Abstract
Purpose. To check whether primary involvement of brain/spinal cord by bone/soft tissue sarcomas' metastases in children is as rare as described and to present various morphological forms of bone/soft tissue sarcomas' CNS metastases. Methods. Patients with first diagnosis in 1999–2014 treated at single center were included with whole course of disease evaluation. Brain/spinal canal magnetic resonance imaging (MRI)/computed tomography were performed in cases suspicious for CNS metastases. Extension from skull/vertebral column metastases was excluded. Results. 550 patients were included. MRI revealed CNS metastases in 19 patients (incidence 3.45%), 14 boys, aged 5–22 years. There were 12/250 osteosarcoma cases, 2/200 Ewing's sarcoma, 1/50 chondrosarcoma, 3/49 rhabdomyosarcoma (RMS), and 1/1 malignant mesenchymoma. There were 10 single metastases and 7 cases of multiple ones; in 2 RMS cases only leptomeningeal spread in brain and spinal cord was found. Calcified metastases were found in 3 patients and hemorrhagic in 4. In one RMS patient there were numerous solid, cystic, hemorrhagic lesions and leptomeningeal spread. Conclusions. CNS metastases are rare and late in children with bone/soft tissue sarcomas, although in our material more frequent (3.45%) than in other reports (0.7%). Hematogenous spread to brain and hemorrhagic and calcified lesions dominated in osteosarcoma. Ewing sarcoma tended to metastasize to skull bones. Soft tissue sarcomas presented various morphological forms.
Highlights
3% of brain metastases are caused by sarcomas and 1–8% of sarcoma patients are estimated to develop brain metastases [1, 2]
These statistics illustrate well the rarity of brain metastases from bone and soft tissue neoplasms in pediatric population. This is an advantageous circumstance as these metastatic lesions carry poor prognosis; the overall mean survival is estimated at 7–16 months, with the majority surviving less than 12 months (e.g., Ewing’s sarcoma) and a minority surviving more than 12 months (e.g., osteosarcoma, chondrosarcoma, and rhabdomyosarcoma (RMS)) [4]
Out of 200 Ewing sarcoma patients brain metastases were found in 2 (1.0%). We found these metastases in one out of 50 chondrosarcoma patients (2.0%), in 3 patients with RMS, and in one patient with MM (4 out of 50 soft tissue sarcoma (STS) patients = 8.0%)
Summary
3% of brain metastases are caused by sarcomas and 1–8% of sarcoma patients are estimated to develop brain metastases [1, 2]. In a big cohort of children with CNS tumors analyzed by Wiens and Hattab, among 1135 patients, there were only 26 with solid nonhematopoietic CNS metastases which account for 2.3% and among those bone and soft tissue tumors constituted not the first but the second most common cause of CNS metastases after kidneys and adrenal glands tumors [3]. These statistics illustrate well the rarity of brain metastases from bone and soft tissue neoplasms in pediatric population. Many publications are based on the assumption that there are two mechanisms of sarcoma spread to the brain: hematogenous dissemination
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