Symptomatic progestin-associated atypical grade II meningioma. A first case report

A Roux¹, A Tauziede-Espariat², M Zanello¹, A Gareton³, H Malaize¹, J Benzakoun⁴, G Zah-Bi¹, C Oppenheim⁵, G Plu-Bureau⁶, F Chretien⁴, J Pallud⁷

Affiliations

¹ Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France.
² Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France.
³ Paris Descartes University, Sorbonne Paris-Cité, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France.
⁴ Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France.
⁵ Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuroradiology, GHU de Paris, Sainte-Anne Hospital, Paris, France.
⁶ INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France; Gynecology Endocrinology Unit, University Hospital Paris Centre, Cochin Hospital, AP-HP, Paris, France.
⁷ Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France. Electronic address: j.pallud@ghu-paris.fr.

PMID: 32277999
DOI: 10.1016/j.neuchi.2019.12.013

Case Reports

Symptomatic progestin-associated atypical grade II meningioma. A first case report

A Roux et al. Neurochirurgie. 2020 Jun.

. 2020 Jun;66(3):174-178.

doi: 10.1016/j.neuchi.2019.12.013. Epub 2020 Apr 8.

Authors

A Roux¹, A Tauziede-Espariat², M Zanello¹, A Gareton³, H Malaize¹, J Benzakoun⁴, G Zah-Bi¹, C Oppenheim⁵, G Plu-Bureau⁶, F Chretien⁴, J Pallud⁷

Affiliations

¹ Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France.
² Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France.
³ Paris Descartes University, Sorbonne Paris-Cité, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France.
⁴ Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuropathology, GHU de Paris, Sainte-Anne Hospital, Paris, France.
⁵ Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France; Department of Neuroradiology, GHU de Paris, Sainte-Anne Hospital, Paris, France.
⁶ INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Paris-Descartes University, Paris, France; Gynecology Endocrinology Unit, University Hospital Paris Centre, Cochin Hospital, AP-HP, Paris, France.
⁷ Department of Neurosurgery, GHU de Paris, Sainte-Anne Hospital, 1, rue Cabanis, Paris, France; Paris Descartes University, Sorbonne Paris-Cité, Paris, France; INSERM, UMR 1266, IMA-Brain, Institute of Psychiatry and Neurosciences of Paris, Paris, France. Electronic address: j.pallud@ghu-paris.fr.

PMID: 32277999
DOI: 10.1016/j.neuchi.2019.12.013

Abstract

Background: Long-term use of high-dose progestin is known to promote the development of meningioma. Atypical meningioma in a patient under progestin has not previously been reported.

Case report: A 53-year-old right-handed woman presented with focal onset seizures, without impaired consciousness. Medical history featured endometriosis, treated successively by cyproterone acetate 25mg/day for 2 months then 50mg/day for 101 months, and chlormadinone acetate 5mg/day for 68 months then 10mg/day for 83 months. Brain MRI revealed multiple extra-axial lesions suggestive of left central meningioma associated with anterior skull base meningiomatosis. Surgical resection of the left central meningioma was achieved and progestin was withdrawn. Neuropathology diagnosed grade II atypical meningioma. Close clinical and imaging monitoring was implemented without adjuvant oncological treatment. At 25 months, imaging follow-up showed no recurrence of the left central meningioma and a significant regression of all other lesions, except for the right frontal lesion.

Conclusions: Neurosurgeons should be aware of the possible aggressiveness of meningioma in patients under progestin, and particularly those treated by different types of progestin over a long period of time without interruption. This may require systematic close monitoring, to adapt neurosurgical management.

Keywords: Atypical meningioma; Chlormadinone acetate; Cyproterone acetate; Neurosurgery; Progesterone agonist.

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Symptomatic progestin-associated atypical grade II meningioma. A first case report

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Symptomatic progestin-associated atypical grade II meningioma. A first case report

Authors

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Abstract

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