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*Most common primary brain tumour.<ref name=pmid25343186>{{Cite journal | last1 = Rogers | first1 = L. | last2 = Barani | first2 = I. | last3 = Chamberlain | first3 = M. | last4 = Kaley | first4 = TJ. | last5 = McDermott | first5 = M. | last6 = Raizer | first6 = J. | last7 = Schiff | first7 = D. | last8 = Weber | first8 = DC. | last9 = Wen | first9 = PY. | title = Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. | journal = J Neurosurg | volume = | issue = | pages = 1-20 | month = Oct | year = 2014 | doi = 10.3171/2014.7.JNS131644 | PMID = 25343186 }}</ref> | *Most common primary brain tumour.<ref name=pmid25343186>{{Cite journal | last1 = Rogers | first1 = L. | last2 = Barani | first2 = I. | last3 = Chamberlain | first3 = M. | last4 = Kaley | first4 = TJ. | last5 = McDermott | first5 = M. | last6 = Raizer | first6 = J. | last7 = Schiff | first7 = D. | last8 = Weber | first8 = DC. | last9 = Wen | first9 = PY. | title = Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. | journal = J Neurosurg | volume = | issue = | pages = 1-20 | month = Oct | year = 2014 | doi = 10.3171/2014.7.JNS131644 | PMID = 25343186 }}</ref> | ||
*May be caused by prior radiation.<ref name=pmid25249493>{{Cite journal | last1 = Baldi | first1 = I. | last2 = Engelhardt | first2 = J. | last3 = Bonnet | first3 = C. | last4 = Bauchet | first4 = L. | last5 = Berteaud | first5 = E. | last6 = Grüber | first6 = A. | last7 = Loiseau | first7 = H. | title = Epidemiology of meningiomas. | journal = Neurochirurgie | volume = | issue = | pages = | month = Sep | year = 2014 | doi = 10.1016/j.neuchi.2014.05.006 | PMID = 25249493 }}</ref> | *May be caused by prior radiation.<ref name=pmid25249493>{{Cite journal | last1 = Baldi | first1 = I. | last2 = Engelhardt | first2 = J. | last3 = Bonnet | first3 = C. | last4 = Bauchet | first4 = L. | last5 = Berteaud | first5 = E. | last6 = Grüber | first6 = A. | last7 = Loiseau | first7 = H. | title = Epidemiology of meningiomas. | journal = Neurochirurgie | volume = | issue = | pages = | month = Sep | year = 2014 | doi = 10.1016/j.neuchi.2014.05.006 | PMID = 25249493 }}</ref> | ||
*Women develop meningioma twice as likely as men.<ref>{{Cite journal | last1 = Wiemels | first1 = J. | last2 = Wrensch | first2 = M. | last3 = Claus | first3 = EB. | title = Epidemiology and etiology of meningioma. | journal = J Neurooncol | volume = 99 | issue = 3 | pages = 307-14 | month = Sep | year = 2010 | doi = 10.1007/s11060-010-0386-3 | PMID = 20821343 }}</ref> | |||
*More than 90% are solitary. | |||
===Prognosis=== | ===Prognosis=== | ||
*Most are benign - usu. a good prognosis. | *Most are benign - usu. a good prognosis. | ||
**May be malignant - bad prognosis. | **Even benign tumors may show extensive local spread - considerable morbidity and mortality. | ||
**Metastases are rare and then usu. after surgery. | |||
*May be malignant - bad prognosis. | |||
*Factors associated with unfavourable prognosis: | |||
**BAP1 mutations.<ref>{{Cite journal | last1 = Shankar | first1 = GM. | last2 = Abedalthagafi | first2 = M. | last3 = Vaubel | first3 = RA. | last4 = Merrill | first4 = PH. | last5 = Nayyar | first5 = N. | last6 = Gill | first6 = CM. | last7 = Brewster | first7 = R. | last8 = Bi | first8 = WL. | last9 = Agarwalla | first9 = PK. | title = Germline and somatic BAP1 mutations in high-grade rhabdoid meningiomas. | journal = Neuro Oncol | volume = 19 | issue = 4 | pages = 535-545 | month = 04 | year = 2017 | doi = 10.1093/neuonc/now235 | PMID = 28170043 }}</ref> | |||
**Presence of TERT promotor mutation.