A rare case of intracranial meningioma with intratumoral metastatic breast cancers

We report an uncommon case of breast cancer metastasis to an intracranial meningioma. A 47-year-old female was admitted to our hospital due to general convulsion. She had undergone a radical operation for left breast cancer 4 years refore, and received postoperative adjuvant therapies. MRI revealed a solid well-circumscribed tumor in the right frontal convexity. The patient underwent tumor resection successfully. The pathological examination revealed ductal carcinoma in the tissue of a transitional meningioma. Tumor-to tumor metastasis is a rare event. Literature review and discussion of such an uncommon occurrence was presented.     

Breast carcinoma metastasis to meningioma in the thoracic spine: A case report and review of the literature

Abstract

Context

Systemic metastasis to a primary tumor of the central nervous system is uncommon. Breast carcinomas metastasizing to a possibly preexisting meningioma in the spine are reported very rarely.

Study design

Case report.

Findings

A 69-year-old female was referred to us with progressive gait disturbance. She had undergone a total mastectomy for carcinoma of the right breast 11 years previously. A magnetic resonance imaging of the thoracic spine showed an intra- and extradural spinal cord tumor. The patient underwent resection of the tumor via laminectomy from T2 to T4. After the operation, the patient's neurological status improved significantly, and she was able to walk without assistance. Histological examination showed the tumor to be a fibrous-type meningioma within a metastatic breast cancer tumor. The patient underwent 40 Gy radiation treatment for local control of the tumor. However, the tumor recurred locally 7 months after the surgery. The patient died of carcinomatous pleurisy 13 months after the surgery.

Conclusion

This case illustrates that a primary meningioma in the thoracic spine can be a recipient of breast cancer metastasis, which may alter the treatment strategy.     

Breast carcinoma metastasis to meningioma in the thoracic spine: A case report and review of the literature

Context

Systemic metastasis to a primary tumor of the central nervous system is uncommon. Breast carcinomas metastasizing to a possibly preexisting meningioma in the spine are reported very rarely.

Study design

Case report.

Findings

A 69-year-old female was referred to us with progressive gait disturbance. She had undergone a total mastectomy for carcinoma of the right breast 11 years previously. A magnetic resonance imaging of the thoracic spine showed an intra- and extradural spinal cord tumor. The patient underwent resection of the tumor via laminectomy from T2 to T4. After the operation, the patient''s neurological status improved significantly, and she was able to walk without assistance. Histological examination showed the tumor to be a fibrous-type meningioma within a metastatic breast cancer tumor. The patient underwent 40 Gy radiation treatment for local control of the tumor. However, the tumor recurred locally 7 months after the surgery. The patient died of carcinomatous pleurisy 13 months after the surgery.

Conclusion

This case illustrates that a primary meningioma in the thoracic spine can be a recipient of breast cancer metastasis, which may alter the treatment strategy.     

Choroid plexus metastasis of renal cell carcinoma causing intraventricular hemorrhage: a case report]

We report a rare case of choroid plexus metastasis of renal cell carcinoma causing intraventricular hemorrhage. A 75-year-old female was admitted to our hospital for SAH. Preoperative examination evoked suspicion of an anterior communicating aneurysm as a cause of SAH. Furthermore, there were lesions on the tuberculum sellae and in the left trigone of the lateral ventricle, which were enhanced by Gd-DTPA on MRI. The patient was operated on via the pterional approach on December 3, 1996, but no aneurysm was found. She underwent total removal of the tuberculum sellae mass, which was postoperatively proved to be a meningioma by histological examination. The intraventricular tumor was supposed to be a meningioma, but it was not treated surgically. Two months later, the patient presented hematuria and was diagnosed as having a right renal cancer and underwent right nephrectomy on March 18, 1997. However, postoperatively, disturbance of consciousness continued. A CT scan revealed intraventricular hemorrhage around the tumor in the trigone of the lateral ventricle on March 21. An emergency operation for tumor and clot removal succeeded in improving the patient's condition. Histological examination of the tumor revealed clear-cell type renal cell carcinoma. Solitary choroidal plexus metastasis from renal cell carcinoma is quite rare: only 5 cases have been reported. But only our case was accompanied by intraventricular hemorrhage. Renal cell carcinomas are divided into two types: a slowly progressive type and a rapidly progressive type. Four cases among the reported 5 cases were the slowly progressive type, and our case was regarded as being of the same type.     

