Risk Of Meningioma Research Articles

EPID-05. THE INCREASED RISK OF MENINGIOMA AMONG INDIVIDUALS WHO ARE NON-HISPANIC BLACK IS MAGNIFIED AMONG MALES AND AMONG THOSE DIAGNOSED WITH GRADE 2-3 TUMORS

Abstract BACKGROUND Demographic factors associated with elevated meningioma incidence include older age, female sex, and Black race. There are limited data exploring how meningioma risk in Black persons varies across the lifespan, interacts with sex, and differs by tumor grade. METHODS The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry combining data from the CDC’s National Program of Cancer Registries and NCI’s Surveillance, Epidemiology and End Results Program, covering the entire U.S. population. Meningioma diagnoses from CBTRUS (2004-2019) were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) as compared to non-Hispanic White individuals (NHW) across 10-year age intervals, and stratified by sex and WHO tumor grade (grade 1 versus grades 2/3, combined). RESULTS From 2004-2019, a total of 53,890 NHB individuals and 322,373 NHW individuals were diagnosed with a primary meningioma. The NHB to NHW IRR was elevated, beginning in the third decade of life (IRR=1.19; 95%CI: 1.11-1.28), peaking in the seventh decade (IRR=1.29; 95%CI: 1.26-1.31), and persisting throughout the lifespan. The IRR peaked in the seventh decade of life across strata of tumor grade, but, within this age group, NHB race/ethnicity was associated with substantially higher risk of grade 2/3 tumors (IRR=1.59; 95%CI: 1.48-1.70) than grade 1 tumors (IRR=1.27; 95%CI: 1.24-1.29). Meningioma risk was elevated in NHB females compared to NHW females (IRR=1.16; 95%CI: 1.15-1.18) and among NHB males compared to NHW males (IRR=1.22; 95%CI: 1.19-1.25), revealing synergistic interaction between NHB race/ethnicity and male sex (PInteraction=0.001). CONCLUSIONS This study identifies an elevated risk of meningioma in NHB relative to NHW, beginning shortly after puberty and continuing across the lifespan. NHB race/ethnicity conferred higher risk of meningioma among men than among women, and higher risk of developing WHO grade 2/3 than grade 1 tumors. These results highlight meningioma as a major potential source of racial disparities in neuro-oncology.

DISP-20. SEX DIFFERENCES IN MENINGIOMA AGGRESSIVE BEHAVIOR IN RURAL POPULATIONS: A GEO-ECOLOGICAL RISK ASSESSMENT OF MENINGIOMAS IN A SINGLE RURAL HEALTH CARE SYSTEM

Abstract BACKGROUND Cause for health outcome disparities in rural populations is multifactorial. These populations are potentially more vulnerable due to rural area environmental policies and practices. Environmental justice populations (EJP) are designated by the Environmental Protection Agency as at risk for generational exposer to environmental contaminants. We assessed these population for an association between EJP density and aggressiveness of indolent brain tumors. Meningiomas are the most common benign intracranial tumor and have a female predominance. We evaluated meningioma patients in a large rural health system for oncogenic risk associated geo-ecological factors. METHODS A retrospective review of 415 pathology confirmed CNS WHO grades 1-3 meningiomas cases between 2007 – 2017 within the Geisinger Health system in Pennsylvania. Cases were mapped by county for meningioma incidence, tumor grade, and tumor recurrence. Counties were rated for EJP density. We mapped geographic areas with a higher meningioma incidence, grade, and rates of recurrence, and evaluated sex-predilections. RESULTS Seventy-three percent of tumors were WHO grade 1 (n=303), 23.4% (n=97) were grade 2, and 3.6% (n=15) were grade 3. The highest incidence of meningiomas were localized to higher density EJP counties that bordered riverbeds, Lackawanna and Luzerne. Females had a 3.5:1 predominance as compared to males. The grade 1 10-year progression free survival rate was 54.7% in Luzerne, Columbia, and Montour counties (moderate to high density EJP). Males in high EJP counties had a 12% increased risk for developing high grade meningiomas. Males aged 51-60 were more likely to develop a grade 2 or 3 meningioma as compared to males aged 61-70 in these counties. Females aged 50-60 more likely had grade 1 meningiomas but demonstrated consistently increasing risk for recurrence every decile. CONCLUSIONS Pennsylvania high density EJP counties (especially along the Lackawanna River supply) have a disproportionate risk for aggressive meningiomas and lower progression free survival as compared to national averages. A sex-discrepancy exists for males in these areas to have the most aggressive tumors.

