Background: The progesterone receptor (PR) is variably expressed in most meningiomas and was found to have prognostic significance. However, the correlation with patient age, tumor location, time to recurrence, and pattern of regrowth has scarcely been discussed.Methods: A surgical series of 300 patients with meningiomas is reviewed. The PR expression was classified as: 0. absent; 1. low (<15%); 2. moderately low (16–50%); 3. moderately high (51–79%); 4. high (≥80%). The PR values were correlated with the patient age and sex, meningioma location, WHO grade, Ki-67 MIB1, recurrence rate, pattern of recurrence (local-peripheral versus multicentric diffuse), and time to recurrence.Results: The PR expression has shown lower rate of high expression in the elderly group (p = 0.032) and no sex difference (including premenopausal versus postmenopausal women), higher expression in medial skull base and spinal versus other locations (p = 0.0036), inverse correlation with WHO grade and Ki67-MIB1 (p < 0.0001). Meningiomas which recurred showed at initial surgery higher rates of low or moderately low PR expression than the non-recurrent ones (p = 0.0004), whereas the pattern of regrowth was not significant. Higher rates of PR values ≥80% were found in cases with time to recurrence >5 years (p = 0.036).Conclusion: The higher PR expression in medial skull base meningiomas, the significant correlation with the time to recurrence, the lack of difference of PR expression between premenopausal and postmenopausal women and between local-peripheral versus multicentric-diffuse recurrences are the most relevant unreported findings of this study. The rate of PR expression must be included in the routine pathological diagnosis of meningiomas because of its prognostic significance.

Fifteen patients with simultaneous presentation of meningiomas with other intracranial tumours are reviewed. The associated tumours included a brain metastasis in six cases, glioma in three, pituitary adenoma in two, craniopharyngioma in one,acoustic schwannoma in two and brain lymphoma in one. A correct preoperative radiological diagnosis was made in 12 patients; in three others the associated tumour was discovered at operation and by histological studies. A one-stage removal of both tumours through the same approach was performed in nine patients, whereas six others underwent two-stage operations with an interval of 1 - 13 months. The literature relating to meningiomas associated with other intracranial tumours is reviewed and the possible pathogenetic correlations are discussed. A diagnostic pitfall may occur for metastasis into a meningioma, glioma surrounding a meningioma and different suprasellar lesions. The surgical indication and management of meningiomas may be significantly influenced by the presence of another different intracranial tumour.