Pathologic Characteristics of Pregnancy-Related Meningiomas

Simple Summary Meningiomas are the most common primary intracranial tumor in adults. Meningiomas are usually benign and slow growing. Treatment is surgical resection in the case of symptomatic growth. Dramatic growth can occur during pregnancy, complicating clinical management and entailing a risk to the well-being of the mother and fetus. Authors of a previous review paper raised the hypothesis that prolactin may be a key contributor to the sudden growth seen in pregnancy-related meningiomas. We set out to investigate the presence of prolactin receptors/prolactin, as well as other female hormones and histopathological characteristics of pregnancy-related meningiomas in Denmark, compared to meningiomas from female controls within the same age group. No differences in hormone receptor distribution were found between the groups and very few meningiomas expressed prolactin receptors, which contradicts the above-mentioned hypothesis. Interestingly, we observed above cut-point proliferative indices of the meningiomas for the entire study population of females in the reproductive age. Meningiomas are the most common intracranial tumor. During pregnancy, explosive growth of a known meningioma occasionally occurs, but the underlying reasons remain unknown. Prolactin has been suggested as a possible key contributor to pregnancy-related meningioma growth. This study sets out to investigate prolactin and prolactin receptor status in 29 patients with pregnancy-related meningiomas in Denmark, from January 1972 to December 2016, as compared to 68 controls aged 20-45 years, also undergoing resection of a meningioma. Furthermore, we investigated potential differences in the progesterone and estrogen receptor statuses, WHO grade, Ki-67 labeling indices, and locations of the resected meningiomas between the cases and controls. Immunohistochemical analyses were performed, and histopathology and intracranial location were assessed with the investigator blinded for the case-control status. None of the samples stained positive for prolactin and very few samples stained positive for prolactin receptors, equally distributed among cases and controls. Estrogen and progesterone receptors generally followed the same distributional pattern between groups, whereas above cut-point Ki-67 labeling indices for both groups were observed. In conclusion, our results did not support the notion of prolactin as a key contributor to pregnancy-related meningioma growth. Rather, the similarities between the cases and controls suggest that meningiomas early in life may comprise a distinct biological entity.

Automated summary

Meningiomas are the most common primary intracranial tumor in adults, and can experience dramatic growth during pregnancy, though the exact reasons remain unknown. Contrary to previous hypotheses, the study did not find evidence supporting prolactin as a key contributor to pregnancy-related meningioma growth. Similarities between cases and controls suggest that meningiomas early in life may represent a distinct biological entity.