Prolonged use of chlormadinone acetate and risk of intracranial meningioma: A population-based cohort study.

Chlormadinone acetate (CMA) is a synthetic progestin for which cases of intracranial meningioma have been reported following prolonged exposure. An observational cohort study was conducted based on the French national health data system. Women aged 10-70 years and who started CMA between 2007 and 2017 were included. Participants were considered to be exposed if they had received a cumulative dose >360 mg of CMA during the first 6 months and very slightly exposed (control group) when they had received a cumulative dose ≤360 mg. The outcome was surgery or radiotherapy for one or more intracranial meningioma(s). Poisson models assessed the relative risk (RR) of meningioma. In total, 828,499 women were included: 469,976 in the exposed group (mean age 39.1 years, SD 10.1) and 358,523 in the control group (38.3 years, SD 11.0). Surgery or radiotherapy for intracranial meningioma between 2007 and 2017 was recorded for 164 and 104 women in the exposed and control groups, respectively. The incidence of meningioma was 18.5 and 6.8 per 100,000 person-years for the exposed and control groups respectively (crude RR = 2.7, 95% confidence interval [CI] 2.1-3.5; age-adjusted RR = 3.1, 95% CI 2.4-4.0). Meningioma incidence reached almost 47 cases/100,000 person-years in the most exposed group (>8.64 g), giving an age-adjusted RR of 6.9, 95% CI 5.1-9.2, relative to the control group. A strong dose-effect relationship was observed between prolonged use of CMA and risk of meningiomas. As with other progestogens, meningiomas associated with CMA are more likely to be found at the base of the skull.

Medroxyprogesterone-related risk of meningioma

Medroxyprogesterone-related risk of meningioma

Risk of medroxyprogesterone-related meningioma

Risk of medroxyprogesterone-related meningioma

IMPACT OF DNA METHYLATION PROfiLING IN REfiNING MENINGIOMA RECURRENCE RISK STRATIfiCATION AND CLINICAL FOLLOW UP

Abstract AIMS To assess clinical impact of the additive information gained from Integrated Meningioma Risk Score on the risk of meningioma recurrence. METHOD DNA methylation (Illumina EPIC Array) analysis was performed on all recurrent meningioma tumours, primary tumours CNS5 WHO grade 2, 3 and grade 1 with unusual morphological features from Dec 2021 to Jan 2024. DNA methylation analysis was performed, and data files were processed on the DKFZ Heidelberg Classifier v12.5/6 (molecularneuropathology.org). The output from the classifier including methylation class combined with WHO Grade and chromosomal loss (1p, 6q,14q) was used to produce an integrated meningioma risk score for recurrence. RESULTS 70 meningioma cases were profiled. This included 68 cranial meningiomas, ((WHO grade 1, n=19; recurrences=7), (grade 2, n=47; recurrences =9), (grade 3 n=2; recurrences=1)) and 2 spinal meningiomas (grade 1 n=1, grade2 n=1). 3 tumours were excluded due to poor calibration scores. Of the 67 cases the diagnosis was revised in 1 case following DNA methylation analysis due to presence of CDKN2A/B loss. Molecular-morphologic integrated risk score was calculated for all 67 cases. In 10% of overall patients the predicted risk of meningioma recurrence was increased to either intermediate or high, whilst 32% had the risk lowered mainly from intermediate to low. Interestingly, 1 patient who underwent a gross total resection of a WHO Grade 2 meningioma, experienced recurrence with the integrated meningioma risk score indicating low risk of recurrence, which is contrary to the clinical aggressiveness of the tumour. CONCLUSION Meningioma integrated risk stratification by DNA methylation profiling has shown concordance of integrated risk score with WHO Grade in 58% of cases. In 42% of cases the predicted risk was altered when compared to the WHO Grade alone. These results need to be further validated with long term data on patient outcomes.

