Meningioma 40 Years after Radiation Therapy for Retinoblastoma: Genetic and Phenotypic Analysis, and Minireview of Literature

Abstract

The authors present a case of 44-year-old Caucasian female diagnosed with meningothelial meningioma 40 years after radiotherapy for sporadic unilateral retinoblastoma. The genetic analysis of DNA from the meningioma revealed no oncogenic mutation in the RB1 gene. The analysis of meningioma cells by flow cytometry revealed the following immunophenotype: vimentin++ CD56+ GFAP− EGFR−. Intermediate intensities of Her-2/neu and Pgp expression were detected in a small percentage of tumour cells. Data suggest that the tumour was most likely induced by radiotherapy and did not arise as a second tumour as there was no hereditary predisposition to retinoblastoma.

Zusammenfassung

Die Autoren präsentieren den Fall einer 44-Jahre alten Kaukasierin, bei der ein meningotheliales Meningeom 40 Jahre nach Radiotherapie eines unilateralen Retinoblastoms diagnostiziert wurde. Die genetische Analyse der DNA des Meningeoms zeigte keine onkogenetischen Mutationen im RB1 Gen. Die Analyse der Meningeomzellen durch die Flow Cytometrie zeigte folgenden Immunphenotyp: vimentin++ CD56+ GFAP EGFR. Die durchschnittlichen Intensitäten von Her-2/neu und Pgp Expressionen wurden in kleinen Proportionen in einigen Tumorzellen gefunden. Diese Daten belegen, dass der Tumor höchstwahrscheinlich durch die Radiotherapie induziert wurde und nicht als Sekundärtumor bei hereditärer Prädisposition zu einem Retinoblastom zu sehen ist.

Key words

retinoblastoma - radiation-induced meningioma - RB1 gene - mutation analysis - immunophenotype

Schlüsselwörter

Retinoblastom - bestrahlungsinduziertes Meningeom - RB1-Gen - Mutations-Analyse - Immunophenotyp

