CNS & pituitary tumors

Meningeal tumors

WHO grading of meningiomas

Last author update: 10 March 2022
Last staff update: 10 March 2022

Copyright: 2002-2024,, Inc.

PubMed Search: 2021 WHO grading of meningiomas[title]

Jared T. Ahrendsen, M.D., Ph.D.
Sanda Alexandrescu, M.D.
Page views in 2023: 13,557
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Cite this page: Ahrendsen JT, Alexandrescu S. WHO grading of meningiomas. website. Accessed May 19th, 2024.
Definition / general
  • Family of neoplasms most likely derived from meningothelial cells of the arachnoid mater
Major updates
WHO (2021)
Diagrams / tables

Contributed by Jared T. Ahrendsen, M.D., Ph.D.

Criteria for meningioma classification

Microscopic (histologic) images

Contributed by Jared T. Ahrendsen, M.D., Ph.D. and Chunyu Cai, M.D., Ph.D.

Brain invasion



Increased cellularity

Small cell transformation

Prominent nucleoli

Atypical meningioma

Anaplastic meningioma

Board review style question #1

An intracranial neoplasm (histology shown in image) is resected from the lateral convexity of a 65 year old woman. Which of the following molecular alterations, if present, is compatible with a CNS WHO grade 3 designation for this tumor type?

  1. EGFR amplification
  2. Germline NF2 mutation
  3. IDH mutation
  4. Monosomy 22
  5. TERT promotor mutation
Board review style answer #1
E. TERT promotor mutation. The neoplasm shown is consistent with meningioma. CNS WHO grade 3 can be applied to meningiomas with either TERT promotor mutation or CDKN2A/B homozygous deletion. EGFR amplification (A) is a feature of IDH wildtype glioblastoma, not meningioma. While patients with germline NF2 mutations (B) (neurofibromatosis type 2) often have multiple meningiomas, this is not sufficient for CNS WHO grade 3 designation. IDH mutations (C) are present in diffusely infiltrating astrocytomas and oligodendrogliomas, not meningiomas. While monosomy 22 (D) is the most common genetic abnormality encountered in meningiomas, it is not sufficient for CNS WHO grade 3 designation.

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Reference: WHO grading of meningiomas
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