Advertisement

Journal of Neuro-Oncology

, Volume 126, Issue 1, pp 107–116 | Cite as

Predictors of recurrence in the management of chordoid meningioma

  • Winward Choy
  • Leonel Ampie
  • Jonathan B. Lamano
  • Kartik Kesavabhotla
  • Qinwen Mao
  • Andrew T. Parsa
  • Orin BlochEmail author
Clinical Study

Abstract

Management of chordoid meningiomas (CMs) is complicated by high rates of recurrence, particularly following subtotal resection. Optimal management is not established given the paucity of published experience. To identify prognostic factors for recurrence following resection, the authors conducted the largest systematic review of CMs to date. A comprehensive search on MEDLINE (OVID and Pubmed), Scopus, Embase, and Web of Science utilizing the search terms “chordoid” AND “meningioma” was performed to identify all reports of pathologically confirmed intracranial CMs. A total of 221 patients were included, comprising 120 females and 101 males. Mean age, MIB-1/Ki67, and tumor size was 45.5 years, 4.3 % (range 0.1–26.6 %), and 4.1 cm (range 0.8–10 cm), respectively. 5-, and 10- year progression free survival was 67.5 and 54.4 %, respectively. Gross total resection (GTR) and subtotal resection was achieved in 172 and 48 patients, respectively. Adjuvant radiotherapy (RT) was given to 30 patients. Multivariate analysis found GTR was strongly correlated with decreased recurrence rates (HR 0.04, p = <0.0001), while higher MIB-1 labeling index (≥5 vs <5 %) was associated with increased recurrence (HR 7.08; p = 0.016). Adjuvant RT, age, gender, and tumor location were not associated with recurrence. GTR resection is the strongest predictor of tumor control, and should be the goal to minimize local progression. Additionally, higher MIB-1 labeling was associated with increased rates of tumor recurrence. Tumors that are subtotally resected or demonstrate higher MIB-1 are at greater recurrence and warrant consideration for RT and close long term follow up.

Keywords

Chordoid Meningioma Surgery Atypical Radiation therapy 

Notes

Author contributions

The manuscript are as follows: Conception and design (Ampie, Choy, Bloch), acquisition of data (Ampie and Choy), statistical analysis (Choy), interpretation of data (Choy and Ampie), drafting article (Choy and Ampie), revising the article (all authors).

Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest to report. Support was derived from the Howard Hughes Medical Institute (LA).

