Difference between revisions of "Brain metastasis"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Metastatic_adenocarcinoma_-_cerebellum_-_high_mag.jpg
| Width      =
| Caption    = Metastatic adenocarcinoma, compatible with colorectal primary. [[H&E stain]].
| Synonyms  =
| Micro      = usu. well-demarcated border between brain and lesion, no cytoplasmic processes (seen in glial tumours), usu. have [[nuclear atypia]] of malignancy, +/-glandular architecture, +/-nucleoli seen
| Subtypes  =
| LMDDx      = primary brain tumour
| Stains    =
| IHC        = GFAP -ve, dependent on primary - typical +ve for keratins
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[brain]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      = intra-axial, typically cerebellum or grey-white junction
| Endoscopy  =
| Prognosis  = poor
| Other      =
| ClinDDx    = primary brain tumour, abscess
| Tx        = surgery, chemotherapy, radiation therapy
}}
'''Brain metastasis''', also '''metastatic brain tumour''', is a [[brain tumour]] that arose elsewhere and spread to the brain.  
'''Brain metastasis''', also '''metastatic brain tumour''', is a [[brain tumour]] that arose elsewhere and spread to the brain.  


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*Percentage of previously diagnosed cancers with brain metastases - by primary site: lung cancer 19.9%, melanoma 6.9%, breast cancer 5.1%, renal cancer 6.5%, colorectal cancer 1.8%.<ref name=pmid15254054>{{Cite journal  | last1 = Barnholtz-Sloan | first1 = JS. | last2 = Sloan | first2 = AE. | last3 = Davis | first3 = FG. | last4 = Vigneau | first4 = FD. | last5 = Lai | first5 = P. | last6 = Sawaya | first6 = RE. | title = Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. | journal = J Clin Oncol | volume = 22 | issue = 14 | pages = 2865-72 | month = Jul | year = 2004 | doi = 10.1200/JCO.2004.12.149 | PMID = 15254054 }}</ref>
*Percentage of previously diagnosed cancers with brain metastases - by primary site: lung cancer 19.9%, melanoma 6.9%, breast cancer 5.1%, renal cancer 6.5%, colorectal cancer 1.8%.<ref name=pmid15254054>{{Cite journal  | last1 = Barnholtz-Sloan | first1 = JS. | last2 = Sloan | first2 = AE. | last3 = Davis | first3 = FG. | last4 = Vigneau | first4 = FD. | last5 = Lai | first5 = P. | last6 = Sawaya | first6 = RE. | title = Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. | journal = J Clin Oncol | volume = 22 | issue = 14 | pages = 2865-72 | month = Jul | year = 2004 | doi = 10.1200/JCO.2004.12.149 | PMID = 15254054 }}</ref>
**''Lung'' followed by ''kidney'' is the order in a smaller series.<ref>{{Cite journal  | last1 = Schouten | first1 = LJ. | last2 = Rutten | first2 = J. | last3 = Huveneers | first3 = HA. | last4 = Twijnstra | first4 = A. | title = Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. | journal = Cancer | volume = 94 | issue = 10 | pages = 2698-705 | month = May | year = 2002 | doi =  | PMID = 12173339 }}</ref>
**''Lung'' followed by ''kidney'' is the order in a smaller series.<ref>{{Cite journal  | last1 = Schouten | first1 = LJ. | last2 = Rutten | first2 = J. | last3 = Huveneers | first3 = HA. | last4 = Twijnstra | first4 = A. | title = Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. | journal = Cancer | volume = 94 | issue = 10 | pages = 2698-705 | month = May | year = 2002 | doi =  | PMID = 12173339 }}</ref>
==Gross/Radiology==
*Intra-axial location.
**Typically at the grey-white junction.<ref name=pmid19727563>{{Cite journal  | last1 = Della Puppa | first1 = A. | last2 = Dal Pos | first2 = S. | last3 = Zovato | first3 = S. | last4 = Orvieto | first4 = E. | last5 = Ciccarino | first5 = P. | last6 = Manara | first6 = R. | last7 = Zustovich | first7 = F. | last8 = Berti | first8 = F. | last9 = Gardiman | first9 = MP. | title = Solitary intra-ventricular brain metastasis from a breast carcinoma. | journal = J Neurooncol | volume = 97 | issue = 1 | pages = 123-6 | month = Mar | year = 2010 | doi = 10.1007/s11060-009-9988-z | PMID = 19727563 }}</ref>


