Hormone-dependent shrinkage of a sphenoid wing meningioma after pregnancy: case report

Abstract

Meningiomas are known to be associated with female sex hormones. Worsening neurological symptoms or newly diagnosed meningiomas have been described in the context of elevated levels of sex hormones, for example, in pregnancy. To the authors’ knowledge, tumor shrinkage after the normalization of hormones has not been described, even if it is known that neurological deficits due to meningioma compression may improve after giving birth. A 32-year-old female patient presented with severe headache and vision disturbances at the end of her second pregnancy. Magnetic resonance imaging revealed an extended mass at the lateral left-sided sphenoid wing that was suspected to be a meningioma. After delivery, the patient’s symptoms improved, and MRI obtained 2 months postpartum showed significant shrinkage of the lesion. Significant tumor shrinkage can occur after pregnancy. Thus, repeat imaging is indicated in these patients.

Unique presentation of giant multiple meningiomas during immediate postpartum, case report and review of literature

“…2 Other authors support that symptoms may appear and worsen during pregnancy. 5,9 Meningiomas can grow during pregnancy, especially in its second half. 4 The mechanisms involved are not fully understood and the present factors are, among others, fluid retention, intraand extracellular edema, vessel congestion, increased vascularity, increased body mass index (BMI) 3 and increased hormones, especially prolactin and estrogen.…”

“…11 Therefore, as it has been reported in the literature, tumor size and symptoms may decline after birth. 4 Kerschbaumer et al 9 Reported a 39-week pregnancy case with a 5cm sphenoidal meningioma, elective surgery was scheduled two months after birth and the tumor reduced its size by 50%. Meningiomas sensitive to hormones may shrink after delivery.…”

“…Therefore, deferred surgery a few months after birth is an option, and may facilitate resection. 9 Patients with positive tumor markers for progesterone show decreased rate of tumor recurrence after resection. 12 Some authors have tested progesterone receptor antagonist RU-486 for the treatment of meningiomas, showing promising results in patients with high progesterone receptor density in tumor tissue 13 and also in multiple meningiomas.…”

Parasellar Meningiomas

“…The context of a high progesterone plasmatic level can lead to an increase in meningioma volume during pregnancy. This volume increase is usually reversible [132][133][134], which is not the case in severe visual disturbances. Therefore, in the case of severe visual impairment, meningioma surgical removal should be considered [128][129][130][131].…”

Meningiomas in Premenopausal Women: Role of the Hormone Related Conditions

“…Several epidemiological and pathological findings other than the higher female incidence may suggest that sex hormones may play a role in the development of these tumors. These include the frequent presence of progesterone and estrogen receptors in the meningioma tissue (2-7), the possible association with tumors of the female system (8)(9)(10), the documented changes of the meningioma biology during the menstrual cycle and pregnancy (11)(12)(13), the sometimes reported regression after delivery (14), the in vitro proliferation of meningioma cell lines in culture after exposure of estrogen and progesterone (15,16). Besides, the incidence and risk of meningioma in patients with sex hormonerelated conditions and during the exogenous use of sex hormones for contraceptive therapies have been investigated in several studies (16)(17)(18)(19)(20)(21)(22).…”