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Goh CQ, Kaur R, Ayeni FE, Eslick GD, Edirimanne S. Bidirectional association between breast cancer and meningioma: a systematic review and meta-analysis. ANZ J Surg 2024; 94:811-818. [PMID: 38361312 DOI: 10.1111/ans.18898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/22/2024] [Accepted: 01/27/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND An association between breast cancer and meningioma has been suggested in cohort studies. We aimed to perform a systematic review and meta-analysis to determine whether there is an association between initial breast cancer and subsequent meningioma diagnosis and vice versa. METHODS A systematic literature search was performed on Medline, Embase, Scopus and Google scholar from inception up to April 2023. A meta-analysis of selected studies was performed using Review Manager 5.4. RESULTS There were eight studies included in the systematic review. Seven had reported Standardized Incidence Ratio (SIR) for female patients and were suitable for the meta-analysis. Only one study reported SIR for male patients. For the association between initial breast cancer and subsequent meningioma, in 795 000 female patients with follow-up ranging from 7 to 13 years, the SIR was 1.27 (95% CI: 1.20-1.34, P-value <0.00001). For the association between initial meningioma and subsequent breast cancer, in 28 000 female patients with follow-up ranging from 6 to 15 years, the SIR was 1.32 (95% CI: 1.21-1.45, P-value <0.00001). There were low heterogeneity and no significant publication bias. CONCLUSION There was a small but significant association between initial breast cancer and subsequent meningioma as well as initial meningioma and subsequent breast cancer in female patients. The potential underlying mechanisms and risk factors were unclear from current literature and would be a potential area for future research.
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Affiliation(s)
- Chia Qi Goh
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Rajneesh Kaur
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Femi E Ayeni
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Guy D Eslick
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Senarath Edirimanne
- Department of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
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Degeneffe A, De Maertelaer V, De Witte O, Lefranc F. The Association Between Meningioma and Breast Cancer: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e2318620. [PMID: 37326990 PMCID: PMC10276307 DOI: 10.1001/jamanetworkopen.2023.18620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Importance A potential relationship between meningioma and breast cancer was suggested 70 years ago. However, to date, no conclusive evidence is available on this topic. Objective To provide a comprehensive review of the literature on the association of meningioma with breast cancer, supported by a meta-analysis. Data Sources A systematic PubMed search was performed up to April 2023 to identify articles on the association of meningioma with breast cancer. The following key words were used strategically: meningioma, breast cancer, breast carcinoma, association, relation. Study Selection All studies reporting women diagnosed with meningioma and breast cancer were identified. The search strategy was not limited by study design or publication date but only included articles in English. Additional articles were identified via citation searching. Studies reporting a complete population of meningiomas or breast cancer patients throughout a specific study period and a proportion of patients with a second pathology could be used for the meta-analysis. Data Extraction and Synthesis Data extraction was performed by 2 authors in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) statement. Meta-analyses regarding both populations were performed using a random-effects model. Risk of bias was assessed. Main Outcomes and Measures The main measures were whether there was an increased prevalence of breast cancer in female patients with meningioma and whether there was an increased prevalence of meningioma in female patients with breast cancer. Results A total of 51 retrospective studies (case reports, case series, and cancer registry reports) describing 2238 patients with both diseases were identified; 18 studies qualified for prevalence analyses and meta-analysis. The random-effects meta-analysis (13 studies) revealed a significantly greater prevalence of breast cancer in female patients with meningioma than in the overall population (odds ratio [OR], 9.87; 95% CI, 7.31-13.32). Meningioma incidence in patients with breast cancer (11 studies) was greater than that in the baseline population; however, the difference according to the random-effects model was not statistically significant (OR, 1.41; 95% CI, 0.99-2.02). Conclusions and Relevance This large systematic review and the meta-analysis on the association between meningioma and breast cancer found nearly 10-fold higher odds of breast cancer in female patients with meningioma compared with the general female population. These findings suggest that female patients with meningioma should be screened more intensively for breast cancer. Further research is required to identify the factors causing this association.
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Affiliation(s)
- Aurélie Degeneffe
- Department of Neurosurgery, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Viviane De Maertelaer
- Biostatistical Unit, Institute of Interdisciplinary Research in Human and Molecular Biology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier De Witte
- Department of Neurosurgery, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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Okada E, Nakamura M, Koshida Y, Mukai K, Toyama Y, Matsumoto M. Breast carcinoma metastasis to meningioma in the thoracic spine: A case report and review of the literature. J Spinal Cord Med 2015; 38:231-5. [PMID: 24617535 PMCID: PMC4397206 DOI: 10.1179/2045772314y.0000000201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Systemic metastasis to a primary tumor of the central nervous system is uncommon. Breast carcinomas metastasizing to a possibly preexisting meningioma in the spine are reported very rarely. STUDY DESIGN Case report. FINDINGS A 69-year-old female was referred to us with progressive gait disturbance. She had undergone a total mastectomy for carcinoma of the right breast 11 years previously. A magnetic resonance imaging of the thoracic spine showed an intra- and extradural spinal cord tumor. The patient underwent resection of the tumor via laminectomy from T2 to T4. After the operation, the patient's neurological status improved significantly, and she was able to walk without assistance. Histological examination showed the tumor to be a fibrous-type meningioma within a metastatic breast cancer tumor. The patient underwent 40 Gy radiation treatment for local control of the tumor. However, the tumor recurred locally 7 months after the surgery. The patient died of carcinomatous pleurisy 13 months after the surgery. CONCLUSION This case illustrates that a primary meningioma in the thoracic spine can be a recipient of breast cancer metastasis, which may alter the treatment strategy.
