Skull Metastasis Research Articles

Laryngotracheal invasion by well‐differentiated thyroid cancer: Diagnosis and management

Ten cases of laryngotracheal invasion by well-differentiated thyroid cancer are described. All the patients were over 40 years of age, with a male preponderance of 4:1. A mass in the neck, stridor, and hemoptysis was the common symptom. Bronchoscopy done in six of ten patients revealed an intraluminal tumour in all. Radiographs of the neck showed invasion of the trachea in six patients. Surgery consisted of tracheostomy alone (three of ten), total thyroidectomy with laryngectomy (one of ten), circumferential resection of trachea (one of ten), and total thyroidectomy with tracheotomy and "shaving" of the intraluminal disease in five of ten patients. Adjuvant external radiation, radioiodine, or laser therapy was given when indicated. Of the ten patients, three died and seven survived. Five of seven were alive without disease for 2.5 years or more, and one had skull metastasis 2 years later but no local disease.

Brain and Skull Metastases of Hepatic or Pancreatic Cancer

Brain and skull metastases from primary hepatic or pancreatic cancer are very rare. The authors describe six cases of metastatic tumors. These are skull (three cases) and brain (one) metastasis of hepatic cancer and brain metastasis (two) of pancreatic cancer. In three hepatic cancer patients, the metastatic lesions were diagnosed before the diagnosis of primary cancer. In these patients, plain skull x-ray showed osteolytic lesions and vascular enlargement. A postcontrast computed tomographic (CT) scan showed an enhanced high-density epidural mass. Angiograms showed a tumor stain fed by abnormal vessels from the external carotid artery. In one patient with a metastatic brain tumor from hepatic cancer, a CT scan showed a high-density mass with hematoma. In one of the brain metastases from pancreatic cancer, a CT scan revealed a cystic, ring-like enhanced lesion in the thalamus. In the other case, a CT scan showed an isodensity mass in the vermis and hydrocephalus. Metastatic tumors from primary hepatic cancer were soft and hemorrhagic, but they were clearly demarcated from the surrounding tissue. In the case of thalamic metastasis, the cyst content was aspirated and an anticancer agent was administered into the cystic cavity. In the other cases, the tumors were totally removed. The outcome was very poor in all cases.

Metastatic Malignant Lymphoma of the Skull with Extradural and Extracranial Extension

A 72-year-old male was hospitalized because of a steadily growing mass (4 x 4 x 2 cm) in the frontal region, noticed following head injury. Six months earlier, he had declined treatment for malignant lymphoma (small non-cleaved cell type), discovered upon evaluation of a subcutaneous mass in his forearm. Neurological examination on admission was negative. Plain skull films revealed a large, osteolytic lesion with an irregular margin. Bone scintigraphy disclosed no uptake other than in the frontal bone. Computed tomography (CT) showed a large, homogeneously enhanced mass with both extradural and extracranial extension, which had destroyed the left frontal bone. The skull tumor was totally resected, and the diagnosis was malignant lymphoma, large cell, immunoblastic and plasmacytoid type. Postoperative combined chemotherapy with vincristine, cyclophosphamide, prednisolone, and adriamycin resulted in the complete disappearance of liver metastases. The patient was readmitted 2 months later, however, because of headache and gradually progressive impairment of consciousness. A CT scan disclosed brain metastasis in the paraventricular region. Radiation therapy (20 Gy) was administered but no further treatment was given. Skull metastasis is not uncommon in cases of malignant lymphoma, but a large mass with both extradural and extracranial extension is rare. Although aggressive chemotherapy was effective, prophylactic irradiation of the brain should have been considered in this case.