Grade-stratified meningioma risk among individuals who are Non-Hispanic black and interactions with male sex.

Meningioma risk factors include older age, female sex, and African-American race. Limited data explore how meningioma risk in African-Americans varies across the lifespan, interacts with sex, and differs by tumor grade. The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry covering the entire U.S. population. Meningioma diagnoses from 2004-2019 were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) compared to non-Hispanic white individuals (NHW) across 10-year age intervals, and stratified by sex and by WHO tumor grade in this retrospective study. 53,890 NHB individuals and 322,373 NHW individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the NHB-to-NHW IRR was elevated for both grade 1 and grade 2/3 tumors. The IRR peaked in the seventh decade of life regardless of grade, and was higher for grade 2/3 tumors (IRR = 1.57; 95% CI: 1.46-1.69) than grade 1 tumors (IRR = 1.27; 95% CI: 1.25-1.30) in this age group. The NHB-to-NHW IRR was elevated in females (IRR = 1.17; 95% CI: 1.16-1.18) and was further elevated in males (IRR = 1.28; 95% CI: 1.26-1.30), revealing synergistic interaction between NHB race/ethnicity and male sex (PInteraction=0.001). Relative to NHW individuals, NHB individuals are at elevated risk of meningioma from young adulthood through old age. NHB race/ethnicity conferred greater risk of meningioma among men than women, and greater risk of grade 2/3 tumors. Population-level differences in meningioma incidence and tumor behavior suggest potential disparities in the geographic, socioeconomic, and racial distribution of meningioma risk factors within the U.S.

Traumatic Brain Injury Increasing Risk of Meningioma? From the Genetic Evidence

BackgroundNumerous studies have demonstrated a strong association between traumatic brain injury (TBI) and an increased risk of meningioma. However, this correlation remains controversial. This study utilized mendelian randomization to explore this relationship from perspective of genetic evidence. MethodsWe employed six traumatic brain injury genome-wide association study (GWAS) datasets from the IEU GWAS database. Summary statistics for meningioma were sourced from the FinnGen R10 database. We assessed heterogeneity and horizontal pleiotropy within the analyzed data. The primary method was inverse variance weighting (IVW) to investigate the causal relationship between TBI and meningioma, excluding cases with horizontal pleiotropy. Four supplementary analysis methods were also used, with abnormal results excluded based on leave-one-out sensitivity analysis. ResultsAll six Mendelian randomization analyses indicated no causal relationship between TBI and meningiomas (Focal brain injury IVW p-value = 0.98; Diffuse brain injury IVW p-value = 0.41; TBI without concussion IVW p-value = 0.45; Intracranial trauma IVW p-value = 0.34; Traumatic subdural hemorrhage IVW p-value = 0.80; Traumatic subarachnoid hemorrhage IVW p-value = 0.92). ConclusionsThe mendelian randomization study revealed that traumatic brain injury does not increase the risk of meningioma based on genetic evidence.

Occupational exposure to radiofrequency electromagnetic fields and brain tumor risk: Application of the INTEROCC job-exposure matrix.