Thyroid metastases]

STUDY AIM: The aim of this retrospective study was to report a short series of thyroid metastases and to emphasize their unusual occurrence and their poor prognosis. PATIENTS AND METHOD: From January 1990 to December 1999, among 619 patients operated for a thyroid malignancy, 14 patients had a thyroid metastasis (2.2%). Mean age of the patients was 66 years (range: 35-81). The thyroid metastasis revealed the primitive tumor (n = 8) or occurred in the follow-up of a cancer already treated (n = 6). The primitive tumor was renal (n = 3), breast (n = 3), lung carcinoma (n = 4) and melanoma (n = 1). In the 3 other patients, the primitive tumor was not detected. The thyroid metastasis was apparently isolated in 13 patients. The surgical procedure was a total (n = 3) or partial (n = 7) thyroidectomy and a cervicotomy with biopsy (n = 4). RESULTS: Eleven patients died less than one year after the diagnosis of the metastasis. One patient survived 1 year, another 2 years. One patient only was alive 22 years after the diagnosis of his renal tumor and 10 years after total thyroidectomy. CONCLUSION: Thyroid metastases are clinically very rare and much more frequent at post-mortem examination. They may reveal the primitive cancer but are often detected during the follow-up after treatment of the primitive tumor. When thyroid metastasis is isolated, a total thyroidectomy is justified especially in renal carcinoma, as long-term survivals have been reported.     

Dural metastasis mimicking falx meningioma. Case report

A case of a 66-year-old woman with anterior-3(rd) falx metastasis from mammary carcinoma is reported. Radiological and therapeutic aspects are reported. The clinical presentation was headache and confusion together with gait disturbance. MRI showed a frontobasal mass with dural attachment suggestive of meningioma. Surgical resection was decided. Histology confirmed the diagnosis of breast cancer dural metastasis. Dural metastases are not frequent. Two radiological aspects are described: subdural hemorrhage and dural mass. No definitive theory exists about etiopathogenesis. As radiological findings are not specific, we emphasize the importance of suspecting dural metastasis in patients with tumor mass involving dura mater.     

Diaphragma sellae metastasis from colon carcinoma mimicking a meningioma. A case report.

We describe a rare case of metastatic intra-suprasellar adenocarcinoma from colonic cancer mimicking a meningioma of the "diaphragma sellae". Autopsy studies indicate breast and lung carcinoma to be the most frequent primary tumor metastasizing this site, particularly in patients with systemic spread. While diabetes insipidus is reported to be one of the commonest symptoms in these cases, the only clinical manifestation of the tumor in our patient was a bitemporal hemianopia, while the primary tumor remained asymptomatic. In the available literature are reported only two pituitary metastasis from operated colon carcinoma. In both cases the diagnosis of the colon cancer preceded the pituitary operation. The clinico-pathological and neuroradiological aspects of this unusual lesion are analyzed in the light of the relevant literature on the topic focusing on recent MRI acquisitions.     

Drop metastasis from sinonasal undifferentiated carcinoma: clinical implications.

