Objective

The aim of this study was to describe progestin-associated meningiomas’ characteristics, outcome and management.

Material and methods

We included 53 patients operated on and/or followed in the department for meningioma with progestin intake longer than one year and with recent drug discontinuation.

Results

Cyproterone acetate (CPA), nomegestrol acetate (NomA), and chlormadinone acetate (ChlA) were involved in most cases. Mean duration of progestin drugs intake was 17.5 years. Tumors were multiple in 66% of cases and were located in the anterior and the medial skull base in 71% of cases. Transitional subtype represented 16/25 tumors; 19 meningiomas were WHO grade I and 6 were grade II. The rate of transitional subtype and skull base location was significantly higher compared to matched operated meningioma general population. No difference was observed given WHO classification. But Ki67 proliferation index tends to be lower and 5/6 of the WHO grade II meningiomas were classified as WHO grade II because of brain invasion. Strong progesterone receptors expression was observed in most cases. After progestin discontinuation, a spontaneous visual recovery was observed in 6/10 patients. Under CPA (n = 24) and ChlA/NomA (n = 11), tumor volume decreased in 71% and 18% of patients, was stabilized in 25% and 64% of patients, and increased in 4% and 18% of patients, respectively. Volume outcome was related to meningioma location.

Conclusions

Outcome at progestins discontinuation is favorable but different comparing CPA versus ChlA-NomA and comparing tumor location. Long-term follow-up is required. In most cases, simple observation is recommended and surgery should be avoided.

中文翻译：

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长期暴露于孕激素患者的脑膜瘤：特征和结果

客观的

本研究的目的是描述孕激素相关脑膜瘤的特征、结果和管理。

材料与方法

我们纳入了 53 名接受脑膜瘤手术和/或随访的脑膜瘤患者，这些患者孕激素摄入量超过一年且近期停药。

结果

大多数病例涉及醋酸环丙孕酮 (CPA)、醋酸诺美孕酮 (NomA) 和醋酸氯地孕酮 (ChlA)。孕激素药物摄入的平均持续时间为 17.5 年。66% 的病例为多发性肿瘤，71% 的病例位于前颅底和内侧颅底。过渡亚型代表 16/25 肿瘤；19 例脑膜瘤为 WHO I 级，6 例为 II 级。与匹配的手术脑膜瘤一般人群相比，移行亚型和颅底位置的发生率显着更高。鉴于世界卫生组织的分类，没有观察到差异。但 Ki67 增殖指数趋于降低，5/6 的 WHO II 级脑膜瘤因脑侵犯被归类为 WHO II 级。在大多数情况下观察到强烈的孕激素受体表达。停用孕激素后，在 6/10 的患者中观察到自发的视力恢复。根据注册会计师（n  =  24) 和 ChlA/NomA ( n  =  11)，肿瘤体积分别在 71% 和 18% 的患者中减少，在 25% 和 64% 的患者中稳定，在 4% 和 18% 的患者中增加。体积结果与脑膜瘤位置有关。

结论

终止孕激素的结果是有利的，但比较 CPA 与 ChlA-NomA 和比较肿瘤位置是不同的。需要长期随访。在大多数情况下，建议进行简单的观察，并应避免手术。