References

  1. 1.
    Kleihues P, Louis DN, Scheithauer BW, Rorke LB, Reifenberger G, Burger PC, Cavenee WK (2002) The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61:215–225; discussion 226–219Google Scholar
  2. 2.
    Couce ME, Aker FV, Scheithauer BW (2000) Chordoid meningioma: a clinicopathologic study of 42 cases. Am J Surg Pathol 24:899–905PubMedCrossRefGoogle Scholar
  3. 3.
    Epari S, Sharma MC, Sarkar C, Garg A, Gupta A, Mehta VS (2006) Chordoid meningioma, an uncommon variant of meningioma: a clinicopathologic study of 12 cases. J Neurooncol 78:263–269. doi: 10.1007/s11060-005-9092-y PubMedCrossRefGoogle Scholar
  4. 4.
    Kepes JJ, Chen WY, Connors MH, Vogel FS (1988) “Chordoid” meningeal tumors in young individuals with peritumoral lymphoplasmacellular infiltrates causing systemic manifestations of the Castleman syndrome. A report of seven cases. Cancer 62:391–406PubMedCrossRefGoogle Scholar
  5. 5.
    Kozler P, Benes V, Netuka D, Kramar F, Hrabal P, Charvat F (2008) Chordoid meningioma: presentation of two case reports, review of the literature, and plea for data standardisation. J Neurooncol 88:115–120. doi: 10.1007/s11060-008-9541-5 PubMedCrossRefGoogle Scholar
  6. 6.
    Lin JW, Ho JT, Lin YJ, Wu YT (2010) Chordoid meningioma: a clinicopathologic study of 11 cases at a single institution. J Neurooncol 100:465–473. doi: 10.1007/s11060-010-0211-z PubMedCrossRefGoogle Scholar
  7. 7.
    Wang XQ, Mei GH, Zhao L, Li ST, Gong Y, Zhong J, Chen H, Jiang CC (2013) Clinical features and treatment of intracranial chordoid meningioma: a report of 30 cases. Histopathology 62:1002–1017. doi: 10.1111/his.12113 PubMedCrossRefGoogle Scholar
  8. 8.
    Zhu HD, Chen H, Xie Q, Gong Y, Mao Y, Zhong P, Che XM, Jiang CC, Huang FP, Zheng K, Li SQ, Gu YX, Bao WM, Yang BJ, Wu JS, Wang Y, Xie LQ, Zheng MZ, Tang HL, Wang DJ, Chen XC, Zhou LF (2013) Chordoid meningioma: a retrospective study of 17 cases at a single institution. Chin Med J 126:789–791PubMedGoogle Scholar
  9. 9.
    Di Ieva A, Laiq S, Nejad R, Schmitz EM, Fathalla H, Karamchandani J, Munoz DG, Cusimano MD (2014) Chordoid meningiomas: incidence and clinicopathological features of a case series over 18 years. Neuropathology. doi: 10.1111/neup.12174 PubMedGoogle Scholar
  10. 10.
    Kano T, Nakazato Y, Tamura M, Ohye C, Zama A, Saito F, Tomizawa S (2009) Ultrastructural and immunohistochemical study of an adult case of chordoid meningioma. Brain Tumor Pathol 26:37–42. doi: 10.1007/s10014-009-0245-0 PubMedCrossRefGoogle Scholar
  11. 11.
    Barresi V, Cerasoli S, Paioli G, Vitarelli E, Giuffre G, Guiducci G, Tuccari G, Barresi G (2006) Caveolin-1 in meningiomas: expression and clinico-pathological correlations. Acta Neuropathol 112:617–626. doi: 10.1007/s00401-006-0097-1 PubMedCrossRefGoogle Scholar
  12. 12.
    Jee TK, Jo KI, Seol HJ, Kong DS, Lee JI, Shin HJ (2014) Clinical features and treatment outcome of chordoid meningiomas in a single institute. J Korean Neurosurg Soc 56:194–199. doi: 10.3340/jkns.2014.56.3.194 PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Kumar S, Tatke M, Husain Z (1996) Chordoid meningioma associated with chronic subdural hematoma. Indian Pediatr 33:783–785PubMedGoogle Scholar
  14. 14.