STUDY DESIGN: The first reported case of multiple intradural, extramedullary spinal metastasis from sinonasal undifferentiated carcinoma is presented. OBJECTIVES: To elucidate the mechanisms by which metastatic disease invades the spinal axis, and to discuss the possibility of spinal drop metastasis from head and neck tumors that invade the dura. SUMMARY OF BACKGROUND DATA: Sinonasal undifferentiated carcinoma is a rare yet aggressive neoplasm of the upper airways and anterior skull base. This neoplasm is known to invade the cranial vault and brain locally. However, it has not previously been reported to seed the cerebrospinal fluid or result in drop metastasis. Such drop metastasis may result in significant neurologic deficit if not diagnosed and treated in a timely manner. METHODS: This report is based on a single patient treated by a multidisciplinary team from the departments of neurosurgery, otolaryngology, and radiation oncology at the University of Southern California School of Medicine. RESULTS: This patient initially underwent resection and local radiation therapy for sinonasal undifferentiated carcinoma of the anterior skull base. At the time of surgery, the tumor was noted to violate the dura and arachnoid along the subfrontal plane. At 11/2 years after the initial treatment, a bandlike distribution developed at T2 as well as paresthesias and numbness below that level. Imaging of the spine showed an intradural, extramedullary tumor at T2 consistent with a schwannoma or meningioma. The patient underwent a laminectomy and tumor resection, which showed poorly differentiated sinonasal carcinoma. Local radiation therapy was administered, and the patient experienced complete recovery of neurologic function. Bilateral leg pain and weakness developed 14 months later. Magnetic resonance imaging of the spine showed a new intradural, extramedullary lesion at T12, remote from the first lesion. This second metastasis was managed with surgical resection and adjuvant radiation therapy. CONCLUSIONS: This is the first reported case of a sinonasal carcinoma leading to intradural extramedullary metastasis. The primary tumor likely seeded the cerebrospinal fluid, thus resulting in drop metastasis. Patients with sinonasal undifferentiated carcinoma that invades the dura should be monitored closely for evidence of metastasis before symptoms develop.     

Coexistence of intracranial meningioma, pulmonary meningiomas, and lung cancer

Pulmonary metastases from a benign meningioma are rare occurrence, and the possible coexistence with other malignancies may be neglected in clinical practice. We report a patient with presumed stage IV lung cancer and a parietal meningioma. The patient underwent meningioma resection and a salvage operation for lung cancer. Palliative chemotherapy resulted in a partial response of the main tumor. Pathologic examination confirmed the rare coexistence of pulmonary squamous cell carcinoma and benign metastatic meningiomas. Although distant metastases from meningiomas are infrequent clinically, the possibility of pulmonary involvement should not be ignored in patients with aberrant responses of separate lesions after chemotherapy.     

Metastasis of breast carcinoma to intracranial meningioma. Case report

A case of metastasis from breast carcinoma found within a cerebral meningioma is reported. Histological diagnosis of the cerebral tumor prompted radiological investigation that visualized the asymptomatic malignant systemic tumor and excluded other metastases elsewhere. The pathogenetic aspects of this exceptional occurence are discussed in the light of the relevant literature.     

Treatment of nonseminomatous testicular tumor with liver metastases

Therapeutic course of 2 cases of nonseminomatous testicular tumor with liver metastasis is reported. One case had mixed tumors including embryonal carcinoma, choriocarcinoma and yolk sac carcinoma, and was positive pulmonary metastasis already at the initial examination. In the other case having mixed tumors of embryonal carcinoma and choriocarcinoma, metastasis to the supraclavicular lymph node was detected at the initial examination. In both cases liver metastasis occurred after complete response could be obtained by treatment chiefly consisting of PVB therapy. For liver metastasis four-drug combination treatment using cisplatin, vinblastine, adriamycin and actinomycin D was performed with partial response. However, this patient eventually died. The other case received VAB-6 therapy with complete response for liver metastasis. It is advisable to consider other modalities therapy in addition to conventional chemotherapy in cases of testicular tumor with liver metastasis since the prognosis is poor in these cases.     

A case of serous surface papillary carcinoma of the peritoneum metastatic to the brain

A case of brain metastasis from peritoneal serous surface papillary carcinoma (SSPC) was reported. This 68-year-old woman was admitted to our department because of decreased consciousness level for the last few days. Her medical past history revealed breast cancer and SSPC of the peritoneum at the age of 64. On admission she was comatose and irritable. Serum and urine examination revealed the syndrome of inappropriate secretion of antidiuretic hormone that was treated with strict restriction of water intake. MRI of the brain demonstrated a nonspecific mass in the subcortical area of the right superior parietal lobule. The mass was successfully removed in en bloc fashion. Pathological diagnosis was SSPC that was compatible with the previous diagnosis obtained from the peritoneum four years previously. Although the patient received whole brain radiation therapy postoperatively, her condition deteriorated rapidly. She died four months after brain surgery. SSPC of the peritoneum is a rare malignant tumor that is defined as a primary tumor histologically indistinguishable from serous carcinoma of the ovary, diffusely involving the peritoneal surface but sparing or only superficially invading the ovaries. Because of the prolongation of survival resulting from advanced chemotherapy for SSPC of the peritoneum, more patients live long enough to develop brain metastasis. Therefore, SSPC of the peritoneum should be kept in mind in the differential diagnosis of a primary site for brain metastasis.     