References

• 1 Abramson DH, Ellsworth RM, Kitchin FD, Tung G. Second nonocular tumors in retinoblastoma survivors. Are they radiation-induced?.  Ophthalmology. 1984;  91 1351-1355
• 2 Albert RE, Omran AR, Brauer EW, Dove DC, Cohen NC, Schmidt H, Baumring R, Morrill S, Schulz R, Baer RL. Follow-up study of patients treated by x-ray for tinea capitis.  Am J Public Health Nations Health. 1966;  56 2114-2120
• 3 Albrecht P, Ansperger-Rescher B, Schüler A, Zeschnigk M, Gallie B, Lohmann DR. Spectrum of gross deletions and insertions in the RB1 gene in patients with retinoblastoma and association with phenotypic expression.  Hum Mutat. 2005;  26 437-445
• 4 Al-Mefty O, Kersh JE, Routh A, Smith RR. The long-term side effects of radiation therapy in adults.  J Neurosurg. 1990;  73 502-512
• 5 Al-Mefty O, Topsakal C, Pravdenkova S, Sawyer JR, Harrison MJ. Radiation-induced meningiomas: clinical, pathological, cytokinetic, and cytogenetic characteristics.  J Neurosurg. 2004;  100 1002-1013
• 6 Ambrose J, Gooding MR, Richardson AE. An assessment of the accuracy of computerized transverse axial scanning (EMI scanner) in the diagnosis of intracranial tumour. A review of 366 patients.  Brain. 1975;  98 569-582
• 7 Andersson U, Guo D, Malmer B, Bergenheim AT, Brännström T, Hedman H, Henriksson R. Epidermal growth factor receptor family (EGFR, ErbB2-4) in gliomas and meningiomas.  Acta Neuropathol. 2004;  108 135-142
• 8 Aristizabal S, Caldwell WL, Avila J. The relationship of time-dose fractionation factors to complications in the treatment of pituitary tumors by irradiation.  Int J Radiat Oncol Biol Phys. 1977;  2 667-673
• 9 Atkinson AB, Allen IV, Gordon DS, Hadden DR, Maguire CJ, Trimble ER, Lyons AR. Progressive visual failure in acromegaly following external pituitary irradiation.  Clin Endocrinol. 1979;  10 469-479
• 10 Beller AJ, Feinsod M, Sahar A. The possible relationship between small dose irradiation to the scalp and intracranial meningiomas.  Neurochirurgia. 1972;  15 135-143
• 11 Bonnin JM, Rubinstein LJ. Immunohistochemistry of central nervous system tumours: its contributions to neurosurgical diagnosis.  J Neurosurg. 1984;  60 1121-1133
• 12 Brady LW. Radiation-induced sarcomas of bone.  Skeletal Radiol. 1979;  4 72-78
• 13 Budka H. Non-glial specificities of immunocytochemistry for the glial fibrillary acidic protein (GFAP). Triple expression of GFAP, vimentin and cytokeratins in papillary meningioma and metastasizing renal carcinoma.  Acta Neuropathol (Berl). 1986;  72 43-54
• 14 Cantini R, Giorgetti W, Valleriani AM, Burchianti M, Amodeo C. Radiation-induced cerebral lesions in childhood.  Childs Nerv Syst. 1989;  5 135-139
• 15 Carroll RS, Black PM, Zhang J, Kirsch M, Percec I, Lau N, Guha A. Expression and activation of epidermal growth factor receptors in meningiomas.  J Neurosurg. 1997;  87 315-323
• 16 Cerasoli S, Gubinelli M, Tison V, Vergoni G, Morigi F, Cenacchi G. Chordoid meningioma: case report.  Brain Pathol. 1994;  4 439
• 17 Chang CH, Pool JL. The radiotherapy of pituitary chromophobe adenomas: an evaluation of indication, technic and result.  Radiology. 1967;  89 1005-1016
• 18 Chozick BS, Benzil DL, Stopa EG, Pezzullo JC, Knuckey NW, Epstein MH, Finkelstein SD, Finch PW. Immunohistochemical evaluation of erb-2 and p53 protein expression in benign and atypical human meningiomas.  J Neurooncol. 1996;  27 117-126
• 19 Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM. Epidemiology of intracranial meningioma.  Neurosurgery. 2005;  57 1088-1095
• 20 Colin P, Scavarda D, Delemer B, Nakib I, Caron J, Bazin A, Bernard MH, Peruzzi P, Scherpereel B, Fauchon V, Delannes M, Redon C, Rousseaux P. Radiothérapie stéréotaxique fractionnée: résultats dans les adénomas hypophysaires, les neurinomes de l’acoustique et les méningiomes du sinus caverneux.  Cancer Radiother. 1998;  2 207-214 , (article in French)
• 21 DeMonte F, Al-Mefty O. Meningiomas. In: Kaye AH, Laws Jr ER. Brain Tumors. 3rd edn. Churchill Livingstone, Edinburgh 1997: 675-704
