THE ASSOCIATION BETWEEN MRI AND INTRA OPERATIVE FINDINGS WITH ESTROGEN RECEPTOR/PROGESTERON RECEPTOR STATUS IN PATIENTS OPERATED FOR INTRA CRANIAL MENINGIOMA IN TERTIARY CARE HOSPITAL

Abstract

Background: Meningiomas constitute about 13-26% of primary intracranial tumours. Women are affected twice. Common in 5th to 6th decades. Meningiomas mostly are asymptomatic but presents with variety of symptoms related due to compression of adjacent structures. The World Health Organization (WHO) has divided the meningioma into three grades: typical, atypical, and anaplastic. Consideration of Pre operative MRI ndings, macroscopic factors (intraoperative meningioma factors), such as tumor size and shape, and the rate of local invasion of this tumor, like bone invasion, can also be useful in determining the prognosis of patients because of differences in brain meningioma in different parts of the brain. Objectives: 1. To study the association between MRI ndings with Estrogen receptor/progesteron receptors status in patients operated for meningioma in Tertiary Care Hospital 2. To study the association between intra operative ndings with Estrogen receptor/progesteron receptors status in patients operated for meningioma in Tertiary Care Hospital Materials and Methods:ADescriptive study was conducted Department of Neurosurgery, Government medical college Thiruvananthapuram between September 2021 to march 2022. 74 cases of meningioma were included in the study. Results: In majority 43(58.11%)), hormonal receptor status was PR+ followed by ER and PR negative 17(22.97%)). Hormonal receptor status was ER+ in only 14 out of 74 patients (18.92%) with no signicant association between them. (p value=0.499) according to age. ER+ most commonly seen in postmenopausal women as compared to PR+(34.15%). MRI Brain in majority of patient with ER +status presented with single tumour commonly at convexity(50%), hard in consistency(29.41%), moderate edema,( 42.86%) commonly calcication not present, diffusion restriction, homogeneous contrast enhancement, sinus involvement with atypical grade (57.14%,) whereas with PR+ presented with single tumor, commonly arises from convexity but spenoid wing is specic site for this receptor, tumor was rm in consistency, had mild edema, moderate vascularity, no calcication, diffusion restriction, homogeneous contrast enhancement, no sinus involvement with typical grade(95.35%). Intraoperative ndings with ER+ patient had single tumor, convexity, hard in consistency (29.41%), moderate edema, mild vascularity, suckable, cusable, maximum patient had calcication (71.43%), maximum had no hyperostosis with Resectable Simpsons grade2. Maximum had no hyperostosis with Resectable Simpsons grade2 Proportion of patients with histopathological grading: - meningo-epithelial meningioma grade 1, psammomatous meningioma grade 1 was signicantly higher in PR+, atypical meningioma grade 2 was signicantly higher in ER+ as compared to PR+ and ER and PR negative. Conclusions: Meningioma expresses predominantly progesterone receptor followed by estrogen receptor. Postmenopausal females have estrogen receptor positive meningioma, in older age group, with MRI features of atypical meningioma, intraoperative hard consistency and higher grades of histopathology, whereas progesterone receptor positive meningioma is common in premenopausal women with typical features of meningioma with soft to rm consistency intraoperative and with lesser grades of histopathology. MRI and intraoperative ndings are associated with hormonal receptor status. Thus, aid in predicting nature and prognosis of meningioma.