    de Tella OI, Jr, Herculano MA, Prandini MN, Stavile JN, Bonatelli Ade P (2003) Chordoid meningioma: report of two cases. Arq de Neuro-Psiquiatr 61:91–94Google Scholar
  15. 15.
    Mullassery D, O’Brien DF, Williams D, Crooks D, Mallucci C, Pizer B, Thorp N, McDowell H (2006) Malignant disseminated chordoid meningioma in a 12-year-old child: a role for early cranial and spinal radiation treatment after subtotal resection. Child’s Nerv Syst 22:1344–1350. doi: 10.1007/s00381-006-0096-5 CrossRefGoogle Scholar
  16. 16.
    Lin JW, Lu CH, Lin WC, Wu YT, Huang YJ, Shih FY, Ho JT, Chuang MJ (2012) A clinicopathological study of the significance of the proportion of choroid morphology in chordoid meningioma. Jo Clin Neurosci 19:836–843. doi: 10.1016/j.jocn.2011.08.037 CrossRefGoogle Scholar
  17. 17.
    Hasegawa S, Yoshioka S, Urabe S, Kuratsu J (2006) Rapidly enlarging chordoid meningioma with abundant mucin production. Neuropathology 26:438–441PubMedCrossRefGoogle Scholar
  18. 18.
    Mawrin C, Perry A (2010) Pathological classification and molecular genetics of meningiomas. J Neuro-Oncol 99:379–391. doi: 10.1007/s11060-010-0342-2 CrossRefGoogle Scholar
  19. 19.
    Arima T, Natsume A, Hatano H, Nakahara N, Fujita M, Ishii D, Wakabayashi T, Doyu M, Nagasaka T, Yoshida J (2005) Intraventricular chordoid meningioma presenting with Castleman disease due to overproduction of interleukin-6. Case report. J Neurosurg 102:733–737. doi: 10.3171/jns.2005.102.4.0733 PubMedCrossRefGoogle Scholar
  20. 20.
    McIver JI, Scheithauer BW, Atkinson JL (2005) Deep sylvian fissure chordoid meningioma: case report. Neurosurgery 57:E1064; discussion E1064Google Scholar
  21. 21.
    Choy W, Kim W, Nagasawa D, Stramotas S, Yew A, Gopen Q, Parsa AT, Yang I (2011) The molecular genetics and tumor pathogenesis of meningiomas and the future directions of meningioma treatments. Neurosurg Focus 30:E6. doi: 10.3171/2011.2.FOCUS1116 PubMedGoogle Scholar
  22. 22.
    Hug EB, Devries A, Thornton AF, Munzenride JE, Pardo FS, Hedley-Whyte ET, Bussiere MR, Ojemann R (2000) Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neuro-Oncol 48:151–160CrossRefGoogle Scholar
  23. 23.
    Lo SS, Cho KH, Hall WA, Kossow RJ, Hernandez WL, McCollow KK, Gerbi BJ, Higgins PD, Lee CK, Dusenbery KE (2002) Single dose versus fractionated stereotactic radiotherapy for meningiomas. Can J Neurol Sci 29:240–248PubMedCrossRefGoogle Scholar
  24. 24.
    Abramovich CM, Prayson RA (2000) Apoptotic activity and bcl-2 immunoreactivity in meningiomas. Association with grade and outcome. Am J Clin Pathol 114:84–92. doi: 10.1309/ULMT-V1UC-D69H-MMQF PubMedCrossRefGoogle Scholar
  25. 25.
    Moiyadi AV, Sridhar E, Gupta T, Ramadwar M (2010) A primary optic nerve sheath chordoid meningioma. J Clin Neurosci 17:397–399. doi: 10.1016/j.jocn.2009.05.035 PubMedCrossRefGoogle Scholar
  26. 26.
    Nambiar A, Pillai A, Parmar C, Panikar D (2012) Intraventricular chordoid meningioma in a child: fever of unknown origin, clinical course, and response to treatment. J Neurosurg Pediatr 10:478–481. doi: 10.3171/2012.9.PEDS11398 PubMedCrossRefGoogle Scholar
  27. 27.
    Marcus HJ, Price SJ, Wilby M, Santarius T, Kirollos RW (2008) Radiotherapy as an adjuvant in the management of intracranial meningiomas: are we practising evidence-based medicine? Br J Neurosurg 22:520–528. doi: 10.1080/02688690802308687 PubMedCrossRefGoogle Scholar
