PMC5985599_01
(a) Hematoxylin and eosin stain (40x magnification) from the first, atypical
meningioma showed a highly cellular tumor with large nuclei and prominent
nucleoli, and an increased mitotic count. (b) The tumor showed a varying
expression pattern for EMA (20x magnification). (c) SSTR2A showed diffuse
and strong membranous and cytoplasmic positivity (20x magnification). (d)
MDM2 amplification resulted in MDM2 overexpression, since additional
immunohistochemistry showed nuclear positivity for MDM2 (40x
magnification).
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Organization (WHO) grade II was made (Figure 1). One year later, MRI showed subdural relapse of the tumor at the same location.
a) Hematoxylin and eosin stain (40x magnification) from the recurrent,
anaplastic meningioma showed a frankly malignant tumor with prominent
cytological atypia, high mitotic count, and extensive necrosis. (b) The
tumor showed only partial positivity for EMA (20x magnification). (c) SSTR2A
showed membranous and cytoplasmic positivity in the majority of the tumor
(40x magnification). (d) MDM2 amplification resulted in MDM2 overexpression,
since additional immunohistochemistry showed nuclear positivity for MDM2
(40x magnification).
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The diagnosis was anaplastic meningioma, WHO grade III (Figure 2).
Representative FISH images from the first, atypical meningioma. (a)
Amplification of CDK4 gene, as indicated by the multiple green signals from
the Spectrum-Green (SG)-labeled, telomeric to DDIT3/12q13 probe (which
covers CDK4 gene) in reference to the Spectrum-Orange (SO)-labeled,
centromeric to DDIT3/12q13 probe. (b) Amplification of MDM2 gene, as
indicated by the multiple red signals from the SO-labeled MDM2/12q14
loci-specific probe in reference to the SG-labeled chromosome 12 centromeric
probe.
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FISH also showed gross CDK4 amplification in 73% and gross MDM2 amplification in 76% of the tumor cells from the first, atypical meningioma (Figure 3).