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