Cranial nerve involvement with carcinoma of prostate

Eleven patients with known prostate cancer presented with cranial nerve deficits and skull metastases during the course of their disease. All were treated with radiation therapy to the base of skull. Of the 11 patients, 10 (91 %) responded to therapy. Four of the patients in the responder group had complete resolution of the cranial nerve deficits. This response lasted until their death. One patient had a complete response but later relapsed and is still alive. He is the only survivor of the 11 patients. Partial responses were achieved in 5 patients. These patients had either improvement but not resolution of the cranial nerve deficit or, in cases of multiple nerve involvement, there was response of some of the involved nerves. Four of the partial responders retained the response until their death. One patient achieved partial response but later relapsed with additional nerve deficits. The development of this problem represented a grave prognostic factor as 10 patients died within a median of five months (range 1–16 months) after presentation. One patient is alive nineteen months later but in poor condition with disease progression. Only 1 patient (9 %) did not achieve any response to therapy. His treatment was not completed due to deterioration of his general health. The seventh cranial nerve was the most frequently involved either alone or in combination with other nerves. The most commonly used treatment schedule was 3,000 rad in 10 treatments (7 cases). We conclude that effective palliation is achieved though short survival is possible.

Endometrial Stromal Sarcoma Metastatic to the Skull

In a 57-year-old female patient, a solitary skull metastasis of endometrial stromal sarcoma of the uterus was found under the left parietal region of the cranium 1 year after total removal of the primary lesion. The histological features of the skull mass were similar to those of the original tumor. Fifteen months after excision of the skull metastasis the patient remains asymptomatic. This is the first such case reported.

Skull Metastasis from Thyroid Carcinoma

Skull Metastasis from Thyroid Carcinoma

Pulmonary blastoma in a 13-year-old boy. Case report and review of the literature

On examining a 13-year-old boy, a skull tumor and multiple pulmonary tumors were discovered. He was given three cycles of multidrug chemotherapy in accordance with Rosen's T-11 protocol. The skull tumor disappeared after the first cycle, but the lung masses remained unchanged. The diagnosis of pulmonary blastoma was made on the surgically removed specimen. Local recurrence occurred in the skull and widespread metastases developed later, despite high dose melphalan treatment with autologous bone-marrow rescue. The patient died 9 months after the debut. The case is presented to show the diagnostic difficulties in this rare tumor and to illustrate its varying biological behavior in the published cases. Child, high dose melphalan, pulmonary blastoma

Femoral and skull metastasis with hypercalcemia: occurrence with esophageal carcinoma without dysphagia

Femoral and skull metastasis with hypercalcemia: occurrence with esophageal carcinoma without dysphagia

Case report: Nonspecificity of multiple lytic skull lesions in the computed tomography evaluation of a cancer patient

A case is presented that illustrates the nonspecificity of the CT findings of multiple lytic skull lesions and emphasizes the complimentary nature of computed tomography, isotope bone scanning and skull radiography in the evaluation of possible skull metastases.

Computerized tomographic findings in intracranial and skull metastases (author's transl)

Findings obtained by CT scan in 45 cases of metastatic brain tumor, 1 case of leptomeningeal metastasis, 1 case of dural metastasis, and 3 cases of metastatic skull tumor were analized. Primary lesions were lung carcinomas in 24 cases, breast carcinomas in 6 cases, renal carcinomas in 4 cases, stomach carcinomas in 4 cases, other malignant tumors in 6 cases, and unknown of origins in 6 cases. In 15 cases of metastatic brain tumor, the lesion was solitary, while in 30 cases the lesions were multiple. Enhancement effect was found in 93% of 118 metastatic tumors. Patterns of enhancement were divided into two types: solid and ring enhancements. Solid enhancement was found in 48.3% of 118 metastatic brain tumors and ring enhancement in 44.7% of them. The Hounsfield numbers of the enhanced areas of the tumors of the solid enhancement type were similar with those of the ring enhancement type both in plain and enhancement CT. Ring enhancement was predominant in tumors larger than 2 cm in diameter, but was not related to the difference of the primary lesions nor to the pathological patterns.

