Clinical And Pathological Features Of Atypical Meningiomas And Multivar-iate Regression Analysis Of Postoperative Recurrence

Purpose:To investigate the clinical, histological and immunohistochemical characteristics of atypical meningiomas(AM), we studied the clinical,pathological features and expressions of E-ca and β-catenin of AM,and researched the relationships between them and the recurrence of AM. we wish to provide some reference for the diagnosis and treatment of AM.Methods:30cases of AM treated at the first affiliated hospital of Zhejiang University School of Medicine and Tongde hospital of Zhejiang Province,from January2007to December2011were analysed retrospectively, at the same time30cases of benign meningiomas(BM) were analysed as control.we retrospectively analysed the clinical, imaging and pathological characteristics of two groups, followed up the patients and compared the differences between them to explore the clinical and pathological characteristics of AM. We performed immunohistochemical analysis including E-ca, β-catenin, PR, Ki67in both groups, combined with the clinical and pathological features of AM, and made Kaplan-Meier single factor analysis and Cox regression analysis of multiple factors between them and the recurrence of AM.Results:1.The increase of male ratio,large size,high skull and brain invasiveness,high mitotic activity,high nucleoplasm ratio,large nucleolus,continuous layered growth, focal pattern necrosis, low rate of calcification,and high rate of relapse were the clinical and pathological features of AM.2.The immunohistochemical expressions of PR,Ki67,E-ca and β-catenin were valuable to the differential diagnosis for BM,but lack of specificity.3.The univariate and multivariate survival analysis of the relationships between12clinical, pathological and immunohistochemical indicators and the postoperative recurrence of AM showed that the extent of resection and E-ca had the value of independent judgment for the postoperative recurrence of AM.But in the prognosis model containing all of the indicators, E-ca lost its statistical significance in multivariate survival analysis.Extent of resection and tumor invasiveness were independent judgment indicators for the postoperative recurrence of AM.Conclusions:1.AM have the clinical and pathological features of increase of male ratio,large size, high skull and brain invasiveness,high mitotic activity,high nucleoplasm ratio,large nucleolus,continuous layered growth, focal pattern necrosis, low rate of calcification,and high rate of relapse. The immunohistochemical expressions of PR,Ki67,E-ca and β-catenin show statistically significant difference between AM and BM for differential diagnosis,but lack of specificity.2.In the univariate and multivariate survival analysis including12clinical,pathological and immunohistochemical indicators, Extent of resection and tumor invasiveness are independent judgment indicators for the postoperative recurrence of AM. So improving the operation skills and total resection rate are the main way to improve the prognosis of patients with AM.