Gender-affirming hormone therapy associated with multiple meningiomas and atypical histology in a transgender woman

2021 ◽  
Vol 14 (7) ◽  
pp. e242813
Author(s):  
Christopher Paul Millward ◽  
Eleri Phillips ◽  
Andrew Folusho Alalade ◽  
Catherine Elizabeth Gilkes
Keyword(s):  
Hormone Therapy ◽  
Cyproterone Acetate ◽  
Tumour Growth ◽  
High Dose ◽  
Mri Scan ◽  
Who Grade ◽  
Olfactory Groove ◽  
Olfactory Groove Meningioma ◽  
And Gender

We present a 69-year-old transgender woman who underwent gender-affirming surgery in 1998 and gender-affirming hormone therapy (cyproterone acetate (CPA) and estradiol) since this time. Following an MRI scan to investigate tremor in 2013, an incidental left anterior clinoid and right petrous meningioma were identified. Subtotal surgical resection was achieved for the anterior clinoid meningioma (WHO grade 1, meningothelial subtype). At follow-up in 2016, an olfactory groove meningioma and left greater wing of sphenoid meningioma were identified. By 2017, both tumours, along with the petrous meningioma, demonstrated significant growth. In 2018, clinical decline was evident and MRI demonstrated further tumour growth. Surgery was scheduled and the olfactory groove meningioma was completely resected (WHO grade 2, chordoid subtype). Hormones were stopped, after which regression of the petrous meningioma was observed. This case demonstrates an association between high-dose CPA and estradiol and the development, growth and regression of meningiomas in a transgender woman.

scholarly journals Extracorporeal irradiation of tumorous calvaria: a case series

2015 ◽  
Vol 122 (5) ◽  
pp. 1127-1130
Author(s):  
Daryoush Tavanaiepour ◽  
William C. Broaddus ◽  
Theodore D. Chung ◽  
Kathryn L. Holloway ◽  
Michelle A. Proper ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Case Series ◽  
B Cell Lymphoma ◽  
Bone Flap ◽  
High Dose ◽  
Allogeneic Bone ◽  
Who Grade ◽  
Extracorporeal Irradiation

OBJECT When intracranial tumors invade the overlying skull, gross resection typically includes removal of the involved bone. Methods used to repair the resulting structural defect in the cranium include artificial prostheses, allogeneic bone grafts, and autoclaving the autologous graft. The authors have previously reported a case involving high-dose extracorporeal ionizing radiation to treat the tumorous calvaria intraoperatively, followed by reimplantation of the treated bone flap. In this paper the authors report the long-term follow-up of that case, as well as results of using extracorporeal irradiation of tumorous calvaria (EITC) for an additional 20 patients treated similarly. METHODS The decision to undergo EITC was typically anticipated preoperatively, but determined intraoperatively, if upon inspection the bone flap was invaded by tumor. The bone flap was then delivered to the radiation oncology department, where a total dose of 120 Gy was delivered, using a clinical linear accelerator, over a period of approximately 15 minutes. After the intracranial tumor resection was completed, the irradiated craniotomy bone flap was reimplanted and the wound was closed in a standard fashion. A retrospective review of patients who had undergone EITC was performed for evidence of calvarial tumor recurrence or other complications. RESULTS Since the originally reported case, 20 additional patients have received EITC during craniotomy for invasive tumors. Eighteen (86%) of 21 patients were diagnosed with meningioma: 12 (67%) with WHO Grade I, 5 (28%) with WHO Grade II, and 1 with WHO Grade III (6%). The remaining 3 patients presented with dural-based B-cell lymphoma with extensive adjacent bone invasion (n = 2) and metastatic adenocarcinoma of the lung (n = 1). Follow-up of the 21 patients ranged from 1 to 132 months, with a mean of 41 months and a median of 23 months. No patients have experienced tumor recurrence, infection associated with the treated calvaria, or evidence of bone flap resorption. CONCLUSIONS Calvaria reconstructions represent an important component in structural and cosmetic outcome following craniectomy for tumorous bone. The authors' long-term experience with EITC has been excellent with no local tumor recurrence or complications. Therefore, EITC represents an excellent and efficient option for cranial reconstruction in such patients.

