Presentation of a meningioma in a transwoman after nine years of cyproterone acetate and estradiol intake: case report and literature review

Abstract

The administration of cyproterone acetate (CPA) and estradiol is a common regimen used by male-to-female transsexuals (transwoman) to adjust their body to their gender identity. Major adverse events are uncommon in these subjects in spite of long-term, high dose cross-sex steroid treatments. We describe the occurrence of a meningioma in a transwoman treated with estrogens and CPA over a period of nine years. The meningioma was revealed during a magnetic resonance imaging (MRI) scan performed as follow-up of a previous surgery for ganglioglioma. CPA intake was discontinued and tumor resection was performed. Histological diagnosis confirmed a strong progesterone receptor-positive and slight estrogen positive meningioma. After surgery, the patient continued her treatment with leuprorelina acetate and estradiol. At one-year follow-up, the MRI scan reveals no recurrence of the tumor. This is the ninth case in literature of a meningioma in a transwoman treated with estrogens and CPA, confirming a possible association between female sex steroids and meningioma. Although there is no still strong evidence of an association between meningioma and CPA, this report may suggest use of alternative treatment for transwomen. This report highlights the importance to record all the cases of meningiomas in high dose CPA-users, in order to improve data.

Chinese abstract

醋酸环丙孕酮（CPA）和雌二醇联合用药是针对男性变性为女性（变性女性）调节并维持其性征的常规治疗方案。尽管其治疗方案多为长期性、高剂量的跨性别激素治疗, 但不良反应鲜有发生。我们对一名已进行9年CPA和雌二醇联合用药的变性女性发生脑膜瘤的病例进行了报道。该患者在进行节细胞胶质瘤术后随访核磁共振（MRI）检查中首次发现脑膜瘤的存在。停服CPA后进行脑膜瘤切术手术。病理学诊断表明该脑膜瘤为强孕激素受体阳性和轻度雌激素阳性。术后患者进行醋酸亮丙瑞林和雌二醇联合用药治疗方案。一年的随访检查表明该患者无肿瘤复发。包括该患者在内, 已有9篇关于变性女性在使用CPA和雌二醇联合用药治疗后发生脑膜瘤的病案报道, 说明女性激素与脑膜瘤的发生有某些潜在关联。虽然目前无强有力的证据表明脑膜瘤的发生和CPA之间存在关联, 但本文仍建议在对变性女性的治疗方案中使用其它药物替换CPA方案。同时本病案报道建议, 为丰富数据记录, 应妥善记录所有关于使用高剂量CPA后发生脑膜瘤的病例数据。

Keywords:

• Meningioma
• cyproterone acetate
• transwomen
• transsexual
• cross-sex steroid treatment

Acknowledgements

Consent: Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.

Disclosure statement

All authors declare no conflict of interest.

Additional information

Funding

Nothing to declare.