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Int J Clin Exp Pathol 2013;6(5):878-888

Original Article
Papillary meningioma: clinical and histopathological observations

Dai-Jun Wang, Ming-Zhe Zheng, Ye Gong, Qing Xie, Yin Wang, Hai-Xia Cheng, Ying Mao, Ping Zhong, Xiao-Ming Che, Cheng-Chuan Jiang,
Feng-Ping Huang, Kang Zheng, Shi-Qi Li, Yu-Xiang Gu, Wei-Min Bao, Bo-Jie Yang, Jing-Song Wu, Li-Qian Xie, Hai-Liang Tang, Hong-Da Zhu,
Xian-Cheng Chen, Liang-Fu Zhou

Department of Neurosurgery, Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai 200040, China. Equal
contributors to this paper.

Received January 26, 2013; Accepted March 13, 2013; Epub April 15, 2013; Published May 1, 2013

Abstract: Papillary meningioma is a rare subtype of malignant meningiomas, which is classified by the World Health Organization as Grade III.
Because of lack of large sample size case studies, many of the specific characteristics of papillary meningioma are unclear. This study
investigated by retrospective analysis the clinical, radiological and histopathological findings of 17 papillary meningioma patients who
underwent surgical resection or biopsy, to assess the characteristics of papillary meningioma. Eight female and nine male patients were
included, with a mean age of 40 (range: 6 to 55) years. Tumors were mostly located in the cerebral convexity and showed irregular margins,
absence of a peritumoral rim, heterogeneous enhancement and severe peritumoral brain edema on preoperative images. Brain invasion was
often confirmed during the operations, with abundant to exceedingly abundant blood supply. Intratumoral necrosis and mitosis was frequently
observed on routinely stained sections. The average MIB-1 labeling index was 6.9%. Seven cases experienced tumor recurrence or
progression, while seven patients died 6 to 29 months after operation. Radiation therapy was given in 52.9% of all cases. Univariate analysis
showed that only the existence of intratumoral necrosis and incomplete resection correlated with tumor recurrence. The 3-year progression
free survival was 66.7% after gross total resection and 63.6% for other cases. The 3-year mortality rate was 50% after gross total resection and
63.6% for other cases. Papillary meningioma has specific clinical and histopathological characteristics. Tumor recurrence (or progression)
and mortality are common. Gross total tumor resection resulted in less recurrence and mortality. (IJCEP1301056).

Keywords: Papillary meningioma, clinical manifestations, histopathology, prognosis

Address correspondence to: Dr. Ye Gong, Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China.
Phone: 86-21-52888682; Fax: 86-21-62490665; E-mail: meningioma@yahoo.cn