Regression of multiple intracranial meningiomas after cessation of long-term progesterone agonist therapy

Case report

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The authors present the case of a patient that demonstrates the long-standing use of megestrol acetate, a progesterone agonist, and its association with multiple intracranial meningioma presentation. Discontinuation of megestrol acetate led to shrinkage of multiple tumors and to the complete resolution of one tumor. Histological examination demonstrated that the largest tumor had high (by > 25% of tumor cell nuclei) progesterone-positive expression, including progesterone receptor (PR) isoform B, compared with low expression of PR isoform A; there was no evidence of estrogen receptor expression and only unaccentuated collagen expression. This is the first clinical report illustrating a causal relationship between exogenous hormones and modulation of meningioma biology in situ.

Abbreviations used in this paper: ER = estrogen receptor; PR = progesterone receptor; PRA = PR isoform A; PRB = PR isoform B.

Article Information

Address correspondence to: Michael Schulder, M.D., The Harvey Cushing Brain Tumor Institute, North Shore University Hospital–Long Island Jewish Health System, 9th Floor, Tower Pavilion, 300 Community Drive, Manhasset, New York 11030. email: schulder@nshs.edu.

Please include this information when citing this paper: published online September 4, 2009; DOI: 10.3171/2009.8.JNS09201.

© AANS, except where prohibited by US copyright law.

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Figures

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    Preoperative T1-weighted contrast-enhanced MR images in coronal slices illustrating the location of the 5 meningioma tumors.

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    Photomicrographs of histological sections obtained for assessment of meningioma. A: The H & E staining shows several whorl patterns of tumor nuclei. B: No estrogen expression (brown) is seen in tumor nuclei, but it is seen in inflammatory cells. C: Most nuclei coexpress (brown) with PR-positive expression. D: Collagen expression (blue) is limited outside the whorl patterns of nuclei. E and F: There is a predominance of PRB expression compared with PRA (brown). Insets show high-power magnification of selected regions within respective images.

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    Preoperative, 6 months postoperative, and 5 years postoperative T1-weighted contrast-enhanced MR images in coronal slices illustrating attenuation of untreated enhanced lesions, and even complete loss of a lesion.

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    Drawing illustrating nongenomic and genomic actions of various known hormone receptor modulators of meningioma growth activity. The schematic illustrates exogenous hormone use for breast cancer treatment targeting the PR, which may promote meningioma growth when there is a predominance of PRB versus PRA. AR = androgen receptor; DA = dopamine; GH = growth hormone; MAPK = mitogen-activated protein kinase; SS = somatostatin; TF = transcription factor.

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