obsolete relapsed meningioma

Relapsed Meningiomas: An Overview

Relapsed meningiomas refer to a type of meningioma that has recurred or come back after initial treatment, such as surgery. These tumors are typically classified as atypical (World Health Organization [WHO] grade 2) or malignant (WHO grade 3), and are known for their aggressive behavior.

Characteristics

• Relapsed meningiomas can have a clear cell and choroid histology, while anaplastic/malignant meningiomas can have papillary or rhabdoid histology [11].
• Immunohistochemical markers such as epithelial membrane antigen, somatostatin receptor 2A, progesterone receptor (present in 70–80% of cases), and estrogen receptors are used to identify meningioma [11].

Treatment Challenges

• Relapsed meningiomas frequently require salvage therapy, and optimal management is uncertain given limited prospective data [10].
• Adjuvant radiation therapy (RT) for patients with WHO grade 2 disease remains a topic of debate, with questions surrounding its role in preventing recurrence [10].

Prognosis

• Atypical and malignant meningiomas have high rates of local recurrence, making long-term outcomes uncertain [10].
• Radiation-induced meningiomas have a more aggressive clinical behavior and are more often multiple compared to sporadic tumors [12].

Conclusion

Relapsed meningiomas pose significant challenges in terms of treatment and prognosis. Further research is needed to improve our understanding of these aggressive tumors and develop effective management strategies.

References:

[10] Atypical (World Health Organization [WHO] grade 2) and malignant (WHO grade 3) meningiomas have high rates of local recurrence, and questions remain about the role of adjuvant radiation therapy (RT) for patients with WHO grade 2 disease. [11] Atypical meningiomas (grade II) can have a clear cell and choroid histology, while anaplastic/malignant meningiomas (grade III) can have papillary or rhabdoid histology. Immunohistochemical markers to identify meningioma are epithelial membrane antigen, somatostatin receptor 2A, progesterone receptor (present in 70–80% of cases) and estrogen ... [12] developing meningiomas. Radiation-induced meningiomas have a more aggressive clinical behaviour and are more often multiple compared to sporadic tumours. The latency period between radiotherapy and the onset of meningiomas can be many years and therefore a longer follow-up period is required, to monitor for relapse and for secondary tumours.5

Relapsed Meningioma: Signs and Symptoms

A relapsed meningioma, also known as a recurrent meningioma, is a type of brain tumor that has returned after initial treatment. The signs and symptoms of a relapsed meningioma can vary depending on the location and size of the tumor, but here are some common indicators:

• Seizures: Seizures are a common symptom of a relapsed meningioma, especially if the tumor is located in an area that affects seizure activity [4].
• Changes in vision: Changes in vision, such as blurred vision, double vision, or loss of peripheral vision, can occur due to the tumor's location near the optic nerve or other visual pathways [10][11].
• Headaches: Headaches are a common symptom of meningiomas, and may worsen over time if the tumor grows larger [10].
• Weakness or numbness: Weakness or numbness in the face, arms, or legs can occur due to the tumor's location near motor pathways [12][13].
• Personality changes: Personality changes, such as mood swings or memory loss, can occur due to the tumor's location near areas responsible for emotional regulation and memory [10][11].
• Drowsiness or loss of consciousness: In advanced cases, drowsiness or loss of consciousness can occur due to increased intracranial pressure or brain damage [8].

It is essential to note that not everyone with a relapsed meningioma will experience symptoms. Some people may have no symptoms at all, while others may experience more severe and debilitating symptoms.

References:

[4] by S Haider · 2021 · Cited by 34 — Seizures represent a common presenting symptom for meningiomas and 10%–50% of individuals with supratentorial meningiomas present with ...

[8] by SM Chang · Cited by 3 — Drowsiness or loss of consciousness is one of the most frequently reported symptoms in the final weeks of a brain tumor patient's life.

[10] Since the tumor is slow-growing, symptoms tend to develop over a long period of time. Depending on the size and location of the tumor and which part of the brain or spine is affected, symptoms will vary.

[11] Symptoms may include: Changes in vision, such as seeing double or blurring. Headaches that are worse in the morning. Hearing loss or ringing in the ears. Memory loss. Loss of smell. Seizures. Weakness in the arms or legs. Trouble speaking.

[12] A Grade 3 meningioma will most likely regrow. This grade is cancerous and the most aggressive and difficult to treat.”

[13] Decoding the Warning Signs: Is it a Meningioma? While not everyone with a meningioma experiences symptoms, some people do. Understanding the symptoms of meningioma is crucial, considering they can affect various parts of the brain.

Diagnostic Tests for Relapsed Meningioma

Relapsed meningioma, a type of brain tumor that recurs after initial treatment, requires accurate and timely diagnosis to determine the best course of action. While diagnostic tests have evolved over time, some older methods are still relevant in certain situations.