scholarly journals Microsurgical Excision of Olfactory Groove Meningeomas, Comparative Studies of Different Surgical Approaches

2013 ◽  
Vol 24 (1) ◽  
pp. 5-7
Author(s):  
Shamsul Alam ◽  
Abu Naim Wakil Uddin ◽  
Md Shamsuzzaman Mondle ◽  
Abul Khair ◽  
Mohosin All Farazi ◽  
...  
Keyword(s):  
Surgical Approaches ◽  
Tumor Diameter ◽  
Recurrence Rates ◽  
Focal Neurological Deficit ◽  
Who Grade ◽  
Olfactory Groove ◽  
Maximum Tumor Diameter ◽  
Olfactory Groove Meningioma ◽  
Medicine Today ◽  
Frontolateral Approach

To review the surgical approaches, techniques, outcomes, and recurrence rates in a series of 6 olfactory groove meningioma (OGM) patients operated from January 2010 to April 2011.Methods: Six patients underwent craniotomy and micro-neurosurgical removal of olfactory groove meningioma maximum. Tumor diameter varied from 5 to 8.5 cm among six cases, 2 cases underwent glabellar mini craniotomy another 2 by bifrontal approach and rest of them were by frontolateral approach. Result: Total removal was possible in all cases. Histopathology revealed typical meningioma (WHO grade 1). there was no operative mortality and no permanent focal neurological deficit except anosmia. One patient developed leak and two cases meningitis which was resolved by lumber drain and antibiotic therapy. No tumor recurrence within six months of followup. For the removal of large olfactory groove meningiomas we used three different surgical approaches: frontolateral approaches, bifrontal approach and glabellar mini craniotomy. We consider the frontolateral approach is an alternative, if not superior, to standard bifrontal approaches. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.13942 Medicine TODAY Vol.24(1) 2012 pp.5-7

scholarly journals Microsurgical Excision of Olfactory Groove Meningiomas, Comparative Studies of Different Surgical Approaches

2020 ◽  
Vol 10 (1) ◽  
pp. 9-19
Author(s):  
Shamsul Alam ◽  
Abu Naim Wakil Uddin ◽  
Mohammad Sujan Sharif ◽  
Md Mashiur Rahman Majumder ◽  
Mohammad Shahnawaz Bari
Keyword(s):  
Lateral Approach ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Tumor Diameter ◽  
Total Removal ◽  
Recurrence Rates ◽  
Focal Neurological Deficit ◽  
Who Grade ◽  
Olfactory Groove ◽  
Olfactory Groove Meningioma

Introduction: To review the surgical approaches, techniques, outcomes and recurrence rates in a series of 11 olfactory groove meningioma (OGM) patients operated from January 2010 to April 2019. Methods: Eleven patients underwent craniotomy and micro-neurosurgical removal of olfactory groove meningioma. Tumor diameter varied from 5 to 8.5 cm among 11 cases, 2 cases underwent Transglabellar/ Subcranial approach, 3 cases by bifrontal approach, 1 case unifrontal approach, 2 extended endonasal and 3 cases fronto-lateral approach. Result: Total removal was possible in all cases except 2 cases. Histopathology revealed typical meningioma (WHO grade 1). There was 1 operative mortality and no permanent focal neurological deficit except anosmia. 3 patients developed CSF leak and two cases meningitis which were resolved by lumber drain and antibiotic therapy. Conclusion: Extended endonasal approach or transglabellar/ subcranial approach were sufficient for gross total removal of OGM which is associated with bony hyperostosis, paranasal extension and optic canal. Bang. J Neurosurgery 2020; 10(1): 9-19

scholarly journals Use of high dose cyproterone acetate and risk of intracranial meningioma in women: cohort study

BMJ ◽  
2021 ◽  
pp. n37
Author(s):  
Alain Weill ◽  
Pierre Nguyen ◽  
Moujahed Labidi ◽  
Benjamin Cadier ◽  
Thibault Passeri ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Skull Base ◽  
Cumulative Dose ◽  
Cyproterone Acetate ◽  
Exposed Group ◽  
Additional Analysis ◽  
Control Group ◽  
High Dose