Radiofrequency electromagnetic fields (RF-EMF, 100 kHz to 300 GHz) are classified by IARC as possibly carcinogenic to humans (Group 2B). This study evaluates the potential association between occupational RF-EMF exposure and brain tumor risk, utilizing for the first time, a RF-EMF job-exposure matrix (RF-JEM) developed in the multi-country INTEROCC case-control study. Cumulative and time-weighted average (TWA) occupational RF-EMF exposures were estimated for study participants based on lifetime job histories linked to the RF-JEM using three different methods: (1) by considering RF-EMF intensity among all exposed jobs, (2) by considering RF-EMF intensity among jobs with an exposure prevalence ≥ the median exposure prevalence of all exposed jobs, and (3) by considering RF-EMF intensity of jobs of participants who reported RF-EMF source use. Stratified conditional logistic regression models were used, considering various lag periods and exposure time windows defined a priori. Generally, no clear associations were found for glioma or meningioma risk. However, some statistically significant positive associations were observed including in the highest exposure categories for glioma for cumulative and TWA exposure in the 1- to 4-year time window for electric fields (E) in the first JEM application method (odds ratios [ORs] = 1.36, 95% confidence interval [95% CI] 1.08, 1.72 and 1.27, 95% CI 1.01, 1.59, respectively), as well as for meningioma for cumulative exposure in the 5- to 9-year time window for electric fields (E) in the third JEM application method (OR = 2.30, 95% CI 1.11, 4.78). We did not identify convincing associations between occupational RF-EMF exposure and risk of glioma or meningioma.

Lifestyle and metabolic factors affect risk for meningioma in women: a prospective population-based study (The Cohort of Norway).

Meningioma is the most common primary brain tumor, with a clear preponderance in women. Obesity is considered a risk factor for the development of meningioma. Obesity is also the clinical hallmark of metabolic syndrome, characterized by glucose intolerance, dyslipidemia, and hypertension. Lifestyle and metabolic factors directly impact overweight and obesity and are therefore potential risk factors for meningioma development. The aim of this study is to assess lifestyle and metabolic factors for meningioma risk in women. The Cohort of Norway (CONOR) is a nationwide health survey, conducted between 1994 and 2003, including anthropometric measures, blood tests, and health questionnaires. Linkage to the National Cancer Registry enabled the identification of intracranial meningioma during follow-up until December 2018. A total of 81,652 women were followed for a combined total of 1.5 million years, and 238 intracranial meningiomas were identified. Increasing levels of physical activity (HR 0.81; 95% CI 0.68-0.96; p trend <0.02) and parity (HR 0.83; 95% CI 0.71-0.97; p trend <0.03) were negatively associated with meningioma risk. Diabetes mellitus or glucose intolerance increased the risk for meningioma (HR 2.54; 95% CI 1.60-4.05). Overweight and obesity were not associated with meningioma risk, nor was metabolic syndrome. However, participants without metabolic dysfunction had a reduced meningioma risk, while participants with all five metabolic factors present had a 4-fold risk increase for meningioma (HR 4.28; 95% CI 1.34-13.68). Lifestyle factors seem to significantly influence meningioma risk. However, disentangling the complex associations and interactions between factors for meningioma risk will be a challenging task for future studies.

Genome-wide association study on meningioma risk in Japan: a multicenter prospective study

PurposeAlthough meningiomas are the most common primary intracranial tumors, their genetic etiologies have not been fully elucidated. To date, only two genome-wide association studies (GWASs) have focused on European ancestries, despite ethnic differences in the incidence of meningiomas. The aim of this study was to conduct the first GWAS of Japanese patients with meningiomas to identify the SNPs associated with meningioma susceptibility.MethodsIn this multicenter prospective case-control study, we studied 401 Japanese patients with meningioma admitted in five institutions in Japan, and 50,876 control participants of Japanese ancestry enrolled in Biobank Japan.ResultsThe quality control process yielded 536,319 variants and imputation resulted in 8,224,735 variants on the autosomes and 224,820 variants on the X chromosomes. This GWAS eventually revealed no genetic variants with genome-wide significance (P < 5 × 10 − 8) and observed no significant association in the previously reported risk variants rs11012732 and rs2686876 due to low minor allele frequency in the Japanese population.ConclusionThis is the first GWAS of meningiomas in East Asian populations and is expected to contribute to the development of GWAS research for meningiomas.