• 22 Draper GJ, Sanders BM, Kingston JE. Second primary neoplasms in patients with retinoblastoma.  Br J Cancer. 1986;  53 661-671
• 23 Ellis F. Dose, time and fractionation: a clinical hypothesis.  Clin Radiol. 1969;  20 1-7
• 24 Eng C, Li FP, Abramson DH, Ellsworth RM, Wong FL, Goldman MB, Seddon J, Tarbell N, Boice  Jr  JD. Mortality from second tumors among long-term survivors of retinoblastoma.  J Natl Cancer Inst. 1993;  85 1121-1128
• 25 Espinosa AB, Tabernero MD, Maillo A, Sayagues JM, Ciudad J, Merino M, Alguero MC, Lubombo AM, Sousa P, Santos-Briz A, Orfao A. The cytogenetic relationship between primary and recurrent meningiomas points to the need for new treatment strategies in cases at high risk of relapse.  Clin Cancer Res. 2006;  12 772-780
• 26 Giaquinto S, Massi G, Ricolfi A, Vitali S. On six cases of radiation meningiomas from the same community.  Ital J Neurol Sci. 1984;  5 173-175
• 27 Grill J, Lamfers MLM, Beusechem VW van, Valk P van der, Huisman A, Sminia P, Alemany R, Curiel DT, Vandertop WP, Gerritsen WR, Dirven CMF. Oncolytic virotherapy of meningiomas in vitro with replication-competent adenovirus.  Neurosurgery. 2005;  56 146-154
• 28 Halliday WC, Yeger H, Duwe GF, Phillips MJ. Intermediate filaments in meningiomas.  J Neuropathol Exp Neurol. 1985;  44 617-623
• 29 Harris JR, Levene MB. Visual complications following irradiation for pituitary adenomas and craniopharyngiomas.  Radiology. 1976;  120 167-171
• 30 Harrison MJ, Wolfe DE, Lau T, Mitnick RJ, Sachdev VP. Radiation-induced meningiomas: experience at the Mount Sinai Hospital and review of the literature.  J Neurosurg. 1991;  75 564-574
• 31 Jaaskelainen J. Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis.  Surg Neurol. 1986;  26 461-469
• 32 Jensen RD, Miller RW. Retinoblastoma: epidemiologic characteristics.  N Eng J Med. 1971;  285 307-311
• 33 Kadasheva AB, Cherekaev VA, Kozlov AV, Belov AI, Zaitsev AM, Kudriavtseva PA. Meningiomas of the wings of the basilar bone in patients undergone a course of radiation therapy for retinoblastoma in infancy (analysis of 3 cases).  Zh Vopr Neirokhir Im N N Burdenko. 2004;  3 24-27 , (article in Russian)
• 34 Karjalainen K, Tarkkanen A, Merenmies L. Suprasellar meningioma 47 years after bilateral retinoblastoma.  Acta Ophthalmol (Copenh). 1988;  66 79-82
• 35 Kleinerman RA, Tucker MA, Tarone RE, Abramson DH, Seddon JM, Stovall M, Li FP, Fraumeni  Jr  JF. Risk of new cancer after radiotherapy in long-term survivors of retinoblastoma: an extended follow-up.  J Clin Oncol. 2005;  23 2272-2279
• 36 Kleinschmidt-DeMasters BK, Lillehei KO. Radiation-induced meningioma with a 63-year latency period. Case report.  J Neurosurg. 1995;  82 487-488
• 37 Kramer S. The hazards of therapeutic irradiation of the central nervous system.  Clin Neurosurg. 1968;  15 301-318
• 38 Liwnicz BH, Berger TS, Liwnicz BS, Aaron BS. Radiation-associated gliomas: A report of four cases and analysis of post radiation tumors of the central nervous system.  Neurosurgery. 1985;  17 436-445
• 39 Maillo A, Orfao A, Sayagues JM, Diaz P, Gomez-Moreta JA, Caballero M, Santamarta D, Santos-Briz A, Morales F, Tabernero MD. New classification scheme for the prognostic stratification of meningioma on the basis of chromosome 14 abnormalities, patient age, and tumor histopathology.  J Clin Oncol. 2003;  21 3285-3295
• 40 Marks JE, Wong J. The risk of cerebral radionecrosis in relation to dose, time and fractionation. A follow-up study.  Prog Exp Tumor Res. 1985;  29 210-218
• 41 Mennel HD, Zinngrebe J, Berweiler-Nippert U, Lorenz H. Meningiomas: histogenesis and classification.  Zentralb Allg Pathol. 1988;  134 27-40
• 42 Montanera W, Chui M, Hudson A. Meningioma and occlusive vasculopathy: coexisting complications of past extracranial radiation.  Surg Neurol. 1985;  24 35-39
• 43 Moss SD, Rockswold GL, Chou SN, Yock D, Berger MS. Radiation-induced meningiomas in pediatric patients.  Neurosurg. 1988;  22 758-761
• 44 Munk J, Peyser E, Gruszkiewicz J. Radiation induced intracranial meningiomas.  Clin Radiol. 1969;  20 90-94
