Involución espontánea de meningioma. Caso clínico y revisión de la literatura / Spontaneus involution of meningioma. Case report and literature review

Los meningiomas son tumores de las meninges cerebrales, de crecimiento lento y generalmente benignos, cuyo tratamiento es esencialmente quirúrgico. Presentan receptores de progesterona, y en menor medida de estrógeno, lo que les hace a veces tener crecimiento o disminución ligada a tratamiento hormonal. Es extremadamente raro que presenten involución espontánea. Presentamos el caso de un varón con un meningioma del planum esfenoidal. Como antecedentes tenía diabetes mellitus, miastenia gravis y un cáncer de próstata. Como tratamiento médico recibía, entre otros, análogos de la gonadotropina (leuprorelina), antiandrogénico (bicalutamida), agonistas β3 y bloqueantes α1. A los 15 meses del bloqueo hormonal se objetivó una reducción del tumor del 90% de su volumen. Los casos publicados previamente muestran que el tratamiento con análogos de la GnRH produce un crecimiento en algunos meningiomas. Existen otros casos publicados sobre reducción en pacientes diabéticos y en tratamiento con bloqueantes α1. Se revisa la literatura sobre meningiomas con involución espontánea (AU)

Meningiomas are tumors of the cerebral meninges, with slow growth and usually benign, whose treatment is essentially surgery. They have progesterone receptors, and to a lesser extent estrogen, which sometimes causes them to have growth or involution linked to hormonal treatment. Its spontaneous involution is extremely rare. We present the case of a male with a meningioma of the sphenoid planum. He had a history of diabetes mellitus, myasthenia gravis and prostate cancer. He was in treatment with analogs of GnRH (leuprorelin), antiandrogen (bicalutamide), β3 agonists and α1 blockers. 15 months after the hormonal blockade, a reduction of the tumor of approximately 90% of its volume was detected. Previous reports show that treatment with gonadotropin analogues produces growth in some meningiomas. Other reports of spontaneous involution affect diabetic patients and patients in treatment with α1 blockers. Literature focus on meningiomas with spontaneous involution is reviewed (AU)

Spontaneus involution of meningioma. Case report and literature review. / Involución espontánea de meningioma. Caso clínico y revisión de la literatura.

Meningiomas are tumors of the cerebral meninges, with slow growth and usually benign, whose treatment is essentially surgery. They have progesterone receptors, and to a lesser extent estrogen, which sometimes causes them to have growth or involution linked to hormonal treatment. Its spontaneous involution is extremely rare. We present the case of a male with a meningioma of the sphenoid planum. He had a history of diabetes mellitus, myasthenia gravis and prostate cancer. He was in treatment with analogs of GnRH (leuprorelin), antiandrogen (bicalutamide), ß3 agonists and α1 blockers. 15 months after the hormonal blockade, a reduction of the tumor of approximately 90% of its volume was detected. Previous reports show that treatment with gonadotropin analogues produces growth in some meningiomas. Other reports of spontaneous involution affect diabetic patients and patients in treatment with α1 blockers. Literature focus on meningiomas with spontaneous involution is reviewed.

Bmp2 antagonizes sonic hedgehog-mediated proliferation of cerebellar granule neurones through Smad5 signalling.

During development of the cerebellum, sonic hedgehog (Shh) is directly responsible for the proliferation of granule cell precursors in the external germinal layer. We have looked for signals able to regulate a switch from the Shh-mediated proliferative response to one that directs differentiation of granule neurones. Bone morphogenetic proteins (BMPs) are expressed in distinct neuronal populations within the developing cerebellar cortex. Bmp2 and Bmp4 are expressed in the proliferating precursors and subsequently in differentiated granule neurones of the internal granular layer, whereas Bmp7 is expressed by Purkinje neurones. In primary cultures, Bmp2 and Bmp4, but not Bmp7, are able to prevent Shh-induced proliferation, thereby allowing granule neuron differentiation. Furthermore, Bmp2 treatment downregulates components of the Shh pathway in proliferating granule cell precursors. Smad proteins, the only known BMP receptor substrates capable of transducing the signal, are also differentially expressed in the developing cerebellum: Smad1 in the external germinal layer and Smad5 in newly differentiated granule neurones. Among them, only Smad5 is phosphorylated in vivo and in primary cultures treated with Bmp2, and overexpression of Smad5 is sufficient to induce granule cell differentiation in the presence of Shh. We propose a model in which Bmp2-mediated Smad5 signalling suppresses the proliferative response to Shh by downregulation of the pathway, and allows granule cell precursor to enter their differentiation programme.