Two-thirds of all meningiomas and four-fifths of intraspinal and sphenoidal meningiomas occur in women. Meningiomas frequently enlarge or become symptomatic during pregnancy or during the luteal phase of the menstrual cycle. There is an increased incidence of meningiomas in women with breast carcinoma. In a series of 23 patients with meningiomas, the authors assayed biopsy specimens of the tumor for the presence of estrogen (ER) and progesterone (PR) receptors, using glycerol density gradient centrifugation and dextran-coated charcoal techniques. Significant levels of ER were found in only 17% of the patients, while significant PR levels were detected in 39%. Only 1 of the 16 tumors from female patients had significant ER levels, whereas 3 of the 7 tumors from men had significant ER levels. Eight of the 16 tumors in women had significant PR levels, whereas only 1 of the 7 tumors in men had a significant PR level. Thus, 3 out of 4 tumors with definite ER were from men, whereas 8 of 9 tumors with definite PR were from women. Of the 8 women whose tumors contained PR, 3 were premenopausal and 5 postmenopausal. The single tumor with high levels of PR in the male patient was histologically atypical. The results of this series were compared with 6 published series of sex steroid assays in meningiomas. These 7 series were divided into 2 groups: one group included 2 reports from the same laboratories in France, and the other the remaining 5 reports. Much higher percentages of both ER- and PR-positive tumors were reported from the French group. The authors suggest that this discrepancy may be due to the use of preoperative glucocorticoid therapy in the series from the United States. Since meningiomas are known to enlarge during periods when levels of circulating progestins are high, the presence of significant quantities of PR in a high percentage of tumors may have therapeutic implications for recurrent, malignant, or incompletely excised tumors, or for medically fragile patients. Conversely, since meningiomas are not known to enlarge during the proliferative phase of the menstrual cycle or with exogenous estrogen therapy, the small number of tumors positive for ER may indicate that ER lacks clinical significance. High levels of PR found in a small group of histologically aggressive tumors in several series may indicate that hormonal therapy may be especially useful in this difficult subset of patients.
ASJC Scopus subject areas
- Clinical Neurology