Abstract Objective To assess the risk of meningioma associated with use of high dose cyproterone acetate, a progestogen indicated for clinical hyperandrogenism. Design Observational cohort study. Setting Data from SNDS, the French administrative healthcare database, between 2007 and 2015. Participants 253 777 girls and women aged 7-70 years living in France who started cyproterone acetate between 2007 and 2014. Participants had at least one reimbursement for high dose cyproterone acetate and no history of meningioma or benign brain tumour, or long term disease status. Participants were considered to be exposed when they had received a cumulative dose of at least 3 g during the first six months (139 222 participants) and very slightly exposed (control group) when they had received a cumulative dose of less than 3 g (114 555 participants). 10 876 transgender participants (male to female) were included in an additional analysis. Main outcome measure Surgery (resection or decompression) or radiotherapy for one or more intracranial meningiomas. Results Overall, 69 meningiomas in the exposed group (during 289 544 person years of follow-up) and 20 meningiomas in the control group (during 439 949 person years of follow-up) were treated by surgery or radiotherapy. The incidence of meningioma in the two groups was 23.8 and 4.5 per 100 000 person years, respectively (crude relative risk 5.2, 95% confidence interval 3.2 to 8.6; adjusted hazard ratio 6.6, 95% confidence interval 4.0 to 11.1). The adjusted hazard ratio for a cumulative dose of cyproterone acetate of more than 60 g was 21.7 (10.8 to 43.5). After discontinuation of cyproterone acetate for one year, the risk of meningioma in the exposed group was 1.8-fold higher (1.0 to 3.2) than in the control group. In a complementary analysis, 463 women with meningioma were observed among 123 997 already using cyproterone acetate in 2006 (risk of 383 per 100 000 person years in the group with the highest exposure in terms of cumulative dose). Meningiomas located in the anterior skull base and middle skull base, particularly the medial third of the middle skull base, involving the spheno-orbital region, appeared to be specific to cyproterone acetate. An additional analysis of transgender participants showed a high risk of meningioma (three per 14 460 person years; 20.7 per 100 000 person years). Conclusions A strong dose-effect relation was observed between use of cyproterone acetate and risk of intracranial meningiomas. A noticeable reduction in risk was observed after discontinuation of treatment.

scholarly journals Blood Pressure Effects of Gender-Affirming Hormone Therapy in Transgender and Gender-Diverse Adults

Hypertension ◽  
2021 ◽  
Author(s):  
Katherine Banks ◽  
Mabel Kyinn ◽  
Shalem Y. Leemaqz ◽  
Eleanor Sarkodie ◽  
Deborah Goldstein ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hormone Therapy ◽  
Blood Pressure Monitoring ◽  
Pressure Effects ◽  
Washington Dc ◽  
Gender Diverse ◽  
Blood Pressure Effects ◽  
Multiple Blood ◽  
And Gender

Gender-diverse people likely suffer from higher rates of cardiovascular disease than cisgender people. Studies on the effects of gender-affirming hormone therapy (GAHT) on blood pressure in adult transgender populations have been inconsistent. We sought to address knowledge gaps on this topic by conducting the largest and longest observational study to date using multiple blood pressure readings from a racially and ethnically diverse sample. We followed the blood pressure of 470 transgender and gender-diverse adult patients (247 transfeminine and 223 transmasculine; mean age, 27.8 years) seen at a Federally Qualified Health Center and an academic endocrinology practice, both in Washington DC. Blood pressure was measured at baseline and at multiple follow-up clinical visits up to 57 months after the initiation of GAHT. Our study found that within 2 to 4 months of starting GAHT, mean systolic blood pressure was lower in the trans feminine group by 4.0 mm Hg ( P <0.0001) and higher in the trans masculine group by 2.6 mm Hg ( P =0.02). These blood pressure changes were maintained during the whole follow-up period. There were no changes to diastolic blood pressure for either group. The prevalence of stage 2 hypertension decreased in the trans feminine group by 47% ( P =0.001) within 2 to 4 months of GAHT. In conclusion, our data support routine blood pressure monitoring after the initiation of GAHT. Further research is needed on the effects of GAHT in older gender-diverse individuals and on optimal formulations of GAHT.

