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Novel histopathological classification of meningiomas based on dural invasion
  1. Makoto Murase1,
  2. Ryota Tamura1,
  3. Yuki Kuranari1,
  4. Mizuto Sato1,
  5. Kentaro Ohara2,
  6. Yukina Morimoto1,
  7. Kazunari Yoshida1,
  8. Masahiro Toda1
  1. 1 Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  2. 2 Department of Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
  1. Correspondence to Dr Masahiro Toda, Neurosurgery, Keio University School of Medicine, Shinjuku-ku 1608582, Japan; todam{at}


Aims Histological invasion into the adjacent brain parenchyma is frequently investigated in meningioma because it is an important morphological criterion for grade II meningioma according to the 2016 WHO classification. However, few studies have focused on dural invasion of meningiomas. Herein, we propose a novel histopathological classification based on dural invasion of meningiomas.

Methods Forty-nine cases with WHO grade I meningiomas who underwent Simpson grade I removal were collected. After the meningeal layer (ML) and periosteal layer (PL) of dura mater were visualised by Masson’s trichrome stain, we evaluated the depth (to the ML and PL) and the patterns (1, expanding; 2, infiltrating) of dural invasion of meningiomas using serial paraffin sections. Invasion-associated markers, including Ki-67, matrix metalloproteinase (MMP)-1, MMP-9 and MMP-13, aquaporin 1 and Na-K-2Cl cotransporter, were quantitatively analysed by immunohistochemistry.

Results Thirty-five cases (71.4%) showed the dural invasion. In 27 of these 35 cases (77.1%), dural invasion was localised in ML. Type 1 (expanding type) and type 2 (infiltrating type) invasions were observed in 23 and 12 cases, respectively. The recurrence rate in cases with type 2 invasion was significantly higher than that in cases with type 1 invasion. The percentage of MMP-1-positive tumour cells was also significantly higher in cases with dural invasion than those without, suggesting involvement of MMP-1 in dural invasion.

Conclusions We quantitatively evaluated the depth and patterns of dural invasion in meningiomas. The patterns of dural invasion were associated with meningioma recurrence.

  • meningioma
  • neuropathology
  • immunohistochemistry

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  • Handling editor Runjan Chetty.

  • Contributors Conception and design: MM, RT, KY and MT. Acquisition of data: MM and YK. Analysis and interpretation of data: MM, RT, YM, MS and KO. Drafting the article: MM and RT. Critical revision of the article: RT and MT. Review of submitted version of the manuscript: KY. Statistical analysis: MM, RT and YK. Study supervision: KY and MT.

  • Funding This work was supported in part by grants from the Japan Society for the Promotion of Science (17H04306 and 18K19622 to MT).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All procedures performed in this study involving human subjects were in accordance with the ethical standards of the institutional ethics committee (reference number: 20050002) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all patients.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.