Use of a long-acting GnRH agonist for benign cystic mesothelioma.
BACKGROUND
Benign cystic mesothelioma, a tumor characteristically found in women during the reproductive years, is rare after bilateral oophorectomy or menopause, suggesting hormonal sensitivity.


METHODS
We treated a 17-year-old woman with a rapidly increasing and symptomatic benign cystic mesothelioma with a long-acting GnRH agonist. A rapid and continued reduction in volume corresponded to the induction and maintenance of a hypoestrogenic state over a 6-month period. However, the subsequent addition of a combination of estrogen and progestin (known as add-back therapy) resulted in a gradual increase in cyst volume, which progressed after discontinuation of all therapy. Resumption of GnRH-analog therapy alone reduced cyst volume again, and the patient underwent surgical removal.


CONCLUSIONS
Long-acting GnRH agonists may have a role in the conservative management of these rare neoplasms. The reduction in volume concomitant with a hypoestrogenic state and regrowth with addition of add-back therapy further suggest extreme sensitivity of this tumor to one or both hormones.
Letterie
G S
GS
Department of Obstetrics and Gynecology, Virginia Mason Medical Center, Seattle, Washington, USA.
Yon
J L
JL
D000293:Adolescent; D003692:Delayed-Action Preparations; D015914:Estrogen Replacement Therapy; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage* / Q000031:analogs & derivatives; D006801:Humans; D018261:Mesothelioma, Cystic / Q000188:drug therapy* / Q000601:surgery; D010386:Pelvic Neoplasms / Q000188:drug therapy* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000601:surgery; D011372:Progestins / Q000627:therapeutic use
D003692:Delayed-Action Preparations; D011372:Progestins; D007987:Gonadotropin-Releasing Hormone