scholarly journals Deuterium-depleted water delayed hormone therapy of prostate cancer

2021 ◽  
Vol 6 (10) ◽  
Keyword(s):  
Prostate Cancer ◽  
Hormone Therapy ◽  
Early Stage ◽  
Anticancer Effect ◽  
Mri Scan ◽  
Double Blind ◽  
Double Blind Clinical Trial ◽  
Single Intervention ◽  
Deuterium Depleted Water

The anticancer effect of deuterium depletion in combination with conventional therapies has been confirmed in phase II double-blind clinical trial with prostate cancer patients. In this study, we describe the case of a patient who was diagnosed with prostate cancer in 2009. He denied the hormone therapy offered, providing an opportunity for following the effect of deuterium depletion as a single intervention. The patient started consuming deuterium-depleted water (DDW) one month after the diagnosis. Already after one month of DDW consumption, his PSA level dropped from 8.7 ng/mL to 6.3 ng/mL and 1.5 years later, an MRI scan could not confirm the presence of the tumor 1 cm in diameter. The 11 years follow-up of the changes in PSA value proved that deuterium depletion controls the growth of prostate cancer. The data also revealed that increasing the length of the break in DDW consumption from 5-6 months to 11 months promoted the progression of the disease as confirmed by an MRI scan. The patient had 13 courses of DDW treatment in 11 years. This study confirms that deuterium depletion is an effective early-stage treatment as a single therapy and delays conventional therapy. Based on previous studies we also conclude that DDW in proper combination with hormone therapy assists in prolonging the development of hormone resistance.

scholarly journals Olfactory groove meningiomas: surgical technique and follow-up review

2007 ◽  
Vol 65 (3b) ◽  
pp. 795-799 ◽  
Author(s):  
Benedicto Oscar Colli ◽  
Carlos Gilberto Carlotti Junior ◽  
João Alberto Assirati Junior ◽  
Marcius Benigno Marques dos Santos ◽  
Luciano Neder ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Technique ◽  
Clinical Outcome ◽  
Operative Mortality ◽  
Total Resection ◽  
Who Grade ◽  
Olfactory Groove ◽  
Brain Compression ◽  
Grade 3

BACKGROUND: Olfactory groove meningiomas comprise 4-10% of the intracranial meningiomas. Generally they give signs of brain compression due to great size they reach before diagnosis. In this study, the clinical outcome of patients with olfactory groove meningiomas surgically treated was analyzed. METHOD: 17 patients operated on from 1988-2006. Female: 16, Male: 1. Age: 19-76 years-old (mean=53.12± 13.11). Follow-up: 1-209 months (mean=51.07±12.73. Bifrontal/bifrontal-bi-orbital approaches were used. Outcome was analyzed using survival/recurrence-free Kaplan-Mayer curves. RESULTS:16 had WHO grade 1; one grade 2 meningiomas. Resection Simpson's grade 1 was in achieved in 64.7%, grade 2 in 29.4% and grade 3 in 5.9%. There was no recurrence during the follow-up. Global and operative mortality were 11.8%. Main postoperative complications were osteomielitis (11.8%) and pneumonia (5.9%). CONCLUSION: Extensive approaches allowed total resection of most olfactory groove meningiomas with no recurrence during the follow-up, but operative mortality and local complications were high.

scholarly journals Recurrent Olfactory Groove Meningioma Filling the Nasal Cavity: A Case Report and Technical Video

2021 ◽  
Author(s):  
Luciano Mastronardi ◽  
Francesco Corrivetti ◽  
Pio Bevilacqua ◽  
Raffaelino Roperto ◽  
Albert Sufianov
Keyword(s):  
Case Report ◽  
Csf Leak ◽  
Intracranial Extension ◽  
Benign Tumors ◽  
Nasal Passage ◽  
Surgical Removal ◽  
Who Grade ◽  
Olfactory Groove ◽  
Olfactory Groove Meningioma ◽  
The Right