Elevated meningioma risk among individuals who are Non-Hispanic Black is strongest for grade 2-3 tumors and synergistically modified by male sex.

Meningioma risk factors include older age, female sex, and African-American race. There are limited data exploring how meningioma risk in African-Americans varies across the lifespan, interacts with sex, and differs by tumor grade. The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry covering the entire U.S. population. Meningioma diagnoses from 2004-2019 were used to calculate incidence rate ratios (IRRs) for non-Hispanic Black individuals (NHB) compared to non-Hispanic white individuals (NHW) across 10-year age intervals, and stratified by sex and by WHO tumor grade. 53,890 NHB individuals and 322,373 NHW individuals with an intracranial meningioma diagnosis were included in analyses. Beginning in young adulthood, the NHB-to-NHW IRR was elevated for both grade 1 and grade 2/3 tumors. The IRR peaked in the seventh decade of life regardless of grade, and was higher for grade 2/3 tumors (IRR=1.57; 95% CI: 1.46-1.69) than grade 1 tumors (IRR=1.27; 95% CI: 1.25-1.30) in this age group. The NHB-to-NHW IRR was elevated in females (IRR=1.17; 95% CI: 1.16-1.18) and further elevated in males (IRR=1.28; 95% CI: 1.26-1.30), revealing synergistic interaction between NHB race/ethnicity and male sex (P Interaction =0.001). Relative to NHW individuals, NHB individuals are at elevated risk of meningioma from young adulthood through old age. NHB race/ethnicity conferred higher risk of meningioma among men than women, and higher risk of developing WHO grade 2/3 tumors. Results identify meningioma as a significant source of racial disparities in neuro-oncology and may help to improve preoperative predictions of meningioma grade.

Risk of intracranial meningioma in patients with acromegaly: a systematic review.

https://www.crd.york.ac.uk/prospero/, identifier CRD42022376998.

Hormonal influences on meningioma risk in women

Summary Meningiomas have been linked to endogenous and exogenous hormones, but the exact mechanisms are unclear. A review of 23 studies (1958–2018) found no significant association between menarche age and meningioma risk. Most contraceptives showed no link, though some specific types indicated high risk. Pregnancy might be protective while breastfeeding over 6 months showed a protective effect in one study. Postmenopausal status increased risk in two studies. Hormone replacement therapy (HRT) results were inconsistent, with some studies indicating increased risk, particularly with long-term use. High cumulative doses of cyproterone acetate (CPA) were significantly associated with increased risk. Overall, hormonal factors’ role in meningioma development varies, with specific hormones and high doses of CPA posing significant risks, suggesting the need for further research.

Examining the Causal Connection between Lipid-lowering Medications and Malignant Meningiomas through Drug-target Mendelian Randomization Analysis

Objectives: This study aims to investigate the causal link between the use of statins, a type of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, and the risk of developing malignant meningiomas, which are aggressive and recurrent tumors of the central nervous system with limited treatment options. Methods: Using Mendelian Randomization (MR) analysis, the study explored the relationship between genetic variants related to the expression of lipid-lowering drug targets (HMGCR, PCSK9, NPC1L1, and APOB) and malignant meningiomas. The analysis utilized data from Genome-Wide Association Studies (GWAS) and expression quantitative trait loci (eQTL) databases, with a focus on the genetic homogeneity of the Finnish population. Instrumental variables for the MR analysis were derived from significant eQTLs for the mentioned drug targets. Results: The MR analysis found a significant association between genetic variants linked to HMGCR inhibitor (statin) exposure and a reduced risk of malignant meningiomas. Specifically, an increased expression of the HMGCR gene in the blood was associated with lower susceptibility to malignant meningiomas (Odds Ratio [OR] = 2.57, 95% Confidence Interval [CI] = 1.05 - 6.31; p = 0.039). No significant associations were observed for other lipid-lowering drug targets. Conclusion: Preliminary evidence suggests that statin use may lower the risk of developing malignant meningiomas, indicating a potential therapeutic benefit for managing this type of cancer. However, further research, including clinical trials, is necessary to confirm these findings and understand the mechanisms behind the protective effect of statins against malignant meningiomas.