Metastatic Breast Carcinoma Presenting as Perforated Appendicitis

SUMMARY: BACKGROUND: Patients presenting with symptoms from unknown metastatic breast carcinoma are becoming increasingly uncommon. Perforated appendicitis from metastatic breast carcinoma is a rare entity with only a few published reports in the literature. CASE REPORT: The case of a 76-year-old female patient who developed perforated appendicitis from previously unknown metastatic breast cancer is presented. During physical examination in the emergency department, a large left breast mass was palpated. The patient underwent an appendectomy and had no gross evidence of disease elsewhere in the intra-peritoneal cavity. Subsequent pathologic examination of the appendix revealed a lobular carcinoma. CONCLUSIONS: The factors that influence the site of metastasis from breast cancer include estrogen receptor status and the subtype of carcinoma - ductal versus lobular.     

Intrameningioma metastasis as first clinical manifestation of occult primary breast carcinoma

Metastasis from extracranial tumor into an intracranial primary tumor is an uncommon event. A predominant tendency of meningioma to be the host tumor for breast carcinoma has been found. In the current report, three cases of breast carcinoma metastatic to intracranial meningiomas are described. In our cases, metastasis in meningioma was the first clinical manifestation of the occult primitive breast carcinoma. We review widely the literature concerning such rare occurrences and discuss all the postulated pathogenetic mechanisms. There are few cases reported in the literature on resonance magnetic imaging of metastatic carcinoma in meningioma. Two of our patients have been studied by MRI, but we do not find predictive radiological finding of this particular association.     

Peritumoral hemorrhage immediately after radiosurgery for metastatic brain tumor

We report a case of a 44-year-old woman with metastatic brain tumors who suffered peri-tumoral hemorrhage soon after stereotactic radiosurgery (SRS). She had been suffering from breast cancer with multiple systemic metastasis. She started to have headache, nausea, dizziness and speech disturbance 1 month before admission. There was no bleeding tendency in the hematological examination and the patient was normotensive. Neurological examination disclosed headache and slightly aphasia. Magnetic resonance imaging showed a large round mass lesion in the left temporal lobe. It was a well-demarcated, highly enhanced mass, 45 mm in diameter. SRS was performed on four lesions in a single session (Main mass: maximum dose was 30 Gy in the center and 20 Gy in the margin of the tumor. Others: maximum 25 Gy margin 20 Gy). After radiosurgery, she had severe headache, nausea and vomiting and showed progression of aphasia. CT scan revealed a peritumoral hemorrhage. Conservative therapy was undertaken and the patient's symptoms improved. After 7 days, she was discharged, able to walk. The patient died of extensive distant metastasis 5 months after SRS. Acute transient swelling following conventional radiotherapy is a well-documented phenomenon. However, the present case indicates that such an occurrence is also possible in SRS. We have hypothesized that acute reactions such as brain swelling occur due to breakdown of the fragile vessels of the tumor or surrounding tissue.     

A case of metastatic tumor of the pituitary gland presenting as a subarachnoid hemorrhage

We reported the case of a 55-year-old man with metastatic tumor of the pituitary gland who suffered from symptomatic pituitary apoplexy with subarachnoid hemorrhage. The patient, who had sigmoid colon carcinoma and left parietal metastatic brain tumor, developed severe headache and decrease of right visual acuity. CT showed a pituitary mass with subarachnoid hemorrhage. Transsphenoidal surgery was performed after replacement therapy with corticosteroids. Histological examination revealed metastasis of adenocarcinoma. Pituitary apoplexy is an unusual manifestation of metastatic pituitary tumor. The case of metastatic tumor of the pituitary gland presenting as subarachnoid hemorrhage such as this case is especial rare.     