  28. 28.
    Yew A, Trang A, Nagasawa DT, Spasic M, Choy W, Garcia HM, Yang I (2013) Chromosomal alterations, prognostic factors, and targeted molecular therapies for malignant meningiomas. J Clin Neurosci 20:17–22. doi: 10.1016/j.jocn.2012.02.007 PubMedCrossRefGoogle Scholar
  29. 29.
    Sandberg MM, Hirvonen HE, Elima KJ, Vuorio EI (1993) Co-expression of collagens II and XI and alternative splicing of exon 2 of collagen II in several developing human tissues. Biochem J 294(Pt 2):595–602PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Whittle IR, Smith C, Navoo P, Collie D (2004) Meningiomas. Lancet 363:1535–1543. doi: 10.1016/S0140-6736(04)16153-9 PubMedCrossRefGoogle Scholar
  31. 31.
    Amatya VJ, Takeshima Y, Sugiyama K, Kurisu K, Nishisaka T, Fukuhara T, Inai K (2001) Immunohistochemical study of Ki-67 (MIB-1), p53 protein, p21WAF1, and p27KIP1 expression in benign, atypical, and anaplastic meningiomas. Hum Pathol 32:970–975. doi: 10.1053/hupa.2001.27119 PubMedCrossRefGoogle Scholar
  32. 32.
    Ho DM, Hsu CY, Ting LT, Chiang H (2002) Histopathology and MIB-1 labeling index predicted recurrence of meningiomas: a proposal of diagnostic criteria for patients with atypical meningioma. Cancer 94:1538–1547PubMedCrossRefGoogle Scholar
  33. 33.
    Lee J, Yu HJ, Lee J, Kim JH, Shin HJ, Suh YL (2014) Lee M (2014) Chordoid meningioma in a pediatric patient with tuberous sclerosis complex. Korean J Pathol 48:302–306. doi: 10.4132/KoreanJPathol.48.4.302 PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Duric KS, Nemir J, Jednacak H, Mrak G, Zarkovic K, Miklic P (2014) Third ventricular chordoid meningeoma or chordoma: diagnostic dilemma based on a single case. Case report and literature review. 24th ESPN Congress (Rome-Italy May 4–7, 2014)—Session 13 Advances in Pediatric Oncology IIGoogle Scholar
  35. 35.
    Yang SF, You C, Sun H, Liu JG (2013) Chordoid meningioma of the fourth ventricle. Neurosurg Quart 23:247–248. doi: 10.1097/Wnq.0b013e318275ddd2 CrossRefGoogle Scholar
  36. 36.
    Sriram PR (2013) Chordoid meningioma, part of a multiple intracranial meningioma: a case report & review. Malays J Med Sci 20:91–94PubMedCentralPubMedGoogle Scholar
  37. 37.
    Passacantilli E, Lapadula G, Caporlingua F, Lenzi J, Antonelli M, Santoro F, Santoro A (2013) Chordoid meningioma: a retrospective series of seven consecutive cases. Neurol Sci 34:1985–1989. doi: 10.1007/s10072-013-1431-8 PubMedCrossRefGoogle Scholar
  38. 38.
    Lee KH, Lall RR, Chandler JP, Bigio EH, Mao Q (2013) Pineal chordoid meningioma complicated by repetitive hemorrhage during pregnancy: case report and literature review. Neuropathology 33:192–198. doi: 10.1111/j.1440-1789.2012.01337.x PubMedCrossRefGoogle Scholar
  39. 39.
    Xi S, Zhang Y, Lin S, Liang J, Zeng J, Wu Q (2012) Intraparenchymal chordoid meningioma: a case report and review of the literature. Int J Surg Pathol 20:600–605. doi: 10.1177/1066896912449043 PubMedCrossRefGoogle Scholar
  40. 40.
    Zhao SL, Li Y, Tian XY, Li Z, Huang Q, Li B (2011) Intraparenchymal cystic chordoid meningioma: a case report and review of the literature. Neuropathology 31:648–653. doi: 10.1111/j.1440-1789.2011.01214.x PubMedCrossRefGoogle Scholar