<ref>{{Cite journal | last1 = Sahm | first1 = F. | last2 = Schrimpf | first2 = D. | last3 = Olar | first3 = A. | last4 = Koelsche | first4 = C. | last5 = Reuss | first5 = D. | last6 = Bissel | first6 = J. | last7 = Kratz | first7 = A. | last8 = Capper | first8 = D. | last9 = Schefzyk | first9 = S. | title = TERT Promoter Mutations and Risk of Recurrence in Meningioma. | journal = J Natl Cancer Inst | volume = 108 | issue = 5 | pages = | month = May | year = 2016 | doi = 10.1093/jnci/djv377 | PMID = 26668184 }}</ref> | |||
**Loss of H3K27me3.<ref>{{Cite journal | last1 = Katz | first1 = LM. | last2 = Hielscher | first2 = T. | last3 = Liechty | first3 = B. | last4 = Silverman | first4 = J. | last5 = Zagzag | first5 = D. | last6 = Sen | first6 = R. | last7 = Wu | first7 = P. | last8 = Golfinos | first8 = JG. | last9 = Reuss | first9 = D. | title = Loss of histone H3K27me3 identifies a subset of meningiomas with increased risk of recurrence. | journal = Acta Neuropathol | volume = | issue = | pages = | month = Apr | year = 2018 | doi = 10.1007/s00401-018-1844-9 | PMID = 29627952 }}</ref> | |||
===Genetics=== | ===Genetics=== | ||
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*+/-Hyperostosis. | *+/-Hyperostosis. | ||
**Associated with invasion into the skull in ~20% of cases.<ref name=pmid22406780>{{Cite journal | last1 = Goyal | first1 = N. | last2 = Kakkar | first2 = A. | last3 = Sarkar | first3 = C. | last4 = Agrawal | first4 = D. | title = Does bony hyperostosis in intracranial meningioma signify tumor invasion? A radio-pathologic study. | journal = Neurol India | volume = 60 | issue = 1 | pages = 50-4 | month = | year = | doi = 10.4103/0028-3886.93589 | PMID = 22406780 }}</ref> | **Associated with invasion into the skull in ~20% of cases.<ref name=pmid22406780>{{Cite journal | last1 = Goyal | first1 = N. | last2 = Kakkar | first2 = A. | last3 = Sarkar | first3 = C. | last4 = Agrawal | first4 = D. | title = Does bony hyperostosis in intracranial meningioma signify tumor invasion? A radio-pathologic study. | journal = Neurol India | volume = 60 | issue = 1 | pages = 50-4 | month = | year = | doi = 10.4103/0028-3886.93589 | PMID = 22406780 }}</ref> | ||
<gallery> | |||
File:Keilbeinmeningeom MRT T1KMax.jpg | Sphenoid wing meningioma (WC/Hellerhoff) | |||
File:Meningioma.jpg | Brain displacement by meningioma (AFIP) | |||
File:Meningioma-1.jpg | Macroscopy (Всеволод Лучанский (vvray)) | |||
</gallery> | |||
==Microscopic== | ==Microscopic== | ||
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Image:Meningioma_-_brain_invasion_-_intermed_mag.jpg | Meningioma with brain invasion - intermed. mag. (WC) | Image:Meningioma_-_brain_invasion_-_intermed_mag.jpg | Meningioma with brain invasion - intermed. mag. (WC) | ||
Image:Meningioma_-_brain_invasion_-_high_mag.jpg | Meningioma with brain invasion - high mag. (WC) | Image:Meningioma_-_brain_invasion_-_high_mag.jpg | Meningioma with brain invasion - high mag. (WC) | ||
File:Meningeotheliomatous_meningeoma_whorl_formations.jpg | Whorls in meningioma. (WC) | |||
File:Image NP T1c 0001.JPG | Whorls in meningioma. (WC) | |||
File:Image NP T1c 0004.JPG | Meningioma annotated. (WC) | |||
</gallery> | </gallery> | ||
www: | www: | ||
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<gallery> | <gallery> | ||
File:Psammomatous_meningioma.jpg | Numerous psammoma bodies (WC/jensflorian) | File:Psammomatous_meningioma.jpg | Numerous psammoma bodies (WC/jensflorian) | ||
File:NP psammomatous meningioma 0002.jpg | Psammomatous meningioma after EDTA treatment (WC) | |||
</gallery> | </gallery> | ||
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=====Metaplastic meningioma===== | =====Metaplastic meningioma===== | ||
* | *No clinical significance. | ||
*Probably do not represent true metaplasia in all cases. | |||
