The Relapsing Course of Certain Meningiomas in Relation to Pregnancy and Menstruation

Abstract

Intracranial tumours not uncommonly show their first symptoms, or a rapid increase in their symptoms, during a pregnancy. This occurs more frequently than can be regarded as purely coincidental, and applies to all types of tumour-extrinsic and intrinsic. On questioning a number of medical men it was evident that a popular belief is held that tumours of the pituitary are particularly likely to behave in this manner, but this contrasts with the experience of most neurologists and neurosurgeons who, similarly questioned, would instance meningiomas, angiomas, and occasionally neurofibromas.It is not widely appreciated, however, that such symptoms may show complete remnission following delivery, or, that in the case of certain slowly growing tumours, this sequence of events may recur repeatedly over a very long period, giving rise to considerable confusion in diagnosis.Two striking cases have come under our care at the Midland Centre for Neurosurgery within a few months of each other, in each of which the type and position of the tumour was almost identical. These are recorded below and on extending this study to include other published reports of confirmed intracranial tumours showing repeated relapses and remissions during and after pregnancy, there is found a remarkable uniformity in the clinical picture, the histology, and the site of growth of the tumour.Case Reports Case 1.-A 45-year-old woman was referred complaining of impaired vision in the right eye. Sixteen years earlier, three weeks before the end of her fifth pregnancy, she had developed, quite painlessly, over a period of about three days, complete ptosis of the right eyelid and impaired movement of that eye. This remained until four weeks after delivery and then recovered completely. Five years later, a few weeks before the end of her sixth pregnancy, she again developed right-sided ptosis and partial oculomotor paresis, and again this recovered completely after delivery. Four years later still, three weeks before the end of her seventh pregnancy, exactly the same thing occurred, but recovery after delivery was only partial, and though the ptosis disappeared, she continued to have varying diplopia over the next eight years. During these years the ptosis frequently became complete again three days before menstruation was due and recovered during the week of menstruation. In the last 12 months her vision had begun to fail steadily and it was this that brought her under our care. The whole 16-year course had been completely painless.Examination revealed that vision in the right eye was reduced to finger counting as a result of a large centrocaecal scotoma, and there was papilloedema in that eye. There was a partial right third nerve paresis, with total loss of upward ocular movement, but no other abnormal neurological signs.Radiographs of the skull showed a thickening of the inner end of the right sphenoidal wing and there was a marked difference in the bone density surrounding the optic canals. A diagnosis of sphenoidal wing meningioma was made and a rig...

Association of meningioma with reproductive factors

“…11 Studies reporting data on parity or pregnancy and brain tumors are few and not consistent. Several reports 13,24,25 have observed increased risks for meningioma with Ôever having been pregnantÕ: an East German study found no relationship with meningioma among women who are reproductively competent 2 and a recent United States hospital based case-control study saw no associations with number of pregnancies or livebirths. 14,26 Two case-control studies 11,12 have reported reduced odds ratios for parity and meningioma, although these estimates were not statistically significant.…”

Meningiomas and hormonal receptors: immunohistochemical study in typical and non-typical tumors

“…Also, it has been observed that these tumors often grow during pregnancy and luteal phase of the menstrual cycle 2 and there is an association between meningiomas and breast cancer and other tumors wich have hormonal dependency 3,4 . Based in these data, there have been many reports which have dealt with the presence of estrogen receptor (ER) and progesterone receptors (PR) in meningiomas [5][6][7][8][9][10][11][12][13][14][15] .…”

Meningioma in untreated congenital adrenal hyperplasia: a relationship?

“…As meningioma mainly express PR, it has been hypothesised that progesterone directly affects the growth and/or development of this tumor. For instance, during the luteal phase of the menstrual cycle, a period of relative progesterone excess, increased growth of meningioma can be observed (cyclic vision problems) [9]. Another argument for the involvement of progestins in the development or growth of meningiomas is the higher incidence of meningiomas in women with lymphangioleiomyomatosis (LAM), a lung disease that is often treated with progesterone [10].…”