Atypical meningioma of grade II symptomatic induced by progestin agonists. A first clinical case.

Context: The prolonged administration of high doses of progestin agonists is recognized to promote the development of meningiomas. The occurrence of atypical meningioma in a patient under progestin agonists has not yet been described to date.

Description of the case: A 53 -year -old right -handed patient presented a partial epilepsy crisis without initial loss of consciousness. Its main medical history was endometriosis which was successively treated by cyproterone acetate 25 mg / day for 2 months then 50 mg / day for 101 months as well as chlormaudinone acetate 5 mg / day for 68 months then 10 mg / day for 83 months. Brain MRI has revealed multiple extra-axial lesions evoking meningioma from the left central region associated with a meningomatosis of the previous floor of the skull base. A neurosurgical excision of the left central meningioma was carried out and the progestin was interrupted. Neuropathological analysis has made it possible to diagnose an atypical meningiom of grade II. A close clinico-radiological monitoring has been proposed without adjuvant oncological treatment. At 25 months, clinico-radiological follow-up revealed no recurrence of left central meningioma as well as significant regression of other tumor location, with the exception of the right frontal lesion.

Conclusion : Neurosurgeons must be aware of the potential aggressiveness of meningioma in progestin patients, especially in patients treated with different types of progestins over a long period of time and without interruption. This suggests close and systematic monitoring of these patients in order to adapt neurosurgical management.

Johan Pallud MD, PhD

Corresponding Author Information: Service of Neurosurgery, GHU Paris-Center Hospitalier Sainte-Anne, 1, rue Cabanis, 75674 Paris Cedex 14, France

As well as Alexandre Roux MD, MSC ^{1 2 3} Arnault Tauziede-Espariat MD ⁴ MARC ZANELLO MD, MSC ^{1 2 3} Albane Gareton BS ^{2 4} Henri Malaize BS ^{1 2 3} Joseph Benzakoun MD, MSC ^{2 3 5} ZAH-BI ^GILLES MD , ^{MSC 1 2 3} Catherine OPPENHEIM MD ^, Geneviève Plu-Bureau MD, PHD ^{6 7} Fabrice Chretien MD, PhD

¹Department of Neurosurgery, Ghu Paris-Sainte-Anne Hospital, Paris, France

²Paris Descartes University, Sorbonne Paris Cité, Paris, France

³INSERM, UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France

⁴Department of Neuropathology, Ghu Paris-Sainte-Anne Hospital, Paris, France

⁵Department of Neuroradiology, Ghu Paris-Sainte-Anne Hospital, Paris, France

⁶Inserm U1153, Obstetricical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistes, Paris-Descartes University, Paris, France

⁷Gynecology Endocrinology Unit, University Hospital Paris Center, Cochin Hospital, Aphp, Paris, France

Atypical meningioma of grade II symptomatic induced by progestin agonists. A first clinical case.

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