*Clincal information is rquired to distinguish between bone invasion and meningiomas with bone formation. | |||
Microscopic: | Microscopic: | ||
*Cartilage or bone formation. | *Cartilage or bone formation. | ||
*Myxoid or xanthomatous changes. | |||
<gallery> | |||
File:Metaplastic_osseous_meningioma.jpg | Ossified meningioma, HE stain. (WC/jensflorian) | |||
File:Metaplastic_xanthomatous_meningioma.jpg | Metaplastic meningioma with xanthomatous changes. (WC/jensflorian) | |||
</gallery> | |||
====Grade II==== | ====Grade II==== | ||
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*Invades the brain (irregular, tongue-like). | *Invades the brain (irregular, tongue-like). | ||
*Absence of leptomeningeal layer. | *Absence of leptomeningeal layer. | ||
*Brain invasion can be present in grade I tumors, these are then classified as "atypical". | *Brain invasion can be present in grade I tumors, these are then classified as "atypical", ie. as grade II tumors. | ||
* | *The prognostic significance of brain invasion is still unclear, some studies do not show a course similiar to grade II meningiomas.<ref>{{Cite journal | last1 = Baumgarten | first1 = P. | last2 = Gessler | first2 = F. | last3 = Schittenhelm | first3 = J. | last4 = Skardelly | first4 = M. | last5 = Tews | first5 = DS. | last6 = Senft | first6 = C. | last7 = Dunst | first7 = M. | last8 = Imoehl | first8 = L. | last9 = Plate | first9 = KH. | title = Brain invasion in otherwise benign meningiomas does not predict tumor recurrence. | journal = Acta Neuropathol | volume = 132 | issue = 3 | pages = 479-81 | month = Sep | year = 2016 | doi = 10.1007/s00401-016-1598-1 | PMID = 27464983 }}</ref><ref>{{Cite journal | last1 = Brokinkel | first1 = B. | last2 = Hess | first2 = K. | last3 = Mawrin | first3 = C. | title = Brain invasion in Meningiomas - Clinical considerations and impact of neuropathological evaluation: A systematic Review. | journal = Neuro Oncol | volume = | issue = | pages = | month = Apr | year = 2017 | doi = 10.1093/neuonc/nox071 | PMID = 28419308 }}</ref><ref>{{Cite journal | last1 = Pizem | first1 = J. | last2 = Velnar | first2 = T. | last3 = Prestor | first3 = B. | last4 = Mlakar | first4 = J. | last5 = Popovic | first5 = M. | title = Brain invasion assessability in meningiomas is related to meningioma size and grade, and can be improved by extensive sampling of the surgically removed meningioma specimen. | journal = Clin Neuropathol | volume = 33 | issue = 5 | pages = 354-63 | month = | year = | doi = 10.5414/NP300750 | PMID = 25034703 }}</ref> | ||
Images: | Images: | ||
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*[http://path.upmc.edu/cases/case373.html Rhabdoid meningioma - case 1 - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case373.html Rhabdoid meningioma - case 1 - several images (upmc.edu)]. | ||
*[http://path.upmc.edu/cases/case393.html Rhabdoid meningioma - case 2 - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case393.html Rhabdoid meningioma - case 2 - several images (upmc.edu)]. | ||
====Other morphological variants==== | |||
These are currently not listed in the WHO as separate entities. | |||
*Oncocytic.<ref>{{Cite journal | last1 = Zunarelli | first1 = E. | last2 = Tallarico | first2 = E. | last3 = Valentini | first3 = A. | last4 = Maiorana | first4 = A. | title = Oncocytic meningioma: study of eight new cases and analysis of 13 reported cases. | journal = Pathology | volume = 42 | issue = 6 | pages = 587-9 | month = | year = 2010 | doi = 10.3109/00313025.2010.508740 | PMID = 20854082 }}</ref> | |||
