Carcinoma of the breast and meningioma: Associated
tumors or random events?
Poster No.:
C-0389
Congress:
ECR 2010
Type:
Educational Exhibit
Topic:
Breast
Authors:
I. Georgiou, M. Piperi, G. Ioannidou, M. P. K. Angelopoulos, O.
Aggelatou; Athens/GR
Keywords:
Meningioma, Breast cancer, neoplasms
DOI:
10.1594/ecr2010/C-0389
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Page 1 of 9
Learning objectives
To illustrate the association between breast cancer and meningioma that indicates a
possible epidemiologic, hormonal and genetic relationship.
Background
The coexistence of multiple primary tumors, benign or malignant is observed in about
2.8% of patient with neoplasms. Meningiomas represent 20% of all central nervous
system tumors while breast cancer is responsible in 30% of all diagnosed tumors in a
year.
The relative risk of meningioma after patients were diagnosed with breast cancer is
particularly high (1.75; 95%CI, 1.08-2.68). The risk was greatest among women age
50-64 years. The relative risk of breast cancer in patients with a known meningioma is
also high (1.92; 95% CI, 1.02-3.29).
The simultaneous occurrence of these tumors is an unusual but well-known event. 87
cases have been described in the literature.
Imaging findings OR Procedure details
We report six new cases that have been evaluated in our hospital. Three patients with
primary breast cancer since three years, who subsequently developed meningioma and
other three patients with preexisting meningioma and after two years developed breast
cancer.
st
1 Case
A 46y.o woman presented on March 2003 with persistent headache, nausea, vomiting
and ophthalmic disturbs. Brain MRI revealed a large mass lesion of 6cm in left parietaloccipital lobe with extension to the right hemisphere and mass effect to the left lateral
ventricle with imaging features of meningioma. On May 2005, for the persistence
of the symptoms, a craniotomy was performed with total excision of the mass. The
Page 2 of 9
histopathologic study confirmed a transitional meningioma Grade II. On September 2005
she underwent a bilateral modified radical mastectomy for bilateral carcinoma of breast.
Estrogen and progesterone receptors were positive. The histopathologic study revealed
the presence of infiltrating ductal carcinoma of right breast with one positive lymph node
metastasis (1/14) and ductal carcinoma in situ (DCIS) of left breast with one positive
lymph node metastasis (1/12). The patient received four cycles of preoperative and three
cycles of postoperative chemotherapy and radiotherapy of bilateral chest wall. She is
currently well and remains free of disease.
nd
2
Case
A 55y.o woman, on May 2001 performed a brain MRI for a two months period imbalance.
The exam revealed a 3.5cm tumor mass in the right posterior parietal region with
characteristics of meningioma. The patient received antiepileptic treatment and remained
without symptoms. On June 2005 underwent in lumpectomy of left breast for an infiltrating
lobulare carcinoma with negative lymph node metastasis. Estrogen and progesterone
receptors were positive. The patient received four cycles of adjuvant chemotherapy
(CMP) and radiotherapy. On February 2006 for the persistence of the symptoms of
CNS underwent in craniotomy with total excision of the lesion which was reported as
meningioma grade I by histopathologic study. She had an uneventful postoperative
recovery with no recurrence of both diseases.
rd
3
Case
A 70y.o woman, in 1998 for several episodes of seizures performed a brain CT scan. The
exam showed a 2.5cm tumor mass lesion in the left parietal lobe with imaging features of
meningioma. On June 2005, a lumpectomy of right breast was performed for an infiltrating
ductal carcinoma with negative lymph node metastasis (0/14) and received six cycles
of chemotherapy. On December 2005, in the right axilla was found a mass lesion and
the patient underwent in total surgical excision of the mass and received chemotherapy
and radiotherapy of right breast and ipsilateral supraclavicular region. One year later the
patient was diagnosed with multiple bone and liver metastasis and died of progressive
disease on November 2007.
th
4 Case
A 62y.o woman on May 2002 underwent in lumpectomy of right breast for an infiltrating
ductal carcinoma grade II. A mastectomy of left breast was performed 26 years ago for
breast cancer. No hormone receptors were assayed in the tumor. The patient received
radiotherapy of right breast and ipsilateral supraclavicular region. On November 2005
during a periodic follow up, a brain CT scan showed a 1.8cm mass lesion in the right
parietal lobe with imaging characteristics of meningioma. On June 2006, the patient
Page 3 of 9
underwent a craniotomy with total excision of the lesion which was subsequently reported
as meningioma by histopathologic study. She had a good postoperative recovery and
since then has been asymptomatic.
