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It has recently been proposed that meningiomas may be classified into four molecular groups (MG): immunogenic (MG1), benign\n                    <jats:italic>NF2<\/jats:italic>\n                    -wildtype (MG2), hypermetabolic (MG3), and proliferative (MG4). The two latter have the worst prognosis, and it has been suggested that they can be identified using ACADL and MCM2 immunostainings. We studied 55 primary atypical meningiomas, treated with gross total resection and no adjuvant therapies, to assess whether ACADL and MCM2 immuno-expression may identify patients at higher recurrence risk, thus requiring adjuvant treatments. Twelve cases resulted ACADL-\/MCM2-, 9 ACADL\u2009+\u2009\/MCM2-, 17 ACADL\u2009+\u2009\/MCM2\u2009+\u2009, and 17 ACADL-\/MCM2\u2009+\u2009. MCM2\u2009+\u2009meningiomas displayed more frequent atypical features (prominent nucleoli, small cells with high nuclear-to-cytoplasmic ratio) and\n                    <jats:italic>CDKN2A<\/jats:italic>\n                    hemizygous deletion (HeDe) (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.011). The immunoexpression of ACADL and\/or MCM2 was significantly associated with higher mitotic index, 1p and 18q deletions, increased recurrence rate (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.0006), and shorter recurrence-free survival (RFS) (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.032). At multivariate analysis, carried out including ACADL\/MCM2 immuno-expression, mitotic index, and\n                    <jats:italic>CDKN2A<\/jats:italic>\n                    HeDe as covariates, this latter resulted a significant and independent prognosticator of shorter RFS (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.0003).\n                  <\/jats:p>","DOI":"10.1007\/s00428-023-03537-2","type":"journal-article","created":{"date-parts":[[2023,4,4]],"date-time":"2023-04-04T08:19:23Z","timestamp":1680596363000},"page":"97-104","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Atypical meningiomas with an immunohistochemical profile consistent with hypermetabolic or proliferative molecular groups show high mitotic index, chromosomal instability, and higher recurrence risk"],"prefix":"10.1007","volume":"483","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7086-1920","authenticated-orcid":false,"given":"Valeria","family":"Barresi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Ammendola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Simbolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Pedron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Caffo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo","family":"Scarpa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,4,4]]},"reference":[{"key":"3537_CR1","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/neuonc\/noac202","volume":"24","author":"QT Ostrom","year":"2022","unstructured":"Ostrom QT, Price M, Neff C, Cioffi G, Waite KA, Kruchko C, Barnholtz-Sloan JS (2022) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2015\u20132019. 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