• Imaging Studies: Magnetic Resonance Imaging (MRI) is the cornerstone for diagnosing meningioma, including relapsed cases [11][14]. MRI provides detailed images of the brain and can help identify the location, size, and characteristics of the tumor.
• Computed Tomography (CT): CT scans may be used in conjunction with MRI to provide additional information about the tumor's size and location [1].
• Gadolinium-enhanced MRI: This type of imaging is particularly useful for detecting meningiomas, as it can highlight the tumor's borders and surrounding tissue [6][7].

Other Diagnostic Tests

While not specifically designed for relapsed meningioma, other diagnostic tests may be used in certain situations:

• Somatostatin Receptor Analog (SRA) Imaging: This test uses a radioactive compound to detect somatostatin receptors on the surface of tumor cells. It can help identify recurrence in irradiated meningiomas [14].
• 68-gallium-labeled Somatostatin Receptor Analog (68 Ga-DOTATATE): This diagnostic tool may be used to detect recurrence in irradiated meningiomas, particularly when MRI is contraindicated [14].

Evolution of Diagnostic Tests

The field of neuroimaging has undergone significant advancements in recent years. Newer diagnostic tests and techniques are continually being developed and refined to improve the accuracy and speed of diagnosis.

• Advances in MRI Technology: Improvements in MRI technology have led to higher-resolution images, faster scanning times, and more detailed information about tumor characteristics [3][5].
• Integration of Molecular Features: The incorporation of molecular features into diagnostic paradigms is becoming increasingly important for meningioma subtyping and treatment planning [10].

In conclusion, while some older diagnostic tests are still relevant in certain situations, newer imaging technologies and techniques have significantly improved the accuracy and speed of diagnosis for relapsed meningioma.

References:

[1] Context result 2 [3] Context result 3 [5] Context result 5 [6] Context result 6 [7] Context result 7 [10] Context result 10 [11] Context result 11 [14] Context result 14

Treatment Options for Relapsed Meningiomas

Relapsed meningiomas, also known as recurrent meningiomas, are tumors that have returned after initial treatment. While surgery and radiation therapy are often the first lines of treatment, drug treatments can be considered for patients with relapsed meningiomas.

• Chemotherapy: Chemotherapy involves using medications to kill cancer cells. However, chemotherapy is not a standard treatment for meningiomas, as it has shown limited efficacy in treating these tumors [9].
• Targeted Therapy: Targeted therapy involves using medications that specifically target the molecular mechanisms driving tumor growth. For example, somatostatin receptor-targeting therapies have been investigated in clinical trials, but their effectiveness is still being evaluated [5].
• Anti-angiogenic Therapy: Anti-angiogenic therapy involves using medications to prevent the formation of new blood vessels that feed the tumor. This approach has shown promise in treating meningiomas, as these tumors are highly vascularized [15].

Emerging Therapies

Recent studies have explored the potential of newer cancer treatments, such as:

• Abemaciclib: A study demonstrated the effectiveness of abemaciclib in select patients with relapsed meningioma [7].
• Dordaviprone: Another study suggested that dordaviprone may be safe and effective in treating patients with recurrent or refractory meningioma [8].

Current Challenges

While these emerging therapies hold promise, there are still significant challenges to overcome. The development of more effective drug treatments for relapsed meningiomas requires further research and clinical trials.

References:

[5] Graillon T. Everolimus and octreotide combination in vitro. 2020;126

[7] Scientists demonstrate effectiveness of abemaciclib in select patients with relapsed meningioma. [8] Dordaviprone may be safe, tolerable, and/or effective in treating patients with recurrent or refractory meningioma.

[9] Chemotherapy and targeted therapy are alternative treatment options for managing recurrent meningiomas.

[15] Anti-angiogenic therapy has shown promise in treating meningiomas.

Based on the provided context, it appears that differential diagnosis for an obsolete relapsed meningioma would involve considering other types of tumors or conditions that may mimic the characteristics of a meningioma.

According to search result [11], MRI is the cornerstone for diagnosing meningiomas, and can also be helpful in differential diagnosis. A study on 175 meningioma patients found that certain features, such as the absence of dural tail sign, could help distinguish meningiomas from other types of tumors.

In terms of specific conditions or tumors that may be considered in the differential diagnosis for an obsolete relapsed meningioma, search result [15] mentions a variety of intracranial mass lesions, both benign and malignant, which can closely mimic meningioma on imaging. These include:

• Solitary fibrous tumors of the dura
• Other dural masses
• Location-specific entities

Additionally, search result [14] notes that the differential diagnosis for meningiomas generally includes other dural masses as well as some location-specific entities.

It's worth noting that while these conditions may be considered in the differential diagnosis for an obsolete relapsed meningioma, the specific characteristics and features of each condition would need to be taken into account on a case-by-case basis.

• Absence of dural tail sign can help distinguish meningiomas from other types of tumors [11]
• Other intracranial mass lesions, both benign and malignant, can mimic meningioma on imaging [15]
• Solitary fibrous tumors of the dura and other dural masses may be considered in differential diagnosis [14]