Progesterone-receptor index in meningiomas: correlation with clinico-pathological parameters and review of the literature

Abstract

For recurrent and untreatable meningiomas alternative therapies, such as anti-progesterone treatment, have been sought. However, the few clinical studies have not determined progesterone receptor (PgR) expression in most cases, and studies correlating quantitative PgR expression (PgR index) with clinico-pathological variables are scarce. The aim of our study was to assess the PgR indices in a consecutive series of meningiomas and correlate these values with clinico-pathological parameters. We analyzed immunohistochemically 82 consecutive meningioma specimens (73 primary and nine recurrent tumors) for PgR and Ki-67 antigen (MIB-1). The male/female ratio was 1:1.7, and median age at the time of surgery was 57 years (range 29-77 years). The series comprised 55 grade I (subtyped as 36 meningothelial, seven fibrous, nine transitional, two psammomatous, and one angiomatous), 23 grade II, and one grade III meningiomas. Nuclear immunostaining for PgR was positive in 56 meningioma specimens (71%). PgR index was 21.4+/-2.8% (mean +/- SE; range 0-79%). Significantly higher expression was found in male patients in the age group <50 years than in those > or = 60 years and in grade I meningothelial meningiomas than in fibrous and transitional subtypes. There was a trend to lower PgR indices in non-benign meningiomas. Cell proliferation rate (MIB-1 index) was 4.4 +/- 0.4% (mean +/- SE; range 0.3-15.4%). Significantly higher MIB-1 indices were found in male than female patients,in recurrent than primary and in grade II than grade I meningiomas. We observed a trend to higher PgR indices in meningiomas with MIB-1 index <5%. In sum, the highest PgR index in our series was observed in patients under the age of 50 years with WHO grade I meningiomas of the meningothelial subtype and low cell proliferation indices. If hormonal therapy has a direct action on the PgR, these patients should respond best to anti-progesterone treatment. We conclude that PgR index is variable in meningioma, depending on clinical parameters and histopathological features. Stratification of anti-progesterone therapy trials on the basis of PgR index should be considered.

Rhabdoid Meningioma: Clinical Features and MR Imaging Findings in 15 Patients

“…16 Actually, progesterone receptor positivity has been reported to negatively correlate with tumor grade by many authors. [16][17][18][19] In other words, there is a reduction of progesterone receptors from WHO grade I to grade II and a progesterone receptor negativity in WHO grade III tumors. [16][17][18][19] The reason why RM presents similarly to benign meningioma is not clear.…”

“…[16][17][18][19] In other words, there is a reduction of progesterone receptors from WHO grade I to grade II and a progesterone receptor negativity in WHO grade III tumors. [16][17][18][19] The reason why RM presents similarly to benign meningioma is not clear. However, this may be because of the fact that the rhabdoid morphology can only present in a part of the tumor, though most RMs have high A B C Fig 1. A 64-year-old woman presenting with memory disturbances.…”

Múltiplas metástases pulmonares de meningioma benigno

“…However, such expression may not be considered an independent prognostic marker (3) . Some authors have confirmed the quantitative expression of progesterone receptors in studies involving a variety of meningioma cases, thereby suggesting that it is possible to conduct clinical trials with antiprogesterone therapy (10) . Although many meningiomas have a good prognosis after treatment, there is still great controversy regarding the best means of management, which requires an understanding of the risks and benefits of radiotherapy and surgical treatment, as well as of the potential long-term risks (3) .…”

“…Nevertheless, postoperative radiotherapy has been recommended for the prevention of local recurrence (3,10) , especially when resection is partial or when histology suggests malignancy (10) . The efficacy of chemotherapy for intracranial meningioma is supposedly low, since no satisfactory results have been shown for isolated cases (3,10) . Several studies have demonstrated a correlation between high expression of progesterone receptors and lower histological level, low recurrence frequency and better prognosis.…”

Management of Malignant Meningiomas

“…Progesterone and androgen receptors are expressed on approximately two thirds of meningiomas and estrogen receptors are expressed on approximately 10% (Wen et al, 2009). Progesterone receptors are predominantly expressed in benign meningiomas with low proliferation indices and they are infrequently expressed in atypical and malignant meningiomas (Wolfsberger et al, 2004). Again, data for malignant meningiomas specifically is limited, likely due to their scarcity.…”