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Affiliation(s)
- Eijiro Okada
- Saiseikai Central Hospital, Mita Minato-ku, Tokyo, Japan,Correspondence to: Eijiro Okada, Saiseikai Central Hospital, Mita Minato-ku, Tokyo, Japan.
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Kiyoshi Mukai
- Saiseikai Central Hospital, Mita Minato-ku, Tokyo, Japan
| | - Yoshiaki Toyama
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Rao G, Giordano SH, Liu J, McCutcheon IE. The association of breast cancer and meningioma in men and women. Neurosurgery 2009; 65:483-9; discussion 489. [PMID: 19687693 DOI: 10.1227/01.neu.0000350876.91495.e0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE An association between breast cancer and intracranial meningioma has been described in women. We sought to determine whether this connection exists in men as well, hypothesizing that causes unrelated to sex may be responsible. METHODS We queried state cancer registries that recorded data on breast cancer and meningioma. International Classification of Diseases for Oncology codes for breast cancer and meningioma were used. The incidence rate of the second primary tumor was compared between identified meningioma and breast cancer cohorts and the general population for each sex. RESULTS Five state registries collected data on men and women from 1995 to 2003. The incidence of meningioma was 2.6 and 0.96 (cases per 100,000) for women and men, respectively, during this period. The incidence of breast cancer was 61 and 0.69 (cases per 100,000) for women and men, respectively, during this period. One man and 439 women were diagnosed with both diseases. The standardized incidence ratio was used to determine the magnitude of association between breast cancer and meningioma. During the study period, the standardized incidence ratio indicated a stronger than expected association between breast cancer and meningioma in women, regardless of which disease was diagnosed first. In every year except one, the standardized incidence ratio indicated no association between breast cancer and meningioma in men, regardless of which disease was diagnosed first. CONCLUSION Our results support a strong association between meningioma and breast cancer in women. Conversely, we were unable to show as strong an association in men. This suggests that the connection between these diseases may be dependent on sex.
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Affiliation(s)
- Ganesh Rao
- Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, Texas, USA.
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Aghi M, Kiehl TR, Brisman JL. Breast Adenocarcinoma Metastatic to Epidural Cervical Spine Meningioma: Case Report and Review of the Literature. J Neurooncol 2005; 75:149-55. [PMID: 16132512 DOI: 10.1007/s11060-005-1408-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
While several cases of cancer metastatic to cranial meningiomas have been reported, metastasis to spinal meningioma has been reported only once, and a mechanism for such metastases has not been investigated. We report a case of breast carcinoma metastatic to an epidural cervical meningioma, summarize the literature on metastases to central nervous system meningiomas, and suggest a possible mechanism. Our patient, a 55-year-old woman, presented with difficulty walking, back pain, and quadriparesis. Magnetic resonance imaging revealed an enhancing C3-4 epidural lesion and an L4 compression fracture. Because of concern that the fracture and epidural lesion might represent metastases, we performed a metastatic work-up, which revealed a right breast mass. The patient underwent C3-C4 laminectomies and an epidural lesion was encountered. Intraoperative frozen section revealed mixed meningioma and breast adenocarcinoma. A gross total resection was achieved and the patient subsequently received spinal irradiation and hormonal therapy. Whereas a literature review revealed numerous reports of metastases to cranial meningiomas, this represents only the second reported case of such pathology in the spine. Mechanisms of this unusual process likely include meningiomas' vascularity, meningiomas' slow growth providing nutrient availability, and perhaps, as suggested by our analysis, E-cadherin expression by both meningiomas and breast cancer. Metastasis to meningioma must be considered in an epidural spinal lesion in all patients with a known malignancy, with surgical aggressiveness tailored to the intraoperative pathologic diagnosis.