Clinically Silent Brain Metastases: Can Radionuclide Scintigraphy Detect Them?

The role of static and dynamic radionuclide brain imaging in the detection of occult brain metastases was evaluated by reviewing the brain images and case histories of 136 patients with neoplastic disease (mostly lung cancer) who, at the time of the scintigraphic study, lacked clinical evidence of brain metastases. Static studies were normal in 121, equivocal in 13, and abnormal in 2. One of the patients with an abnormal study had dural metastases; the other had skull metastases. None of the 13 equivocal scans was found to be indicative of metastasic disease. Cerebral flood flow studies were performed in 99 of the 136 patients and all were negative for evidence of metastatic disease. The results of this study do not support the use of brain scintigraphy for routine screening of asymptomatic cancer patients.

Ultrastructural study of two central nervous system lymphomas.

Electron microscopy was performed on two CNS lymphomas, one primary and the second a skull metastasis from a brain primary lymphoma. The former revealed a tumor perivascularly arranged, which was composed of rounded cells having no specialized organellae. Biopsies from the primary and metastasis of the second case revealed a predominance of rounded cells with scanty cytoplasm, another population of cells with phagocytic activity and a third group with elongated ctyoplasmic processes which stain positively for microglia. By electron microscopy some of these processes resembled neurites or oligondendroglia, while others suggested an astrocytic appearance.

Occult Follicular Thyroid Carcinoma: An Unusual Presentation of Multiple Lytic Bony Metastasis in the Skull of a 66-Year Malay Man

Follicular carcinoma of the thyroid usually presents as nodules with rare cases showing metastasis at diagnosis. But occult follicular carcinoma without any thyroid enlargement and presenting as multiple lytic bone lesions is unusual and relatively rare. Here we report a 66-year old Malay man presenting with occipito-parietal swelling for last two years. He had no thyroid enlargement; no thyroid related symptoms and his biochemical thyroid profile was normal. Computerised tomography of skull reported multiple lytic lesions in the occipito-parietal region. FNAC and histopathological examination confirmed the diagnosis of metastatic follicular carcinoma. We present this case because of the rarity of the disease. Ibrahim Med. Coll. J. 2007; 1(2): 25-27 Key Words: Occult follicular carcinoma thyroid, skull metastasis, normal thyroid findings. doi: 10.3329/imcj.v1i2.2906

Mechanism of Split Cranial Sutures in Metastatic Neuroblastoma

Skull metastases and split cranial sutures frequently occur in patients with neuroblastoma (4, 5, 16). This communication emphasizes the pattern of cranial and intracranial metastases found at autopsy. Radiographic and clinical findings are correlated. Material The present series consists of ten patients with neuroblastoma for whom complete autopsy evaluation was available. These were selected from more than 200 cases coded as neuroblastoma at the University of Michigan Medical Center since 1940. Cases with no autopsy, incomplete autopsy, disputed tissue diagnosis, or incidental finding of neuroblastoma after death from other causes have been excluded. Many of the patients died at home or in other hospitals. Retinoblastomas and neuroblastomas originating from olfactory epithelium (esthesioneuroblastoma, esthesio-neuroepithelioma) or other tissue inside the cranium have been eliminated. Findings A summary of the roentgenographic and necropsy findings for the 10 patients is presented in Table I. Metastases to the skull were observed at autopsy in 5 cases. The bony metastases were diffuse and usually continuous with a soft, nodular, often hemorrhagic tumor plaque which elevated the epicranium (Fig. 1). This nodularity was palpable through the scalp. The bony metastases in all 5 cases were continuous with a similar tumor plaque in the epidural space (Figs. 2 and 3). The tumor appeared to separate the dura mater from the inner table of the skull. The dural metastases tended to be generalized, involving both the convexity and the base, but strongly favoring the external surface of the dura mater. The dura seemed to act as a barrier to deeper penetration of neoplasm. Minor extensions of the tumor to the internal aspect of the dura were found in only 2 cases. It should be noted that 1 patient without cranial involvement at autopsy (S. G.) died of operative complications and not directly of neuroblastoma. The leptomeninges and brain were free of neoplasm (Figs. 3 and 4) on both gross and microscopic examination in all 10 cases. The pachymeningeal tumor plaque could in every instance be easily lifted away from the leptomeninges. When the dural masses were large, molding of the brain was present (Fig. 3). The dural venous sinuses were patent in 4 of the patients with dural metastases. The autopsy protocol of the fifth case did not describe the appearance of the dural venous sinuses. Split cranial sutures were noted by the prosector in 3 of the 5 cases with cranial and dural metastases. He did not comment on the appearance of the sutures in 1 case and recorded absence of split cranial sutures in 6 of the total group of 10 patients.