Abstract Background Meningiomas are usually benign tumors and account for 15% of the overall intracranial tumors. Less than 3% of them extend up to the sinonasal region. Case Report A 61-year-old woman, operated on for a huge olfactory meningioma 8 years before, came for progressive nasal obstruction. On physical examination, a mass that completely obliterated the right nasal passage was detected. A c.e. cranial MRI confirmed the presence of an enhancing mass completely occupying the right nostril, without intracranial extension. A biopsy of the mass revealed a meningioma (WHO grade I) and the patient was admitted to our department for the surgical removal of the endonasal recurrent tumor. Results The meningioma was approached and excised by endonasal endoscopic approach using a microdebrider and electrocautery. A linear residual of tumor was left attached to the previous anterior skull base’ vascularized galeal flap, in order to avoid a communication with the intracranial compartment and a possible cerebrospinal fluid (CSF) leak. The postoperative course was uneventful, and the patient immediately referred an improvement in breathing. A c.e. postoperative MRI confirmed the nearly total removal of tumor. Conclusions We present a video with the most relevant steps of transnasal endoscopic surgical removal of a quite rare case of a recurrent olfactory groove meningioma, completely obliterating the right nostril.

Primary CNS Lymphoma - High-Dose-Chemotherapy with Autologous PBSCT and Hyperfractionated Radiotherapy as First-Line-Therapy - Results of a Multicenter Phase II Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 680-680 ◽  
Author(s):  
Gerald Illerhaus ◽  
Reinhard Marks ◽  
Guenther Derigs ◽  
Christan Peschel ◽  
Norbert Frickhofen ◽  
...  
Keyword(s):  
Phase Ii ◽  
Phase Ii Study ◽  
High Dose Chemotherapy ◽  
Water Soluble ◽  
High Dose ◽  
Who Grade ◽  
Hyperfractionated Radiotherapy ◽  
Multicenter Phase ◽  
Autologous Pbsct

Abstract Primary NHL of the CNS (PCNSL) carries a poor prognosis despite initial response to steroids and radiotherapy (RT). Addition of methotrexate (MTX) to RT has improved the prognosis of patients (pts) with PCNSL, but a significant proportion of patients are still not cured. To improve relapse free survival and to reduce neurotoxicity we initiated a multicenter phase II study with early dose intensified chemotherapy (CT) and PBSCT followed by hyperfractionated whole-brain radiation (WBRT) for pts aged under 65yrs. The use of high-dose (HD) lipophilic blood-brain-barrier-penetrating agents (BCNU, Thiotepa) in addition to maximum doses of water-soluble agents (MTX, AraC) is a novel approach in the treatment of PCNSL. To reduce the risk of delayed neurotoxicity, intrathecal chemotherapy was completely avoided and CT was administered before RT. Induction treatment included 3 repetitive cycles of HD-MTX (8g/m2). AraC (2x 3g/m2) and thiotepa (40mg/m2) followed by rG-CSF were used for stem-cell-mobilisation. The conditioning regimen included BCNU (400mg/m2) and thiotepa (2x5mg/kgBW) prior PBSCT. Additional hyperfractionated WBRT (45 Gy, 2x1Gy/d) was administered as consolidation. From 1999 to 2003 thirty pts (age under 65y) have been enrolled in the study (median age 54, range 30–64y). 21 of 30 pts responded to HD-MTX (6 CR, 15 PR). 22/30 pts received high dose CT and autologous PBSCT according to the protocol. Four pts refractory to MTX proceeded to RT directly and 1 patient died from PD subsequently. One patient died because of treatment-related liver toxicity after High-Dose MTX. Beside cytopenia no severe acute toxicities [WHO Grade 3 or 4] were observed after high-dose chemotherapy. After intention-to-treat analysis the response-rate was 89%. All patients that completed the protocol obtained CR (22/22). Three of these pts died, two died during follow-up due to relapse after 1 or 5 years respectively, the third patient died after 25 mo due to progressive heart failure. With a median follow-up of 42 months (range 3–84 mo) the overall survival of all pts included and pts that fulfilled the protocol is 71,3% and 86,5%, respectively. We conclude that sequential systemic application of high-dose differential acting cytostatic agents with consolidating hyperfractionated radiotherapy is very effective and well tolerable. In a new multicenter phase II study, pts will be treated with more intensive high dose CT and PBSCT omitting consolidating radiotherapy.

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