Triple approach for diagnosis and grading of meningiomas: Histology, morphometry of Ki-67/Feulgen stainings, and cytogenetics

With regard to meningioma grading and the recently introduced ''atypical'' meningioma, we evaluated 160 cases retrospectively by conventional histology and image analysis. For that, the cell nuclei were stained with a Ki-67 (MIB1)/Feulgen-method on paraffin sections, thus enabling the assessment of both the Ki-67 proliferation index and nuclear morphometric features, such as tumour cell arrangement, nuclear pleomorphism, and cellularity. It could be demonstrated that the Ki-67 proliferation index is the most important criterion for distinguishing anaplastic meningiomas (WHO ''grade'' III) (mean Ki-67 index: 11%) from those of common type (WHO ''grade'' I) (mean Ki-67 index: 0.7%). The parameter for the ''relative volume weighted mean nuclear volume'' is another valuable morphometric feature. The ''atypical'' meningioma (WHO ''grade'' LI) which should represent an intermediate category between common type and anaplastic meningiomas is characterized by a mean Ki-67 proliferation index of 2.1%. Common type meningiomas which comprise almost 50% of the cases of this series have a relapse rate of 9%. ''Atypical'' and anaplastic meningiomas recurred in 29% and 50%, respectively. Since the term ''atypical'' meningioma is confusing in the context of tumour grading, the term ''intermediate type meningioma'' is proposed. Furthermore, the results of cytogenetic analyses of 142 cases of this series were evaluated and compared with the meningioma grades. Thereby, 25 cases disclosed, independent of the typical loss of one chromosome 22, cytogenetic features assumed to be progression-associated, e.g., the gain or loss of different chromosomes and the deletion of the short arm of one chromosome 1 (hyperdiploidy, increased hypodiploidy, 1p-), when correlated to the histological and morphometric findings or the high relapse rate. For meningioma diagnosis and grading, a practical guideline is proposed based upon histology, morphometry (Ki-67), and cytogenetics.