• 45 Musa BS, Pople IK, Cummins BH. Intracranial meningiomas following irradiation.  A growing problem? Br J Neurosurg. 1995;  9 629-637
• 46 Nishio S, Morioka T, Inamura T, Takeshita I, Fukui M, Sasaki M, Nakamura K, Wakisaka S. Radiation-induced brain tumours: potential late complications of radiation therapy for brain tumours.  Acta Neurochir (Wien). 1998;  140 763-770
• 47 Preston-Martin S, Paganini-Hill A, Henderson BE, Pike MC, Wood C. Case-control study of intracranial meningiomas in women in Los Angeles County, California.  J Natl Cancer Inst. 1980;  65 67-73
• 48 Preston-Martin S, Yu MC, Henderson BE, Roberts C. Risk factors for meningiomas in men in Los Angeles County.  J Natl Cancer Inst. 1983;  70 863-866
• 49 Preston-Martin S, Staples M, Farrugia H, Giles G. Primary tumors of the brain, cranial nerves and cranial meninges in Victoria, Australia, 1982–1990: patterns of incidence and survival.  Neuroepidemiology. 1993;  12 270-279
• 50 Rubinstein AB, Shalit MN, Cohen ML, Zandbank U, Reichenthal E. Radiation-induced cerebral meningioma: a recognizable entity.  J Neurosurg. 1984;  61 966-971
• 51 Rusyniak WG, Marchese MJ, Nelson CN. Benign meningioma with a short latency period following irradiation.  Surg Neurol. 1992;  38 261-264
• 52 Sadamori N, Shibata S, Mine M, Miyazaki H, Miyake H, Kurihara M, Tomonaga M, Sekine I, Okumura Y. Incidence of intracranial meningiomas in Nagasaki atomic-bomb survivors.  1996;  67 318-322
• 53 Sadetzki S, Flint-Richtr P, Ben-Tal T, Nass D. Radiation-induced meningioma: a descriptive study of 253 cases.  J Neurosurg. 2002;  97 1078-1082
• 54 Salvati M, Cervoni L, Artico M. High-dose radiation-induced meningiomas following acute lymphoblastic leukemia in children.  Childs Nerv Syst. 1996;  12 266-269
• 55 Salvati M, Cervoni L, Puzzilli F, Bristot R, Delfini R, Gargliardi FM. High-dose radiation-induced meningiomas.  Surg Neurol. 1997;  47 435-442
• 56 Sarissky M, Redondo MDT, Espinosa AB, Maillo A, Sayagues JM, Orfao A. Immunophenotypic analysis of benign human meningiomas.  Cytometry. 2004;  59A 83 , (abstract)
• 57 Schlegel J, Ullrich B, Stumm G, Gass P, Harwerth I-M, Hynes NE, Keissling M. Expression of the c-erbB-2-encoded oncoprotein and progesterone receptor in human meningiomas.  Acta Neuropathol (Berl). 1993;  86 473-479
• 58 Schüler A, Weber S, Neuhäuser M, Jurklies C, Lehnert T, Heimann H, Rudolph G, Jöckel K-H, Bornfeld N, Lohmann DR. Age at diagnosis of isolated unilateral retinoblastoma does not distinguish patients with and without a constitutional RB1 gene mutation but is influenced by a parent-of-origin effect.  Eur J Cancer. 2005;  41 735-740
• 59 Shibui S, Nomura K, Matsuoka K, Kaneko A, Nakajima T. Two cases of the middle fossa tumor following radiotherapy against retinoblastoma.  No Shinkei Geka. 1987;  15 1087-1091 , (article in Japanese)
• 60 Simon M, Park TW, Koster G, Mahlberg R, Hackenbroch M, Bostrom J, Loning T, Schramm J. Alterations of INK4a(p16-p14ARF)/INK4b(p15) expression and telomerase activation in meningioma progression.  J Neurooncol. 2001;  55 149-158
• 61 Soffer D, Pittaluga S, Feiner M, Beller AJ. Intracranial meningiomas following low-dose irradiation to the head.  J Neurosurg. 1983;  59 1048-1053
• 62 Starshak RJ. Radiation-induced meningioma in children: report of two cases and review of the literature.  Pediatr Radiol. 1996;  26 537-541
• 63 Su M, Ono K, Tanaka R, Takahashi H. An unusual meningioma variant with glial fibrillary acidic protein expression.  Acta Neuropathol (Berl). 1997;  94 499-503
• 64 Tse JY, Ng HK, Lo KW, Chong EY, Lam PY, Ng EK, Poon WS, Huang DP. Analysis of cell cycle regulators: p16INK4A, pRb, and CDK4 in low- and high-grade meningiomas.  Hum Pathol. 1998;  29 1200-1207
• 65 Wanschitz J, Schmidbauer M, Maier H, Rössler K, Vorkapic P, Budka H. Suprasellar meningioma with expression of glial fibrillary acidic protein: a peculiar variant.  Acta Neuropathol (Berl). 1995;  90 539-544
• 66 Wilson CB. Meningiomas: genetics, malignancy, and the role of radiation in induction and treatment. The Richard C. Schneider Lecture.  J Neurosurg. 1994;  81 666-675

Correspondence