Department of Neurosurgery, Lille University Hospital, Hôpital Nord, Rue E. Laine, 59037, Lille cedex, France.
Lille University, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, 59000, Lille, France.
Neurosurg Rev. 2022 Apr;45(2):1691-1699. doi: 10.1007/s10143-021-01708-w. Epub 2021 Nov 30.
WHO grade II progestin-related meningiomas have been reported in recent series but we found no previous study describing their long-term outcome. Our study aimed to evaluate patients operated on for high-grade intracranial meningioma and who underwent long-term exposure to high dose of cyproterone acetate, nomegestrol acetate, and chlormadinone acetate. Our study retrospectively included 9 patients with high-grade progestin-related intracranial meningioma between December 2006 and September 2021. In each patient, clinico-radiological follow-up was performed every 6 months after diagnosis and treatment withdrawal recommendation. The mean progestative exposure was 11.4 years. Edema existence or absence of cleft sign on MRI were the key factors for surgical indication. All patients underwent surgery. Adjuvant radiotherapy was indicated in 1 patient, and Gamma Knife radiosurgery was proposed in 2 other patients for a second location of meningioma. Six patients harbored a grade II chordoid meningioma subtype with 100% PR expression and 3 patients a grade II atypical meningioma subtype with lower PR expression. The mean follow-up was 8.1 years and none of the 9 patients presented with a recurrence. Patients with grade II progestin-related meningiomas have less tumor recurrence after surgery than patients with sporadic grade II meningiomas, especially after progestin withdrawal. The presence/appearance of peri-meningioma edema and the absence of cleft sign before volumetric change should suggest the existence of an underlying WHO grade II meningiomas. In these cases, surgical resection may immediately be considered and adjuvant radiotherapy should be reserved for proven recurrence cases.
WHO 分级 II 孕激素相关脑膜瘤在最近的系列中已有报道，但我们没有发现之前描述其长期结果的研究。我们的研究旨在评估因接受高剂量醋酸环丙孕酮、醋酸甲地孕酮和醋酸氯地孕酮而长期暴露于孕激素的高分级颅内脑膜瘤患者。我们的研究回顾性纳入了 2006 年 12 月至 2021 年 9 月期间 9 例患有高分级孕激素相关颅内脑膜瘤的患者。在每位患者中，在诊断和治疗停药建议后，每 6 个月进行一次临床-放射学随访。孕激素暴露的平均时间为 11.4 年。MRI 上是否存在水肿以及是否存在裂隙征是手术指征的关键因素。所有患者均接受了手术。1 例患者接受辅助放疗，2 例患者因脑膜瘤的第二个部位接受伽玛刀放射外科手术。6 例患者存在 100% PR 表达的 II 级脊索样脑膜瘤亚型，3 例患者存在 II 级非典型脑膜瘤亚型，PR 表达较低。平均随访 8.1 年，9 例患者均无复发。与散发性 II 级脑膜瘤患者相比，孕激素相关脑膜瘤患者手术后肿瘤复发较少，尤其是在孕激素停药后。脑膜瘤周围水肿的存在/出现以及体积变化前裂隙征的缺失应提示存在潜在的 WHO 分级 II 级脑膜瘤。在这些情况下，可能立即考虑手术切除，并且应将辅助放疗保留用于证实的复发病例。