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Affiliation(s)
- Manish Aghi
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
BACKGROUND Meningiomas are biologically complex and clinically and surgically challenging. These features, combined with the rewarding potential for cure, make them of great interest to neurologists, neurosurgeons, and neuroscientists alike. REVIEW SUMMARY Initially, we review the clinical context of meningiomas, particularly recent changes in histopathological classification, diagnosis, and neuroimaging. Secondly, the underlying basic science as it has evolved over the last decades is summarized. The status of areas recently of intense interest, such as steroid hormone receptors and oncogenic viruses is described. Additionally, emerging areas of great promise, such as cytogenetics and molecular biology are presented. Lastly, we describe recent advances in management. In particular, skull-base surgery, image-guided surgery, and advances in radiotherapy are emphasized. The possible impact of basic research on management and outcome is also outlined. CONCLUSIONS Although usually benign and amenable to cure, meningiomas still present significant diagnostic and treatment challenges. Advances in basic science, surgery, and adjuvant therapy are widening the potential for safe, effective, evidence-based management leading to even better outcomes
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Affiliation(s)
- Katharine J Drummond
- Department of Neurosurgery, The Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Abstract
Breast carcinoma has a high predisposition to metastasize to the brain parenchyma. An association between carcinoma of the breast and intracranial meningioma has been reported. The available published articles regarding patients with intracranial meningioma and breast carcinoma have been reviewed. To the best of our knowledge, 86 cases including our 4 cases have so far been reported. All cases were female, and the mean age was 62.4 years when intracranial meningioma was diagnosed. The mean interval of the 2 tumours was 4.5 years. Twenty-five cases of breast tumour were infiltrating duct carcinomas. The location of intracranial meningioma and pathologic subtype showed no specific predominance. Hormone receptor study was performed in 28 cases. In meningioma, the positive rate of progesterone receptor (32.1%) is higher than oestrogen receptor (7.1%); while the positive rate of oestrogen receptor (53.6%) is higher than the progesterone receptor (42.9%) in breast cancer. A review of this study is presented with emphasis on the existence of intracranial meningioma and breast cancer in one patient at different periods. Lesions of the central nervous system in patients with breast cancer should not be immediately labeled as metastases. Intracranial meningioma should be excluded. Likewise, patients with meningioma should have periodic physical examinations and mammographies whereby disease may be diagnosed and treated at an early stage
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Affiliation(s)
- Ann Shung Lieu
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Custer BS, Koepsell TD, Mueller BA. The association between breast carcinoma and meningioma in women. Cancer 2002; 94:1626-35. [PMID: 11920521 DOI: 10.1002/cncr.10410] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Published case reports of a possible association between meningioma and breast carcinoma are not uncommon in the literature. Four published analytic studies have addressed this suggested association specifically. Three of these studies reported significant associations, with relative risk estimates mostly between 1.5 and 2.0. The other study reported relative risk point estimates near 1.5, but confidence intervals included 1.0. The current study was a population-based, retrospective cohort analysis that evaluated the risk of subsequent breast carcinoma in women who were diagnosed with meningioma and the risk of subsequent meningioma in women who were diagnosed with breast carcinoma. METHODS The measure of association is the relative risk and is reported as the standardized incidence ratio (SIR). Using western Washington State cancer registry data and intercensal population estimates for western Washington State, incidence rates of second primary tumor were compared between identified meningioma and breast carcinoma cohorts and the general population for the years 1992-1998. RESULTS The risk of breast carcinoma after patients were diagnosed with meningioma (SIR) was 1.54 (95% confidence interval [95% CI], 0.77-2.75). The risk of meningioma after patients were diagnosed with breast carcinoma was 1.40 (95% CI, 0.67-2.58), and the risk of meningioma after patients were diagnosed with invasive breast carcinoma was 1.64 (95% CI, 0.79-3.02). In each combination for age groups ages > 50 years, risks were elevated, but the confidence intervals included 1.0. CONCLUSIONS These results suggest that the risk of meningioma among women who have experienced breast carcinoma and the risk of breast carcinoma among women who have experienced meningioma are elevated moderately. Shared risk factors may account for the relatively week bidirectional associations seen in this and other studies.
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Affiliation(s)
- Brian S Custer
- Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195, USA.
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Perry A, Cai DX, Scheithauer BW, Swanson PE, Lohse CM, Newsham IF, Weaver A, Gutmann DH. Merlin, DAL-1, and progesterone receptor expression in clinicopathologic subsets of meningioma: a correlative immunohistochemical study of 175 cases. J Neuropathol Exp Neurol 2000; 59:872-9. [PMID: 11079777 DOI: 10.1093/jnen/59.10.872] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The molecular pathogenesis of meningiomas is poorly characterized. Loss of NF2 (merlin) expression has been reported in 30%-80% of all sporadic meningiomas. Recently, we found that loss of expression for a second Protein 4.1-family tumor suppressor. DAL-1, is also common. A biologically important role for progesterone receptor (PR) has also been proposed based on its reported inverse relationship with tumor grade. In order to better define the pathogenetic roles of these proteins, we studied the merlin, DAL-1, and PR immunoprofiles in 175 fully characterized meningiomas, including nonrecurring versus recurring benign, proliferative versus brain invasive atypical and anaplastic subtypes. Loss of expression for either Protein 4.1-family tumor suppressor (merlin or DAL-1) was almost universal (92%), with combined losses being common (58%). Individually, absence of merlin or DAL-1 protein was detected in 74% and 76% respectively, with no significant differences among the 5 subsets. PR immunoreactivity was commonly associated with retained DAL-1 expression (p < 0.001) and with tumor grade, with 51% of benign, 21% of atypical, and 11% of anaplastic tumors staining positive (p < 0.001). We conclude that PR immunohistochemistry may have diagnostic utility in meningothelial neoplasms. Protein 4.1-family tumor suppressor losses are likely important early events in meningioma pathogenesis, whereas PR expression is associated with benignity.
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Affiliation(s)
- A Perry
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri 63110-1093, USA
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