Fast-Growing Meningioma in a Woman Undergoing Fertility Treatments

Patterson, Adam P.; Elashaal, Abdurrahim

doi:10.1155/2016/3287381

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…Interrogation of the SE landscape implicates PR as a core transcriptional driver of a subset of tumors. These data provide a putative explanation for the strong epidemiologic sex bias and case reports of meningiomas receding following discontinuation of progesterone agonists (3)(4)(5)(6)(7). The uneven responses reported in clinical trials may thus be driven by distinct epigenetic subgroups of tumors.…”

Section: Discussionmentioning

confidence: 82%

“…Grade I tumors affl ict female over male patients at a 3:1 ratio, a predilection that is lost in highergrade tumors ( 1 ). Case reports and small studies have implicated progesterone agonists in meningioma growth, with reports of tumor regression following discontinuation of exogenous progesterone ( 3,4 ). However, clinical trials have demonstrated inconsistent results, and predicting responders to hormone therapy remains a signifi cant challenge (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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The Meningioma Enhancer Landscape Delineates Novel Subgroups and Drives Druggable Dependencies

et al. 2020

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Meningiomas are the most common primary intracranial tumor with current classifi cation offering limited therapeutic guidance. Here, we interrogated meningioma enhancer landscapes from 33 tumors to stratify patients based upon prognosis and identify novel meningioma-specifi c dependencies. Enhancers robustly stratifi ed meningiomas into three biologically distinct groups (adipogenesis/cholesterol, mesodermal, and neural crest) distinguished by distinct hormonal lineage transcriptional regulators. Meningioma landscapes clustered with intrinsic brain tumors and hormonally responsive systemic cancers with meningioma subgroups, refl ecting progesterone or androgen hormonal signaling. Enhancer classifi cation identifi ed a subset of tumors with poor prognosis, irrespective of histologic grading. Superenhancer signatures predicted drug dependencies with superior in vitro effi cacy to treatment based upon the NF2 genomic profi le. Inhibition of DUSP1, a novel and druggable meningioma target, impaired tumor growth in vivo . Collectively, epigenetic landscapes empower meningioma classifi cation and identifi cation of novel therapies. SIGNIFICANCE:Enhancer landscapes inform prognostic classifi cation of aggressive meningiomas, identifying tumors at high risk of recurrence, and reveal previously unknown therapeutic targets. Druggable dependencies discovered through epigenetic profi ling potentially guide treatment of intractable meningiomas.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

The Meningioma Enhancer Landscape Delineates Novel Subgroups and Drives Druggable Dependencies

et al. 2020

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“…While studies investigating meningioma and fertility treatment are limited to retrospective case reports and one case-control study [10][11][12][13], the association of progesterone receptor expression and meningioma has been studied more extensively [30]. There are various situations in addition to fertility treatment where patients might be exposed to high dose estrogen or progesterone.…”

Section: Discussionmentioning

confidence: 99%

“…One large case control study found no association between fertility treatment and meningioma [10]. There have been three cases of meningioma diagnosed in women with a history of fertility treatment described in the literature [11][12][13]. Recently, Wengel et al identified eight transgender patients who developed meningioma during hormone therapy.…”

Section: Introductionmentioning

confidence: 99%

Fertility treatment is associated with multiple meningiomas and younger age at diagnosis

et al. 2019

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Purpose: Meningiomas are more common in females and 70-80% express the progesterone receptor, raising the possibility that high-dose exogenous estrogen/progesterone exposure, such as occurs during fertility treatments, may increase the risk of developing a meningioma. The goal of this study was to report the incidence of prior fertility treatment in a consecutive series of female meningioma patients. Methods: A retrospective review (2015-2018) was performed of female patients with meningioma, and those with prior fertility treatment were compared to those without fertility treatment using standard statistical methods. Results: Of 206 female patients with meningioma, 26 (12.6%) had a history of fertility treatments. Patients underwent various forms of assisted reproductive technology including: in vitro fertilization (50.0%), clomiphene with or without intrauterine insemination (34.6%), and unspecified (19.2%). Median follow up was 1.8 years. Tumors were WHO grade I (78.6%) or grade II (21.4%). Patients who underwent fertility treatments presented at significantly younger mean age compared to those who had not (51.8 vs 57.3 yrs, p = 0.0135, 2-tailed T-test), and on multivariate analysis were more likely to have multiple meningiomas (OR: 4.97, 95% CI: 1.4-18.1, p = 0.0154) and convexity/falx meningiomas (OR: 4.45, 95% CI: 1.7-11.5, p = 0.0021). Conclusions: Patients in this cohort with a history of fertility treatment were more likely to present at a younger age and have multiple and convexity/falx meningiomas, emphasizing the importance of taking estrogen/progesterone exposure history when evaluating patients with

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“…In the study of Korhonen et al (18) the fertility treatments did not influence the risk of meningioma. Three single case reports describe meningiomas diagnosed in women with history of fertilization (41)(42)(43). In the study of Shahin et al (44), the group of female patients with meningioma and history of fertility treatment had significantly younger age and higher rate of multiple non-skull base meningiomas as compared to the group with no fertility treatment.…”

Section: Fertility Therapiesmentioning

confidence: 99%

Meningiomas in Premenopausal Women: Role of the Hormone Related Conditions

Maiuri¹,

Mariniello²,

Somma³

et al. 2020

Front. Oncol.

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BackgroundSeveral 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.MethodsFrom 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.ResultsIn 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.ConclusionThe 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.

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Fast-Growing Meningioma in a Woman Undergoing Fertility Treatments

Cited by 6 publications

References 13 publications

The Meningioma Enhancer Landscape Delineates Novel Subgroups and Drives Druggable Dependencies

The Meningioma Enhancer Landscape Delineates Novel Subgroups and Drives Druggable Dependencies

Fertility treatment is associated with multiple meningiomas and younger age at diagnosis

Meningiomas in Premenopausal Women: Role of the Hormone Related Conditions

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