Figure 4.

Case examples demonstrating how molecular profiling can inform care. T1 post-contrast MRI from two WHO grade 2 meningiomas (A,B) who both presented with a seizure and underwent gross total resection (C,D). The patient on the left had a hypermitotic methylation profile and chromosome losses at 1p, 6, 14, haplo-insufficiency of CDKN2A, and 22q, making it a Driver et al. integrated grade 3 tumor, with a high Chen et al. gene expression risk score. He underwent 59.4 Gy adjuvant radiotherapy and had an in-field recurrence (E) at 15 months post-operative. The patient on the right also had a WHO grade 2 meningioma that had an immune-enriched methylation profile and chromosome 8 loss with haplo-insufficiency of chromosome 22, making it a Driver et al. integrated grade 1 tumor [86], and had a low Chen et al. gene expression risk score [126]. She was observed given the favorable molecular profile without adjuvant radiotherapy and had no recurrence at 2 years post-operative (F).