Roentgen therapy in neuroblastoma; a review of seventy three cases.

In the neuroblastomas of infancy and childhood the physician is dealing with a multipotential tumor which may be curable. The outcome will in part depend upon the localization of the primary lesion, the presence and distribution of metastases, and the selection of the type of therapy. Neuroblastoma was first described by Virchow (1) in 1864 and classified as a glioma. The clinical picture was described by Pepper (2) in 1901 and Hutchison (3) in 1907, and their names have become associated with two clinical types based upon the distribution of the metastases, the adrenal hepatic distribution of the tumor being subsequently known as Pepper's type and the adrenal skeletal, specifically with skull metastases, as the Hutchison type. Studying the suprarenal tissues of embryos, Wright (4) in 1910 first recognized the similarity of the cells to those of these tumors and concluded that the origin must be from the sympathetic nervous system. Farber (5) in 1940 and Karsner (6) in 1942 finally dispelled the concept o...

Primary Bronchus Carcinoma

THE past two decades have witnessed a changing concept in our ideas regarding the pathology and diagnosis of primary bronchus carcinoma, but the proper therapy of these lesions still remains a much disputed issue. A summary review of the clinical and histopathologic diagnosis of this condition as seen here in our clinic is presented. Diagnosis and therapy will be stressed in the hope that eventually a sufficient series of case reports may be accumulated for future guidance in the most efficient methods of therapy of this serious lesion. Pathology Primary bronchus carcinoma was first diagnosed in this clinic in 1917. Since then, 73 other cases have been observed, but in only 65 has the clinical diagnosis, as suggested by history, physical, and x-ray examination, been substantiated by pathologic section. Of this histopathologic material available for study, the diagnoses were confirmed in 31 by autopsy; in 31 by biopsy of the primary (generally at bronchoscopy); in 9 by biopsy from metastatic foci, and in two by examination of the lung tissue removed at operation. Although we fully realize the futility of any gross pathologic classification of these growths, we strongly feel that the arbitrary division of such lesions into those of peripheral and those of central or hilar origins, as suggested by Rabin and Neuhof, serves the practical purpose of assigning the possible operability of such lesions. We have thus attempted to so classify these 65 proven cases from the pathologic and clinical data available and have found only seven that were located near the periphery of the lung in contradistinction to the central origin of the majority. The relations of such finding to the histologic structure as occasionally suggested will be discussed later. A survey of the frequencies of metastasis and extensions as observed both clinically and at postmortem follows (Table III). Bone metastasis was noted in 19 cases and was observed in the following order of diminishing frequency, i. e., ribs, 10 per cent; vertebra: or clavicle, 8 per cent in each; skull or femur, 4 per cent, in each; pelvis or sternum, 2 per cent in each. Only three of our cases showed brain or skull metastasis, a frequency much lower than that of Fried's and probably due to the fact that the brain was not routinely studied in our autopsy material. One of the most striking features encountered was the number of cases in which the metastatic foci from the primary lesion so overshadowed or dominated the clinical picture as to produce in a fair minority of 11 cases no pulmonary symptoms at the time of admission here.