Case of Meningioma during Luteinizing Hormone-Releasing Hormone Agonist Prostate Cancer Treatment
- 3 years ago
Neurol Med Chir (Tokyo). 2014 Apr; 54(4): 327–330. doi: 10.2176/nmc.cr2012-0417
A 70-year-old man underwent gastrectomy for early stage gastric cancer, and remained well after that for 7 years. He received a brain check-up at another hospital in November 2007, and no intracranial abnormalities were detected (Fig. 1). In April 2008, early stage prostate cancer (T1C, N0, M0) was detected. Prostatectomy was performed, and leuprorelin acetate and bicalutamide were administered prophylactically to the patient. Monthly treatment was then maintained. In December 2010, he suffered from headache and a brain magnetic resonance imaging (MRI) at another hospital demonstrated an intracranial mass lesion. He was referred to our hospital on January 31, 2011.
No neurological deficits were observed. Brain MRI revealed a large extraaxial parasagittal mass near the bregma which compressed bilateral frontal lobes and extended into the falx and skull. It showed iso-intense on T1-weighted images (WI) and high-intense on T2WI, and was homogeneously enhanced after intravenous injection of contrast materials. The diameter of the tumor reached 5 cm (Fig. 2). Hyperostosis of the skull near the mass was identified by skull X-ray. Many feeding arteries originating from bilateral pial arteries and branches of external carotid arteries were recognized on cerebral angiogram. The superior sagittal sinus (SSS) was segmentally occluded near the bregma. Prostate-specific antigen (PSA) was 0 ng/ml, carcinoembryonic antigen (CEA) was 1.8 ng/ml, and Ca19-9 was 9.7 U/ml. The tumor was regarded as a parasagittal meningioma invading the falx, SSS, and skull. An operation was performed on March 14, 2011.
Under general anesthesia, the medial frontoparietal bone was removed in a divided manner. At the same time, a part of the tumor which invaded the skull was also removed. Then, the dura around the tumor was cut, and the border between the tumor and its dural attachment was separated, and the tumor surface was dissected from the brain while interrupting the pial supply. The tumor was pinkish and fragile and tended to bleed. Internal decompression was suitably done, and the tumor was removed in a piecemeal manner. Almost all the tumor attachment, affected falx, and SSS were removed. A part of the attachment near the intact cortical bridging vein was left as it was coagulated. The extent of tumor removal was judged as Simpson grade 2. Dural plasty using Goatex, and cranioplasty using a titanium plate were performed. The tumor was histopathologically proved to be a meningothelial meningioma without atypical or anaplastic features. The molecular immunology borstel-1 (MIB-1) staining index was 5% or less. Cytoplasmic immunoreactivity for the luteinizing hormone-releasing hormone (LH-RH) receptor was detected (Fig. 3). The used primary antibody was mouse monoclonal anti-LH-RH receptor antibody (Thermo, Fremont, California, USA).
A 70-year-old man underwent gastrectomy for early stage gastric cancer, and remained well after that for 7 years. He received a brain check-up at another hospital in November 2007, and no intracranial abnormalities were detected (Fig. 1). In April 2008, early stage prostate cancer (T1C, N0, M0) was detected. Prostatectomy was performed, and leuprorelin acetate and bicalutamide were administered prophylactically to the patient. Monthly treatment was then maintained. In December 2010, he suffered from headache and a brain magnetic resonance imaging (MRI) at another hospital demonstrated an intracranial mass lesion. He was referred to our hospital on January 31, 2011.
No neurological deficits were observed. Brain MRI revealed a large extraaxial parasagittal mass near the bregma which compressed bilateral frontal lobes and extended into the falx and skull. It showed iso-intense on T1-weighted images (WI) and high-intense on T2WI, and was homogeneously enhanced after intravenous injection of contrast materials. The diameter of the tumor reached 5 cm (Fig. 2). Hyperostosis of the skull near the mass was identified by skull X-ray. Many feeding arteries originating from bilateral pial arteries and branches of external carotid arteries were recognized on cerebral angiogram. The superior sagittal sinus (SSS) was segmentally occluded near the bregma. Prostate-specific antigen (PSA) was 0 ng/ml, carcinoembryonic antigen (CEA) was 1.8 ng/ml, and Ca19-9 was 9.7 U/ml. The tumor was regarded as a parasagittal meningioma invading the falx, SSS, and skull. An operation was performed on March 14, 2011.
Under general anesthesia, the medial frontoparietal bone was removed in a divided manner. At the same time, a part of the tumor which invaded the skull was also removed. Then, the dura around the tumor was cut, and the border between the tumor and its dural attachment was separated, and the tumor surface was dissected from the brain while interrupting the pial supply. The tumor was pinkish and fragile and tended to bleed. Internal decompression was suitably done, and the tumor was removed in a piecemeal manner. Almost all the tumor attachment, affected falx, and SSS were removed. A part of the attachment near the intact cortical bridging vein was left as it was coagulated. The extent of tumor removal was judged as Simpson grade 2. Dural plasty using Goatex, and cranioplasty using a titanium plate were performed. The tumor was histopathologically proved to be a meningothelial meningioma without atypical or anaplastic features. The molecular immunology borstel-1 (MIB-1) staining index was 5% or less. Cytoplasmic immunoreactivity for the luteinizing hormone-releasing hormone (LH-RH) receptor was detected (Fig. 3). The used primary antibody was mouse monoclonal anti-LH-RH receptor antibody (Thermo, Fremont, California, USA).