*Whorling-sclerosing.<ref>{{Cite journal | last1 = Haberler | first1 = C. | last2 = Jarius | first2 = C. | last3 = Lang | first3 = S. | last4 = Rössler | first4 = K. | last5 = Gruber | first5 = A. | last6 = Hainfellner | first6 = JA. | last7 = Budka | first7 = H. | title = Fibrous meningeal tumours with extensive non-calcifying collagenous whorls and glial fibrillary acidic protein expression: the whorling-sclerosing variant of meningioma. | journal = Neuropathol Appl Neurobiol | volume = 28 | issue = 1 | pages = 42-7 | month = Feb | year = 2002 | doi = | PMID = 11849562 }}</ref> | |||
*Rosette-forming.<ref>{{Cite journal | last1 = Liverman | first1 = C. | last2 = Mafra | first2 = M. | last3 = Chuang | first3 = SS. | last4 = Shivane | first4 = A. | last5 = Chakrabarty | first5 = A. | last6 = Highley | first6 = R. | last7 = Hilton | first7 = DA. | last8 = Byrne | first8 = NP. | last9 = Wesseling | first9 = P. | title = A clinicopathologic study of 11 rosette-forming meningiomas: a rare and potentially confusing pattern. | journal = Acta Neuropathol | volume = 130 | issue = 2 | pages = 311-3 | month = Aug | year = 2015 | doi = 10.1007/s00401-015-1456-6 | PMID = 26106026 }}</ref> | |||
<gallery> | |||
File:Meningioma_Whorling_sclerosing.jpg | Whorling-sclerosing features in meningioma (HE/jensflorian) | |||
File:Meningioma_pseudorosettes.jpg | Meningioma with rosette-forming features (HE/jensflorian) | |||
</gallery> | |||
===Histologic grading=== | ===Histologic grading=== | ||
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==IHC== | ==IHC== | ||
*EMA +ve.<ref name=Ref_PSNP13>{{Ref PSNP|13}}</ref> | *EMA +ve (approx. 90%).<ref name=Ref_PSNP13>{{Ref PSNP|13}}</ref> | ||
*Other CKs usually -ve. | *PR +ve (approx. 75%, expression decreases from grade I to III). | ||
*SSTR2A +ve (approx. 95%). | |||
*S100 variable (up to 35% cases, usually patchy).<ref>{{cite journal |vauthors=Behling F, Fodi C, Skardelly M, Paulsen F, Tabatabai G, Honegger J, Tatagiba M, Schittenhelm J |title=The prognostic role of the immunohistochemical expression of S100 in meningiomas |journal=J Cancer Res Clin Oncol |volume= |issue= |pages= |date=July 2022 |pmid=35838837 |doi=10.1007/s00432-022-04186-9 |url=}}</ref> | |||
*SOX10 -ve. | |||
*GFAP -ve. | |||
*CD34 usu. -ve (approx 8% cases positive). | |||
*CD13 +ve.<ref>{{cite journal |vauthors=Marletta S, Luchini C, Sperandio N, Torresani E, Sorio A, Girolami I, Scarpa A, Eccher A, Ghimenton C |title=CD13 is a useful tool in the differential diagnosis of meningiomas with potential biological and prognostic implications |journal=Virchows Arch |volume=480 |issue=6 |pages=1223–1230 |date=June 2022 |pmid=35212813 |pmc=9184408 |doi=10.1007/s00428-022-03304-9 |url=}}</ref> | |||
*Other CKs usually -ve (approx 6% cases positive, mostly secretory meningiomas). | |||
==Molecular== | ==Molecular== | ||
Non-syndromal meningiomas may show SMO and | Non-syndromal meningiomas may show AKT1/TRAF7, SMO, KLF4/TRAF7, and PIK3CA mutations (1/3 of cases).<ref>{{Cite journal | last1 = Clark | first1 = VE. | last2 = Erson-Omay | first2 = EZ. | last3 = Serin | first3 = A. | last4 = Yin | first4 = J. | last5 = Cotney | first5 = J. | last6 = Ozduman | first6 = K. | last7 = Avşar | first7 = T. | last8 = Li | first8 = J. | last9 = Murray | first9 = PB. | title = Genomic analysis of non-NF2 meningiomas reveals mutations in TRAF7, KLF4, AKT1, and SMO. | journal = Science | volume = 339 | issue = 6123 | pages = 1077-80 | month = Mar | year = 2013 | doi = 10.1126/science.1233009 | PMID = 23348505 }}</ref> | ||
*AKT/TRAF7 mutations are usually basal and associated with meningothelial histology. | |||
*KLF4/TRAF7 mutations are highly specific for secretory histology. | |||