Solitary cranial metastasis of thyroid carcinoma 13 years after primary surgery: Report of a case

Thyroid cancers rarely metastasize to the brain: the incidence of brain metastasis of differential thyroid carcinomas has been reported at only 0.69%–1.3%. We report a case of a solitary brain metastasis from thyroid follicular carcinoma found 13 years after primary surgery. A 73-year-old woman was admitted to our hospital for investigation of headaches, double vision, and facial nerve palsy, 13 years after a subtotal thyroidectomy for thyroid follicular carcinoma. Magnetic resonance imaging (MRI) showed a solitary mass in the midbrain associated with a focal osteolytic lesion of the temporal bone. Further radiological examinations revealed no other mass lesion. After making a provisional preoperative diagnosis of a primary brain tumor, we performed subtotal removal of the tumor. Histopathological examination confirmed metastasis of thyroid follicular carcinoma. Thus, the patient underwent completion thyroidectomy followed by internal radiotherapy. She has remained well in the 4 years since her operation, without any signs of further recurrence.     

Axillary nodal metastasis of occult breast primary cancer

Occult breast cancer presenting with axillary metastases is an unusual presentation and can be a diagnostic and therapeutic challenge. A comprehensive work-up, including mammogram, sonogram, magnetic resonance imaging, and even pathologic examination of the mastectomy specimen may not disclose the primary tumor in up to one third of patients. We report a case of a 42-year-old female with occult breast cancer presenting axillary nodal metastasis. She complained of a swelling of the right axillary lymph node, but no breast mass was palpable. Biopsy of the lymph node was performed and histological examination showed a metastatic carcinoma. Estrogen receptor of the lymph node was positive. Calcifications were obtained by mammography and ultrasonography of the right axillary node contained metastasis. All these data suggested an occult carcinoma of the breast and modified radical mastectomy was performed. Pathological findings of the removed specimen failed to find the primary breast cancer lesion. Our case is one more example of this rare occurrence. We assume that the primary carcinoma is so small as to escape detection by histology. It is doubtful if mammography can help to localize these elusive lesions. More refined high resolution methods, are needed to solve this oncologic problem.     

Pure and primary squamous cell carcinoma of the breast

A case of a pure squamous cell carcinoma (SCC) of the breast is a 75 y.o. white female is reported. The cancer was discovered at the clinical exam requested by the patient for a growing mass in the left breast. Mammogram and an ultrasound exam showed a big cystic mass (4 cm x 4 cm) with a liquid content and a small polypoid mass of 0.5 cm x 0.5 cm arising from the inner surface of the cyst. A fine needle aspiration was done and the cytological report was consistent with squamous cell carcinoma. A left modified radical mastectomy was carried out. The skin was not involved and the lymph nodes were negative, and no other cutaneous tumor elsewhere was found. The stage was II (T 2a N o M o). The patient did well and was discharged 10 days post-op and now she is still doing well with no signs of recurrences or metastasis. This cancer should not be confused with a much more largely manifest metaplastic changes in a usual breast cancers. The criteria to define "pure" a squamous cell Ca of the breast are: 1) that no other neoplastic element such as ductal or mesenchymal ones are present in the tumor; 2) that the tumor is independent of adjacent cutaneous structure; 3) that no other distant epidermoid tumor exists in the patient. The origin of this tumor is controversial; it has been stated as arising from dermatoid cyst of the breast, chronic abscesses, complete metaplasia of glandular breast tissue. Despite the rarity of this neoplasia it should be kept in mind that in a cystic mass of the breast in older patient could arise a squamous cell carcinoma.     

Metastasis of breast carcinoma to intracranial meningioma

A patient who had been treated for bilateral breast carcinoma subsequently developed a metastatic breast lesion in a meningioma. Although it is not uncommon for more than one tumor to occur in the same patient, metastases from one tumor into another tumor are rare ('tumor to tumor' phenomenon). Meningiomas are the most common primary, intracranial tumors to harbor metastases, the majority of which arise from breast and lung carcinomas. Patients with a history of breast cancer and a solitary, intracranial mass with radiological features consistent of meningioma should be evaluated surgically. The lesion may be a primary cerebral malignancy, a metastatic lesion, or a meningioma with or without a metastatic lesion.