation to a WHO grade 2 atypical meningioma (Figure 1B). Due to tumor regrowth, he was referred to our hospital for a third surgery at 71 years of age (Figure 1C). The pathological specimen of the tumor indicated a diagnosis of malignant progression to anaplastic meningioma, WHO grade 3, with overt anaplasia and a high Ki-67 index (Figures 1D,E). Two years later, a fourth surgical resection was required with progressive gait disturbance, and the patient was again diagnosed with an anaplastic meningioma (Figures 1F-H). Another recurrent lesion progressed toward the eloquent motor area at the posterior aspect of the tumor removal cavity (Figure 1I); however, surgical resection of the lesion was associated with a high risk of postoperative paralysis, and additional radiotherapy was ineffective.
case_images: A paired analysis with Todai OncoPanel. Chromosomal copy number variations in anaplastic meningioma. The upper panel shows the total copy number, and the lower panel shows the allelic copy number ratio with B allele frequency at the fourth (A) and third surgeries (B). Implications for driver events along with tumor progression (C).
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case_images: fig2
case_images: We also found multiple chromosomal copy number losses, including 1p/22q co-deletion (Figure 2A). Although the profile of the chromosomal CNVs of Tumor S3 was similar to that of Tumor S4, some chromosomal changes, such as the gain of 1q, 6p, and 14q and the loss of 4q and 10p, were additionally observed in Tumor S4 (Figure 2B), suggesting that Tumor S4 exhibits a pattern of branched clonal evolution from Tumor S3 (Figure 2C).