*TRAF7 mutations are the first step and occur thorughout the WD40 domain. <ref>{{cite journal |vauthors=Dogan H, Blume C, Patel A, Jungwirth G, Sogerer L, Ratliff M, Ketter R, Herold-Mende C, Jones DTW, Wick W, Vollmuth P, Zweckberger K, Reuss D, von Deimling A, Sahm F |title=Single-cell DNA sequencing reveals order of mutational acquisition in TRAF7/AKT1 and TRAF7/KLF4 mutant meningiomas |journal=Acta Neuropathol |volume=144 |issue=4 |pages=799–802 |date=October 2022 |pmid=35984495 |doi=10.1007/s00401-022-02485-6 |url=}}</ref> | |||
Intraventricular meningiomas have NF2 mutations. | |||
<ref>{{cite journal |vauthors=Jungwirth G, Warta R, Beynon C, Sahm F, von Deimling A, Unterberg A, Herold-Mende C, Jungk C |title=Intraventricular meningiomas frequently harbor NF2 mutations but lack common genetic alterations in TRAF7, AKT1, SMO, KLF4, PIK3CA, and TERT |journal=Acta Neuropathol Commun |volume=7 |issue=1 |pages=140 |date=August 2019 |pmid=31470906 |pmc=6716845 |doi=10.1186/s40478-019-0793-4 |url=}}</ref> | |||
Several inherited diseases are associated with meningiomas: | Several inherited diseases are associated with meningiomas: | ||
*[[Neurofibromatosis]] type II<ref>{{Cite journal | last1 = Fontaine | first1 = B. | last2 = Rouleau | first2 = GA. | last3 = Seizinger | first3 = BR. | last4 = Menon | first4 = AG. | last5 = Jewell | first5 = AF. | last6 = Martuza | first6 = RL. | last7 = Gusella | first7 = JF. | title = Molecular genetics of neurofibromatosis 2 and related tumors (acoustic neuroma and meningioma). | journal = Ann N Y Acad Sci | volume = 615 | issue = | pages = 338-43 | month = | year = 1991 | doi = | PMID = 2039155 }}</ref> | *[[Neurofibromatosis]] type II<ref>{{Cite journal | last1 = Fontaine | first1 = B. | last2 = Rouleau | first2 = GA. | last3 = Seizinger | first3 = BR. | last4 = Menon | first4 = AG. | last5 = Jewell | first5 = AF. | last6 = Martuza | first6 = RL. | last7 = Gusella | first7 = JF. | title = Molecular genetics of neurofibromatosis 2 and related tumors (acoustic neuroma and meningioma). | journal = Ann N Y Acad Sci | volume = 615 | issue = | pages = 338-43 | month = | year = 1991 | doi = | PMID = 2039155 }}</ref> | ||
*Germline SMARCE1 and SMARCB1 mutations<ref>{{Cite journal | last1 = Smith | first1 = MJ. | last2 = O'Sullivan | first2 = J. | last3 = Bhaskar | first3 = SS. | last4 = Hadfield | first4 = KD. | last5 = Poke | first5 = G. | last6 = Caird | first6 = J. | last7 = Sharif | first7 = S. | last8 = Eccles | first8 = D. | last9 = Fitzpatrick | first9 = D. | title = Loss-of-function mutations in SMARCE1 cause an inherited disorder of multiple spinal meningiomas. | journal = Nat Genet | volume = 45 | issue = 3 | pages = 295-8 | month = Mar | year = 2013 | doi = 10.1038/ng.2552 | PMID = 23377182 }}</ref><ref>{{Cite journal | last1 = van den Munckhof | first1 = P. | last2 = Christiaans | first2 = I. | last3 = Kenter | first3 = SB. | last4 = Baas | first4 = F. | last5 = Hulsebos | first5 = TJ. | title = Germline SMARCB1 mutation predisposes to multiple meningiomas and schwannomas with preferential location of cranial meningiomas at the falx cerebri. | journal = Neurogenetics | volume = 13 | issue = 1 | pages = 1-7 | month = Feb | year = 2012 | doi = 10.1007/s10048-011-0300-y | PMID = 22038540 }}</ref> | *Germline SMARCE1 and SMARCB1 mutations<ref>{{Cite journal | last1 = Smith | first1 = MJ. | last2 = O'Sullivan | first2 = J. | last3 = Bhaskar | first3 = SS. | last4 = Hadfield | first4 = KD. | last5 = Poke | first5 = G. | last6 = Caird | first6 = J. | last7 = Sharif | first7 = S. | last8 = Eccles | first8 = D. | last9 = Fitzpatrick | first9 = D. | title = Loss-of-function mutations in SMARCE1 cause an inherited disorder of multiple spinal meningiomas. | journal = Nat Genet | volume = 45 | issue = 3 | pages = 295-8 | month = Mar | year = 2013 | doi = 10.1038/ng.2552 | PMID = 23377182 }}</ref><ref>{{Cite journal | last1 = van den Munckhof | first1 = P. | last2 = Christiaans | first2 = I. | last3 = Kenter | first3 = SB. | last4 = Baas | first4 = F. | last5 = Hulsebos | first5 = TJ. | title = Germline SMARCB1 mutation predisposes to multiple meningiomas and schwannomas with preferential location of cranial meningiomas at the falx cerebri. | journal = Neurogenetics | volume = 13 | issue = 1 | pages = 1-7 | month = Feb | year = 2012 | doi = 10.1007/s10048-011-0300-y | PMID = 22038540 }}</ref> | ||