Meningioma recurrence: Time for an online prediction tool?

Meningioma, the most common brain tumor, traditionally considered benign, has a relatively high risk of recurrence over a patient's lifespan. In addition, with the emergence of several clinical, radiological, and molecular variables, it is becoming evident that existing grading criteria, including Simpson's and World Health Organization classification, may not be sufficient or accurate. As web-based tools for widespread accessibility and usage become commonplace, such as those for gene identification or other cancers, it is timely for meningioma care to take advantage of evolving new markers to help advance patient care. A scoping review of the meningioma literature was undertaken using the MEDLINE and Embase databases. We reviewed original studies and review articles from September 2022 to December 2023 that provided the most updated information on the demographic, clinical, radiographic, histopathological, molecular genetics, and management of meningiomas in the adult population. Our scoping review reveals a large body of meningioma literature that has evaluated the determinants for recurrence and aggressive tumor biology, including older age, female sex, genetic abnormalities such as telomerase reverse transcriptase promoter mutation, CDKN2A deletion, subtotal resection, and higher grade. Despite a large body of evidence on meningiomas, however, we noted a lack of tools to aid the clinician in decision-making. We identified the need for an online, self-updating, and machine-learning-based dynamic model that can incorporate demographic, clinical, radiographic, histopathological, and genetic variables to predict the recurrence risk of meningiomas. Although a challenging endeavor, a recurrence prediction tool for meningioma would provide critical information for the meningioma patient and the clinician making decisions on long-term surveillance and management of meningiomas.

A cohort study of CNS tumors in Multiple Endocrine Neoplasia Type 1.

Multiple Endocrine Neoplasia Type-1 (MEN1) is thought to increase the risk of meningioma and ependymoma. Hereby, we aimed to describe the frequency, the incidence and specific clinical and histological features of CNS tumors in the MEN1 population (except pituitary tumors). The study population included patients harboring CNS tumors diagnosed with MEN1 syndrome after 1990 and followed-up in the French MEN1 national cohort. Standardized incidence rate (SIR) was calculated based on the French Gironde CNS tumors registry. Genomic analyses were performed on somatic DNA from 7 CNS tumors including meningiomas and ependymomas from MEN1 patients, then in 50 sporadic meningiomas and ependymomas. Twenty-nine CNS tumors were found among the 1498 symptomatic patients (2%) (incidence=47.4/100'000 person-years; SIR=4.5), including 12 meningiomas (0.8%) (incidence=16.2/100'000; SIR=2.5), 8 ependymomas (0.5%) (incidence=10.8/100'000; SIR=17.6), 5 astrocytomas (0.3%) (incidence=6.7/100'000; SIR=5.8), and 4 schwannomas (0.3%) (incidence=5.4/100'000; SIR=12.7). Meningiomas in MEN1 patients were benign, mostly meningothelial, with 11 years earlier onset compared to the sporadic population and an F/M ratio of 1/1. Spinal and cranial ependymomas were mostly classified WHO grade 2. A biallelic MEN1 inactivation was observed in 4/5 ependymomas and 1/2 meningiomas from the MEN1 patients, whereas MEN1 deletion in one allele was present in respectively 3/41 and 0/9 sporadic meningiomas and ependymomas. Incidence of each CNS tumor was higher in the MEN1 population than in the French general population. Meningiomas and ependymomas should be considered part of the MEN1 syndrome, but somatic molecular data are missing to conclude for astrocytomas and schwannomas.