th
5 Case
A 65y.o woman on May 2006 presented with headache, nausea and diminished
mentalism. Seven years ago, a mastectomy was performed for an infiltrating ductal
carcinoma of left breast following chemotherapy and radiotherapy. Cranial CT reported
a right sylvian mass lesion with homogeneous contrast enhancement. Cranial MRI
showed that lesion seemed to be connected with dural extension. There were no
other enhancing leptomeningeal or parenchymal lesions. The primary diagnosis was an
en plaque meningioma but metastatic carcinoma was also included in the differential
diagnosis. The patient is currently well with no recurrence of both disease.
th
6 Case
In the previous five cases another one can be added of a 77y.o woman with breast cancer
diagnosed in 2003. She was admitted in our hospital for esoftalmo. MRI revealed a mass
lesion of left ophthalmic nerve with imaging features of meningioma. Biopsy of the lesion
was difficult because of the location.
Images for this section:
Page 4 of 9
Fig. 1: Meningioma of ophthalmic nerve (CT and MR imaging)
Page 5 of 9
Conclusion
The clinical literature has suggested that the association may not be based on metastatic
events but, rather, on common risk factors, like age and sex distribution. First, both
breast carcinoma and meningioma occur much more frequently in women than in
th
th
men (2:1). Second, both tumors occur more frequently as age increases (5 -6
decades). In addition, increased tumor growth has been observed during pregnancy for
both meningioma and breast carcinoma, suggesting hormone-induced stimulation. The
pregnancy and the menstrual cycle are sometime related to the rapid increase of both
tumors. In other respects, however, the hormonal characteristics of breast cancer and
meningioma are different. Meningiomas present large amounts of progesterone (PR)
receptors in the virtual absence of estrogen receptors and these tumors do not seem to
respond to hormonal treatments with tamoxifen or medroxyprogesterone acetate.
Recent efforts to determine shared genetic predisposition for these two types of neoplasm
have provided more information but have neither dismissed nor supported the reported
link between the two tumors. In particular, although the BRCA1 and BRCA2 genes have
been linked to familiar and sporadic forms of breast carcinoma, an analysis of BRCA1 and
BRCA2 genes in patients with sporadic meningiomas has suggested that alterations of
the BRCA1 and BRCA2 genes are not common pathogenetic events in the development
of meningioma.
It is possible that an association between breast carcinoma and meningioma may be
due to an overlap in the gene-environment interactions necessary for tumor genesis. For
both tumors, recent research has focused on loss of heterozygosity (LOH), or the loss
of one allele in a tumor cell from a chromosome region for which individual normal cells
are heterozygous: It is believed that LOH promotes tumor genesis through a process
whereby the expression of the disease occurs with the loss of the normal allele through
gene-environment interactions.
Particularly, two chromosomal regions 1p13-p12 and 22q11-q13, frequently exhibit
LOH in breast carcinoma, meningioma and other types of tumor. At least three tumor
suppressor inactivation genes have been identified on the long arm of chromosome
22. Observed associations between breast carcinoma and meningioma may be due
to the activation (or inactivation) of genes in these regions. However, the tumor
genesis pathways may diverge for breast carcinoma and meningioma, because on other
unrelated chromosomal regions have been proposed as critical events. For example, it
is hypothesized that the 14q24 to 14q32 regions is the critical regions responsible for
immortalizing cells, resulting in the most aggressive forms of meningioma, yet this region
has not been implicated in the development of breast carcinoma. There was no evidence
for PTEN mutations in families with breast cancer and brain tumors.
Page 6 of 9
The Knowledge of the association of these tumors is important in the
differential diagnosis of patient with breast cancers who develop central nervous
manifestations and in the close follow up of patients with meningioma for
subsequent development of breast cancer.
Images for this section:
Fig. 1: Deletion mapping of chromosome arm 22q. Allelic losses on chromosome arm 22q
are frequently observed in human meningiomas and in breast cancer.The common region
of deletion, outlined by a rectangle superimposed on the maps.Markers names appear
on the linkage maps at left.Filled circles:LOH. Open circles:Retained heterozygosity. No
circles:not informative.
Page 7 of 9
Personal Information
I. Georgiou
Breast Imaging Department, Anticancer Hospital of Athens, Athens, GREECE
M. Piperi, G. Ioannidou
Radiotherapy Department, Anticancer Hospital of Athens, Athens, GREECE
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