  41. 41.
    Campos-Franco J, Otero E, Lopez-Garcia E, Abdulkader I, Gonzalez-Quintela A (2011) Chordoid meningioma in a patient with lymphangioleiomyomatosis. J Neuro-Oncol 105:667–669. doi: 10.1007/s11060-011-0622-5 CrossRefGoogle Scholar
  42. 42.
    Kaloshi G, Antonelli M, Vreto G, Lame A, Kerri I, Bushati T, Rroji A, Petrela M (2011) Report of two cases of chordoid meningioma in patients with Castleman syndrome. J Neuro-Oncol 104:395–397. doi: 10.1007/s11060-010-0483-3 CrossRefGoogle Scholar
  43. 43.
    Malloy KA, Chigbu DI (2011) Anterior temporal chordoid meningioma causing compressive optic neuropathy. Optom Vis Sci 88:645–651. doi: 10.1097/OPX.0b013e3182114320 PubMedCrossRefGoogle Scholar
  44. 44.
    Jeon CJ, Kim MJ, Lee JS, Lee JH, Kong DS, Shin HJ, Suh YL, Kim KM, Choe YH (2010) Castleman’s disease associated with a cerebellar chordoid meningioma and intestinal lymphangiectasia. Child’s Nerv Syst 26:1647–1652. doi: 10.1007/s00381-010-1196-9 CrossRefGoogle Scholar
  45. 45.
    Wind JJ, Jones RV, Roberti F (2010) Fourth ventricular chordoid meningioma. J Clin Neurosci 17:1301–1303. doi: 10.1016/j.jocn.2010.03.013 PubMedCrossRefGoogle Scholar
  46. 46.
    Fukushima S, Terasaki M, Shigemori M (2008) Chordoid meningioma arising in the pineal region: a case report. Brain tumor Pathol 25:91–95. doi: 10.1007/s10014-008-0235-7 PubMedCrossRefGoogle Scholar
  47. 47.
    Song KS, Park SH, Cho BK, Wang KC, Phi JH, Kim SK (2008) Third ventricular chordoid meningioma in a child. J Neurosurg Pediatr 2:269–272. doi: 10.3171/PED.2008.2.10.269 PubMedCrossRefGoogle Scholar
  48. 48.
    Scott A, Sharkawi E, Micallef C, Johns P, Grant L (2008) Chordoid meningioma presenting as painful orbital apex syndrome in pregnancy. Int Ophthalmol 28:355–357. doi: 10.1007/s10792-007-9135-9 PubMedCrossRefGoogle Scholar
  49. 49.
    Marhx-Bracho A, Rueda-Franco F, Ibarra-de la Torre A, Garcia-Gonzalez O, Bornstein-Quevedo L, de Leon-Bogorge B (2008) Chordoid meningioma of the foramen magnum in a child: a case report and review of the literature. Child’s Nerv Syst 24:623–627. doi: 10.1007/s00381-007-0568-2 CrossRefGoogle Scholar
  50. 50.
    Liu AJ, Wang FL, Li XH (2007) Chordoid meningioma: a report of two cases. Chin Med J 120:726–728PubMedGoogle Scholar
  51. 51.
    Lui PC, Chau TK, Wong SS, Lau PP, Tse GM, Thomas TM, Ng HK (2007) Cytology of chordoid meningioma: a series of five cases with emphasis on differential diagnoses. J Clin Pathol 60:1024–1028. doi: 10.1136/jcp.2006.040204 PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Donato G, Ferraro G, Signorelli F, Iofrida G, Lavano A, Amorosi A, Maltese L, Perrotta I, Tripepi S, Pardatscher K, Signorelli CD (2006) Chordoid meningioma: case report and literature review. Ultrastruct Pathol 30:309–314. doi: 10.1080/01913120600820591 PubMedCrossRefGoogle Scholar
  53. 53.
    Takei H, Rivera A, Suzuki H, Bahrami A, Powell SZ (2006) Jugular foramen chordoid meningioma. Pathol Int 56:397–401. doi: 10.1111/j.1440-1827.2006.01976.x PubMedCrossRefGoogle Scholar
  54. 54.
    Matyja E, Grajkowska W, Lazarczyk M, Marchel A, Czernicki T (2006) Chordoid meningiomas of a different histopathological pattern: a report of two cases. Folia Neuropathol 44:34–41PubMedGoogle Scholar