*Loss of SUFU (SHH-Pathway)<ref>{{Cite journal | last1 = Aavikko | first1 = M. | last2 = Li | first2 = SP. | last3 = Saarinen | first3 = S. | last4 = Alhopuro | first4 = P. | last5 = Kaasinen | first5 = E. | last6 = Morgunova | first6 = E. | last7 = Li | first7 = Y. | last8 = Vesanen | first8 = K. | last9 = Smith | first9 = MJ. | title = Loss of SUFU function in familial multiple meningioma. | journal = Am J Hum Genet | volume = 91 | issue = 3 | pages = 520-6 | month = Sep | year = 2012 | doi = 10.1016/j.ajhg.2012.07.015 | PMID = 22958902 }}</ref> | *Loss of SUFU (SHH-Pathway).<ref>{{Cite journal | last1 = Aavikko | first1 = M. | last2 = Li | first2 = SP. | last3 = Saarinen | first3 = S. | last4 = Alhopuro | first4 = P. | last5 = Kaasinen | first5 = E. | last6 = Morgunova | first6 = E. | last7 = Li | first7 = Y. | last8 = Vesanen | first8 = K. | last9 = Smith | first9 = MJ. | title = Loss of SUFU function in familial multiple meningioma. | journal = Am J Hum Genet | volume = 91 | issue = 3 | pages = 520-6 | month = Sep | year = 2012 | doi = 10.1016/j.ajhg.2012.07.015 | PMID = 22958902 }}</ref> | ||
*Rare YAP1 fusions in a subset of pediatric meningioma (HIPPO pathyway).<ref>{{Cite journal | last1 = Sievers | first1 = P. | last2 = Chiang | first2 = J. | last3 = Schrimpf | first3 = D. | last4 = Stichel | first4 = D. | last5 = Paramasivam | first5 = N. | last6 = Sill | first6 = M. | last7 = Gayden | first7 = T. | last8 = Casalini | first8 = B. | last9 = Reuss | first9 = DE. | title = YAP1-fusions in pediatric NF2-wildtype meningioma. | journal = Acta Neuropathol | volume = | issue = | pages = | month = Nov | year = 2019 | doi = 10.1007/s00401-019-02095-9 | PMID = 31734728 }}</ref> | |||
Methylation profiling distinguishes two major groups with six distinct clinically relevant methylation classes.<ref>{{Cite journal | last1 = Sahm | first1 = F. | last2 = Schrimpf | first2 = D. | last3 = Stichel | first3 = D. | last4 = Jones | first4 = DT. | last5 = Hielscher | first5 = T. | last6 = Schefzyk | first6 = S. | last7 = Okonechnikov | first7 = K. | last8 = Koelsche | first8 = C. | last9 = Reuss | first9 = DE. | title = DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. | journal = Lancet Oncol | volume = | issue = | pages = | month = Mar | year = 2017 | doi = 10.1016/S1470-2045(17)30155-9 | PMID = 28314689 }}</ref> | |||
===DDx of meningioma & IHC<ref name=pmid16393681>{{cite journal |author=Hahn HP, Bundock EA, Hornick JL |title=Immunohistochemical staining for claudin-1 can help distinguish meningiomas from histologic mimics |journal=Am. J. Clin. Pathol. |volume=125 |issue=2 |pages=203–8 |year=2006 |month=February |pmid=16393681 |doi=10.1309/G659-FVVB-MG7U-4RPQ |url=http://ajcp.ascpjournals.org/content/125/2/203.full.pdf}}</ref>=== | ===DDx of meningioma & IHC<ref name=pmid16393681>{{cite journal |author=Hahn HP, Bundock EA, Hornick JL |title=Immunohistochemical staining for claudin-1 can help distinguish meningiomas from histologic mimics |journal=Am. J. Clin. Pathol. |volume=125 |issue=2 |pages=203–8 |year=2006 |month=February |pmid=16393681 |doi=10.1309/G659-FVVB-MG7U-4RPQ |url=http://ajcp.ascpjournals.org/content/125/2/203.full.pdf}}</ref>=== | ||