Case Report and Literature review. Neuropsychiatry Manifestation of Frontal Lobe Neoplasm- Meningioma. Prevalence, Presentation and Pathogenesis

IntroductionMeningiomas are the most frequent primary brain tumor. Although most Meningiomas are benign, their location in the central nervous system can predict symptomatology which could result in significant morbidity and mortality. However, due to the slow-growing nature, meningiomas are usually asymptomatic, and diagnosis is often made incidentally on neuroimaging or at an autopsy. The incidence rate is 1.2-fold higher in Black Americans than White Americans. Neuropsychiatry manifestation might be only initial presentation; thus, psychiatrists are often the first to see these patients, and the correct diagnosis may be made only when the tumor has grown to a considerable size and begun to displace the brain.ObjectivesThe aim of this study is to understand the biological basis of psychiatry symptoms in patients with Frontal Lobe meningiomas.MethodsA review of literature and individual patient data analysis was conducted. The literature review was conducted on PubMed, Medline, MeSH, Google Scholar, and mount Sinai’s levy Library using the key words; meningioma, meningioma with psychiatric symptoms, psychosis, depression, neuropsychiatry manifestation of meningiomas.ResultsThe review revealed that 88% of brain tumors and psychiatric symptoms are located in the frontal region. Meningiomas accounts for 13%-26% of intracranial tumors. There is a reported low incidence due to its slow growing nature and are usually asymptomatic. Incidence of meningiomas is predominant in females, and is attributed to hormonal factors, this is associated with estrogen and progestogen cycles. Reports shows that smoking has been linked to increase risk of meningiomas in men. Frontal lobe meningiomas may present with only psychological symptoms that resemble depression, anxiety states, hypomania and schizophrenia. Personality and mental status changes are also noted in Frontal lobe tumors. Left sided lesions are associated with inhibition of motor activity, impairment in motor and initiative aspect of speech, diminished generalization ability and general inertia of mental process.Conclusions Given the absence of frank neurological symptoms, to help localize the lesion, most meningiomas are missed due to diagnostic overshadowing of the primary psychiatric illness. Peritumoral edema indicates the underlying mechanism and location of the lesion predicts symptomatology. Like our patient who is an 81-year-old male with no past psychiatry history, presenting to our comprehensive psychiatry emergency program with psychiatric manifestation as the initial presentation and subsequently with MRI suggestive of Right Frontal extra-axial meningioma. This study shows that primitive frontal lobe tumors are likely to be misdiagnosed as patients with such tumors are often referred first to psychiatrist. High index of suspicious is needed.Disclosure of InterestNone Declared

Use of progestogens and the risk of intracranial meningioma: national case-control study

ABSTRACTObjectiveTo assess the risk of intracranial meningioma associated with the use of selected progestogens.DesignNational case-control study.SettingFrench National Health Data System (ie, Système National des Données de Santé).ParticipantsOf 108 366 women...

Extensive androgen exposure and meningioma risk – A matched cohort study

IntroductionMeningiomas frequently occur within the field of neuro-oncology, but it is unclear whether exogenous or imbalanced endogenous hormones are involved in the pathophysiology. A previous case-control study found an almost 20-fold increase in the risk of developing meningioma among users of androgenic anabolic steroids. We, therefore, investigated this hypothesis. MethodsWe compared the incidence rate of meningioma in a cohort of males sanctioned for the use of androgenic anabolic steroids with age- and sex-matched controls with an identical enrollment date. ResultsWe followed 1189 males sanctioned for using androgenic anabolic steroids for a total of 13,305 person-years and found 0 cases of meningioma. The control cohort of 59,450 males was followed for a total of 654,938 person-years, and 16 were diagnosed with meningioma. Thus, the incidence rate ratio was 0 (95% CI: 0–12.8). ConclusionWe did not find any evidence supporting the hypothesis of an increased risk of meningioma development with the use of androgenic anabolic steroids. Due to the limited sample size, we cannot exclude androgenic anabolic steroids as a potential risk factor for meningioma development, despite the lack of apparent evidence in this study.