  55. 55.
    Mitsuhashi T, Ono S, Inohara T, Otomo T, Aoki A, Ueki Y (2006) Chordoid meningioma–case report. Neurol Medi-Chir 46:37–40CrossRefGoogle Scholar
  56. 56.
    Purkayastha S, Gupta AK, Varma DR, Radhakrishnan V (2005) Chordoid meningioma mimicking tuberculoma. Riv Neuroradiol 18:64–70CrossRefGoogle Scholar
  57. 57.
    Denaro L, Di Rocco F, Gessi M, Lauriola L, Lauretti L, Pallini R, Fernandez E, Maira G (2005) Pyrogenic cytokine interleukin-6 expression by a chordoid meningioma in an adult with a systemic inflammatory syndrome. Case report and review of the literature. J Neurosurg 103:555–558. doi: 10.3171/jns.2005.103.3.0555 PubMedCrossRefGoogle Scholar
  58. 58.
    Ozen O, Sar A, Atalay B, Altinors N, Demirhan B (2004) Chordoid meningioma: rare variant of meningioma. Neuropathology 24:243–247PubMedCrossRefGoogle Scholar
  59. 59.
    Murali R, Ng T (2004) Chordoid meningioma masquerading as chordoma. Pathology 36:198–201. doi: 10.1080/00313020410001672073 PubMedCrossRefGoogle Scholar
  60. 60.
    Varma DR, Rao BR, Parameswaran S, Gupta AK, Joseph S, Radhakrishnan VV (2003) Chordoid meningioma: a report of two cases. Neurol India 51:522–524PubMedGoogle Scholar
  61. 61.
    Yeon JY, Lee JI, Kim JH, Suh YL (2003) Chordoid meningioma: a case report. J Korean Med Sci 18:768–771PubMedCentralPubMedCrossRefGoogle Scholar
  62. 62.
    Haque M, Ohata K, Tsuyuguchi N, Sakamoto S, Hara M (2002) A case of pineal region meningioma without dural attachment, presented with bilateral hearing impairment. Acta Neurochir 144:209–211. doi: 10.1007/s007010200027 PubMedCrossRefGoogle Scholar
  63. 63.
    Mori S, Oka K, Hakozaki H, Soga Y, Hayano M, Oka T, Nakazato Y, Mori N (2001) Chordoid meningioma. A case report. Pathol Res Pract 197:515–518. doi: 10.1078/0344-0338-00120 PubMedCrossRefGoogle Scholar
  64. 64.
    Lee DK, Kim DG, Choe G, Chi JG, Jung HW (2001) Chordoid meningioma with polyclonal gammopathy–case report. J Neurosurg 94:122–126. doi: 10.3171/jns.2001.94.1.0122 PubMedCrossRefGoogle Scholar
  65. 65.
    Wada T, Suzuki M, Beppu T, Arai H, Yoshida Y, Ogawa A, Sasou S (2000) A case of subcortical meningioma. Acta Neurochir 142:209–213. doi: 10.1007/s007010050026 PubMedCrossRefGoogle Scholar
  66. 66.
    Yano H, Shinoda J, Hara A, Shimokawa K, Sakai N (2000) Chordoid meningioma. Brain tumor Pathol 17:153–157PubMedCrossRefGoogle Scholar
  67. 67.
    Kobata H, Kondo A, Iwasaki K, Kusaka H, Ito H, Sawada S (1998) Chordoid meningioma in a child. Case report. J Neurosurg 88:319–323. doi: 10.3171/jns.1998.88.2.0319 PubMedCrossRefGoogle Scholar
  68. 68.
    Glasier CM, Husain MM, Chadduck W, Boop FA (1993) Meningiomas in children: MR and histopathologic findings. AJNR Am J Neuroradiol 14:237–241PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Winward Choy
    • 1
  • Leonel Ampie
    • 1
  • Jonathan B. Lamano
    • 1
  • Kartik Kesavabhotla
    • 1
  • Qinwen Mao
    • 2
  • Andrew T. Parsa
    • 1
  • Orin Bloch
    • 1
    Email author
  1. 1.Department of Neurological SurgeryNorthwestern University, Feinberg School of MedicineChicagoUSA
  2. 2.Department of PathologyNorthwestern University, Feinberg School of MedicineChicagoUSA

Personalised recommendations