[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Central nervous system](https://durgical.com/en/general-pathology/areas/cns/) › Meningioma

# Meningioma

- Lesion

Meningiomas grow from the brain's covering, are usually slow and benign, and press on the brain rather than invade it.

Updated Nov 12, 2026

## Key points

- Histology: whorls of meningothelial cells, intranuclear pseudoinclusions and psammoma bodies (laminated calcifications).
- Imaging: extra-axial dural-based mass with a dural tail; may thicken the overlying bone (hyperostosis).
- Grade 1: most variants; grade 2 (atypical): more mitoses, brain invasion, or clear cell and chordoid types; grade 3 (anaplastic): very high mitoses or carcinoma-like look, or TERT promoter mutation or CDKN2A/B deletion.
- Drivers: NF2 loss (most), TRAF7, KLF4, AKT1, SMO in NF2-intact skull-base tumours.
- Risk factors: radiation to the head, NF2; many express progesterone receptors and may grow in pregnancy.

## What it is

Meningiomas are tumours of arachnoid cap cells attached to the dura. They are the commonest primary intracranial tumour in adults, more frequent in women, and usually benign (grade 1). They grow along the falx, convexity, sphenoid wing, olfactory groove, tentorium and spinal canal, compressing the brain. Loss of NF2 is the commonest driver; multiple meningiomas suggest neurofibromatosis type 2 or prior radiation. Higher-grade forms recur and can invade the brain.

## Structure

- Gross: firm, rounded, well-demarcated mass that indents the brain and can be peeled away; en plaque forms spread as sheets over dura.
- Micro: syncytial cells in lobules and whorls, fibroblast-like spindle cells in fibrous variant.
- Markers: EMA, progesterone receptor and SSTR2A positive.

## Meningioma grades

| CNS WHO grade | Defining features | Behaviour |
| --- | --- | --- |
| [Grade 1](https://durgical.com/en/conditions/meningioma/) | Usual variants (meningothelial, fibrous, transitional, psammomatous), low mitotic rate | Slow growth; cured by complete removal |
| Grade 2 (atypical) | Increased mitoses, brain invasion, or clear cell or chordoid variant | Recurs more often |
| Grade 3 (anaplastic) | Very high mitotic rate, carcinoma- or sarcoma-like, TERT promoter mutation or CDKN2A/B deletion | Aggressive, recurs, can metastasise |

## Clinical notes

- Often found by chance; symptoms depend on site: seizures, focal deficits, anosmia (olfactory groove), visual loss (sphenoid wing).
- In children or young adults, a meningioma should raise suspicion of NF2 or prior radiation.

## Memory aid

Meninges make whorls and sand (psammoma); press, do not invade; women more than men.

## Test yourself

Think of the answer, then tap the question to see it.

## What are psammoma bodies in a meningioma?

Round laminated calcifications that form in the centre of cell whorls.

## Which gene is most often lost in meningiomas?

NF2 (merlin), also mutated in neurofibromatosis type 2.

## Which finding makes a meningioma grade 2 even without many mitoses?

Invasion of brain tissue, or the clear cell or chordoid variant.

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## Connections

## Related 6

- [CNS tumours: an overview](https://durgical.com/en/general-pathology/cns-tumours-an-overview/)
- [Familial tumour syndromes of the nervous system](https://durgical.com/en/general-pathology/familial-tumour-syndromes-of-the-nervous-system/)
- [Schwannoma and neurofibromatosis type 2](https://durgical.com/en/general-pathology/schwannoma-and-neurofibromatosis-type-2/)
- [Pathologic calcification: dystrophic vs metastatic](https://durgical.com/en/general-pathology/pathologic-calcification-dystrophic-vs-metastatic/)
- [Radiation and cancer: ultraviolet and ionizing](https://durgical.com/en/general-pathology/radiation-and-cancer-ultraviolet-and-ionizing/)
- [Grading and staging: what TNM means](https://durgical.com/en/general-pathology/grading-and-staging-what-tnm-means/)

## Related conditions 4

- [Meningioma](https://durgical.com/en/conditions/meningioma/)
- [Neurofibromatosis (types 1 and 2)](https://durgical.com/en/conditions/neurofibromatosis/)
- [Breast cancer](https://durgical.com/en/conditions/breast-cancer/)
- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Meningioma: Diagnosis and Treatment - NCI](https://www.cancer.gov/rare-brain-spine-tumor/tumors/meningioma) (National Cancer Institute, 2026).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/meningioma/