==Microscopic==
==Microscopic==

Revision as of 05:17, 29 October 2014

Brain metastasis
Diagnosis in short

Metastatic adenocarcinoma, compatible with colorectal primary. H&E stain.
LM usu. well-demarcated border between brain and lesion, no cytoplasmic processes (seen in glial tumours), usu. have nuclear atypia of malignancy, +/-glandular architecture, +/-nucleoli seen
LM DDx primary brain tumour
IHC GFAP -ve, dependent on primary - typical +ve for keratins
Site brain
Radiology intra-axial, typically cerebellum or grey-white junction
Prognosis poor
Clin. DDx primary brain tumour, abscess
Treatment surgery, chemotherapy, radiation therapy

Brain metastasis, also metastatic brain tumour, is a brain tumour that arose elsewhere and spread to the brain.

General

  • Most common brain tumour in adults.[1][2]
  • Common metastases (in order): lung, breast, kidney, gastrointestinal, melanoma.[3]
  • Percentage of previously diagnosed cancers with brain metastases - by primary site: lung cancer 19.9%, melanoma 6.9%, breast cancer 5.1%, renal cancer 6.5%, colorectal cancer 1.8%.[4]
    • Lung followed by kidney is the order in a smaller series.[5]

Gross/Radiology

  • Intra-axial location.
    • Typically at the grey-white junction.[6]

Microscopic

Appearance varies by subtype.

Features of metastatic carcinoma:

  • Tubule formation/glands.
  • Usually well-circumscribed/sharply demarcated from surrounding tissue.
  • Usually nuclear atypia including:
    • Nuclear hyperchromasia.
    • Variation of nuclear size.
    • Variation of nuclear shape.
  • Mitoses - common.

DDx:

Images

  • CRC metastasis to cerebellum - very low mag. (WC)

  • CRC metastasis to the cerebellum - intermed. mag. (WC)

  • CRC metastasis to cerebellum - high mag. (WC)

  • Brain metastasis - high mag. (WC)

IHC

Main article: Immunohistochemistry
  • Carcinoma: pankeratin +ve.
    • Lung adenocarcinoma and SCLC: TTF-1 +ve, CK7 +ve, CK20 -ve.
    • Breast carcinoma: CK7 +ve, ER +ve, PR +ve, BRST2 +ve/-ve.
    • Colorectal carcinoma: CK7 -ve, CK20 +ve, CDX2 +ve, TTF-1 -ve.
    • Clear cell renal cell carcinoma: PAX8 +ve, CK7 -ve, CK20 -ve, vimentin +ve, CD10 +ve.
  • Melanoma: S-100 +ve, HMB-45 +ve, Melan A +ve.

See also

References

  1. ↑ Pekmezci, M.; Perry, A. (2013). "Neuropathology of brain metastases.". Surg Neurol Int 4 (Suppl 4): S245-55. doi:10.4103/2152-7806.111302. PMID 23717796.
  2. ↑ Suki, D.; Khoury Abdulla, R.; Ding, M.; Khatua, S.; Sawaya, R. (Oct 2014). "Brain metastases in patients diagnosed with a solid primary cancer during childhood: experience from a single referral cancer center.". J Neurosurg Pediatr 14 (4): 372-85. doi:10.3171/2014.7.PEDS13318. PMID 25127097.
  3. ↑ Greenwald, J.; Heng, M. (2007). Toronto Notes for Medical Students 2007 (2007 ed.). The Toronto Notes Inc. for Medical Students Inc.. pp. NS9. ISBN 978-0968592878.
  4. ↑ Barnholtz-Sloan, JS.; Sloan, AE.; Davis, FG.; Vigneau, FD.; Lai, P.; Sawaya, RE. (Jul 2004). "Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System.". J Clin Oncol 22 (14): 2865-72. doi:10.1200/JCO.2004.12.149. PMID 15254054.
  5. ↑ Schouten, LJ.; Rutten, J.; Huveneers, HA.; Twijnstra, A. (May 2002). "Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma.". Cancer 94 (10): 2698-705. PMID 12173339.
  6. ↑ Della Puppa, A.; Dal Pos, S.; Zovato, S.; Orvieto, E.; Ciccarino, P.; Manara, R.; Zustovich, F.; Berti, F. et al. (Mar 2010). "Solitary intra-ventricular brain metastasis from a breast carcinoma.". J Neurooncol 97 (1): 123-6. doi:10.1007/s11060-009-9988-z. PMID 19727563.
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