Delayed regression of atypical meningiomatosis following discontinuation of gender-affirming hormone therapy in a transgender woman: a case report.

INTRODUCTION

Cyproterone acetate (CPA) is an antiandrogen that may be used in combination with estradiol in gender reaffirmation therapy. Whilst CPA is associated with an increased risk of meningioma in cisgender women, literature on its risks and optimal management in cases of meningioma in transgender women remains sparse.

CASE PRESENTATION: The authors present the case of a 67-year-old transgender female who presented acutely with meningiomatosis. The patient had been on long term, high dose CPA and estradiol gender reaffirming therapy. CPA and estradiol therapy were held and the large, left sided lesions causing peritumoural oedema and significant mass effect were surgically resected. Histology confirmed atypical meningiomatosis with diffuse but weak progesterone receptor expression. Post-operative MRI scans demonstrated delayed regression of the remaining lesions following CPA and estradiol cessation at 12-months. Volumetric analysis revealed a mean tumour volume reduction of 21% at 12-months. Minimal change in tumour volume was seen on imaging at both 4-weeks and 6-months after cessation.

CONCLUSIONS

CPA cessation alone may be an effective way to halt and even regress meningioma progression. However, its effect appears to be delayed, indicating that cessation alone is suboptimal in cases causing significant mass effect and symptomatology. In such cases, early surgical intervention should be considered.