Meningiomas in Premenopausal Women: Role of the Hormone Related Conditions

Abstract

Background: Several epidemiological and pathological findings suggest that the female sex hormones may influence the development of meningiomas. However, the role of pregnancy, oral contraceptives, and fertilization therapies is still controversial.

Methods: From the surgical series of 354 patients with meningiomas operated between 2006 and 2019, the group of 72 premenopausal women was separately considered. The tumor location, WHO grade, Ki67-labeling index (LI), progesterone receptor (PR) expression, and histological types were studied in premenopausal women with and without hormone-related conditions were compared.

Results: In this premenopausal group, 24 patients had hormone-related conditions, including use of oral contraceptives in 16, intrauterine fertilization in one, pregnancy in three, and tumors of the female reproductive system in four. The group of patients with hormone-related conditions, as compared to that with no hormone related conditions, showed slightly lower median age (38 versus 43 years) and no significant difference of meningioma location WHO grade, Ki 67-Li, PR expression and histological type. The clinical onset during pregnancy in three patients and tumor growth during contraceptive progesterone therapy in two others were evidenced.

Conclusion: The biological behavior of meningiomas and their pathological findings, including PR expression, are not correlated with the different hormone related conditions in premenopausal female patients. Contraceptives and fertilization therapies, mainly with progesterone, should be avoided in patients with meningiomas.

Keywords: fertilization therapies; meningioma; oral contraceptives; pregnancy; progesterone receptor expression.

Figure 1

Immunohistochemical evaluation of progesterone receptor antibody expression: nuclear signal respectively in less than 1% (A), in 15% (B) and in 95% (C) of neoplastic cells (200× magnification).

Figure 2

Post-contrast cranial MRI of 35-year-old female with tuberculum sellae meningioma presenting sudden onset of visual deficit during artificial in vitro fertilization treatment on the therapy with human chorionic gonadotrophin.

Figure 3

Preoperative post contrast MRI, axial (A), coronal (B) and sagittal (C) sequences of 37-year-old female with large ethmoidal–sphenoidal planum meningioma presenting with visual loss and intracranial hypertension syndrome at 26^th week of pregnancy; postoperative post-contrast axial (D) and coronal (E) sequences.

Figure 4

Preoperative post-contrast MRI, axial (A), coronal (B) and sagittal (C) sequences of 30- year-old female with giant meningioma of spheno-ethmoidal planum presenting with bilateral visual deficit at 30^th week of pregnancy; postoperative postcontrast axial (D) and coronal (E) sequences: complete tumor removal.