losartan-potassium and Meningioma

Topics: Brain Neoplasms; Diagnosis, Differential; Erythropoietin; Female; Glioma; Hemangiosarcoma; Humans; Immunohistochemistry; Lectins; Male; Meningioma; Plant Lectins; Receptors, Cell Surface; Receptors, Thrombin; von Willebrand Factor

Human erythropoietin in concert with intraoperative hemodilution, tumor embolization, and surgical staging was used to manage a red blood cell mass in an anemic Jehovah's Witness patient with a hypervascular meningioma. Erythropoietin (3000 U thrice weekly) and oral iron (1300 mg daily) were given for 1 month prior to surgery, raising the hemoglobin level from 11.8 to 14.1 gm/100 ml. A posterior fossa craniectomy combined with a temporal craniectomy was then performed so that partial petrosectomy, section of the transverse sinus, incision of the tentorium, and exposure of the lesion could be carried out. The first stage of the surgery was terminated immediately prior to tumor mobilization. Isovolemic hemodilution was initiated just before the skin incision. Postoperatively, the hemoglobin concentration dropped to 11.5 gm/100 ml. The erythropoietin dose was doubled and administration of oral iron continued, leading to a hemoglobin level of 14.0 gm/100 ml at 1 month after the first operation. The tumor was embolized using superselective catheterization. The next day, at the second stage of the surgery, the tumor was extirpated, again employing isovolemic hemodilution. By the 4th postoperative day, the hemoglobin level had dropped to 9.4 gm/100 ml. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case. Since erythropoietin has the potential to augment all other forms of autologous banking, its role in elective neurosurgery may become increasingly important in an era of heightened concern about heterologous transfusion.

Topics: Blood Transfusion, Autologous; Christianity; Cranial Fossa, Posterior; Craniotomy; Embolization, Therapeutic; Epilepsy; Erythropoietin; Female; Hemodilution; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Middle Aged

While secondary erythrocytosis is often associated with tumors arising from the kidney, other tumors have been described to originate in the liver, uterus, ovary, adrenal gland, and central nervous system, among which cerebellar hemangioblastomas are involved in most instances. Two cases of meningioma associated with erythrocytosis have already been reported. We observed a 59-year-old female patient who had developed a frontal meningioma associated with erythrocytosis. Before surgery, she had a significantly elevated total red blood cell volume with a normal plasma volume. Serum erythropoietin (Epo) dosage assessed by radioimmunoassay was within the normal range. The tumor was removed and the pathologic study found a meningotheliomatous meningioma. Total RNA from the tumor was hybridized to a monkey cDNA Epo probe. A strong 1.6-kb messenger RNA (mRNA) signal was observed, which is the expected size of human Epo mRNA. In situ hybridization with the 35S-labeled Epo probe was performed on frozen tumor tissue sections. A significant hybridization was observed in all the tumor cells, whereas the stroma was negative. Therefore, in this meningioma associated with erythrocytosis, Epo was produced by the tumor cells themselves.

Topics: Erythropoietin; Female; Humans; Immunohistochemistry; In Situ Hybridization; Meningeal Neoplasms; Meningioma; Middle Aged; Polycythemia; RNA, Messenger

A meningioma was discovered in a 66 year old man with non-progressive alcoholic cirrhosis and abstinence for the 5 previous years. The development of polycythemia ten months later was related to an inappropriate secretion of erythropoietin. Conventional causes for this phenomenon could not be found. Erythropoietin assays in erythroblast cultures from both the patient's blood and post-mortem, from tumor fragments demonstrated a significant elevation of erythropoietic activity. The diagnosis of polycythemia secondary to meningioma is suggested. Only one similar case has apparently been reported.

Topics: Aged; Cerebellum; Erythropoietin; Humans; Male; Meningeal Neoplasms; Meningioma; Paraneoplastic Endocrine Syndromes; Polycythemia

Topics: Adenoma; Adult; Erythropoietin; Female; Humans; Kidney Neoplasms; Leiomyoma; Male; Meningioma; Middle Aged; Neoplasms; Polycythemia; Stomach Neoplasms; Uterine Neoplasms