Abstract
Miliary metastasis to the central nervous system (CNS) is a rare presentation of metastasis mainly found in primary adenocarcinoma of the lung. Its association with breast cancer is even less frequent. We present the case of a 50-year-old female patient diagnosed in 2010 with stage IIA infiltrating ductal breast cancer RE (-), RP (+), HER 2 (-), HER2 NEU (+). She was treated with modified radical left breast mastectomy, radiation therapy, and chemotherapy. Her condition began presenting oppressive frontal headache without irradiation, predominantly in the evening, intensity 8/10, which decreased when sleeping and was exacerbated with stressful situations, in addition to progressive cognitive deterioration. Simple and contrasted computed tomography (CT) of the skull and thoracoabdominal were requested, showing multiple micronodular lesions with calcium density in the brain parenchyma, left pleural effusion, hypo and hyperdense lesions in the liver parenchyma, as well as osteoblastic lesions in the lumbar spine. Simple and contrasted magnetic resonance imaging (MRI) of the skull showed multiple supra and infratentorial intra-axial lesions. The most frequent associated symptom with miliary metastasis is cognitive impairment. Miliary metastasis, confirmed by imaging studies and histopathology, requires the ruling out of other causes of this calcification pattern, such as neurocysticercosis, due to specific treatment for each pathology.
Highlights
BackgroundMiliary metastasis was first described in 1951 as "carcinomatous encephalitis." It was described as multiple plaques formed from perivascular distribution [1]
Physiological, and pathological (tuberculosis, cysticercosis, TORCH (Toxoplasma gondii, others, rubella virus, cytomegalovirus (CMV), and herpes simplex virus (HSV)) disease, chronic viral encephalitis, Fahr's disease, thyroid or parathyroid disease) [4] calcifications could complicate the clinical diagnosis of miliary metastasis since they present with similar symptoms such as hemiparesis, dysarthria, short/long-term memory loss, seizures, language abnormalities, ataxia, dementia, psychosis, or headache [2,5]
The objective of this work is to describe a case of central nervous system miliary metastasis secondary to breast cancer, as well as a literature review on this topic
Summary
Miliary metastasis was first described in 1951 as "carcinomatous encephalitis." It was described as multiple plaques formed from perivascular distribution [1]. It is a rare presentation in breast cancer. The objective of this work is to describe a case of central nervous system miliary metastasis secondary to breast cancer, as well as a literature review on this topic. The patient showed alterations in mental state, with disorientation in time and space. A simple and contrasted CT scan of the skull was performed, showing multiple micronodular lesions in the entire cerebral parenchyma, both white and gray matter, without meningeal enhancement. The patient was treated with prophylactic anticonvulsants and antiedema steroids and was transferred to a tertiary center to receive holocranial radiotherapy
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