Solitary Cerebral Metastases Research Articles

Solitary Cerebral Metastases vs. High-grade Gliomas: Usefulness of Two MRI Signs in the Differential Diagnosis.

The differentiation between cerebral metastases (CM) and high-grade gliomas (HGG) can be difficult on magnetic resonance imaging (MRI). The aim of this study was to evaluate the usefulness of searching two MRI signs (signal alteration in the adjacent cortex, SAAC, and peripheral rim sign, PRS), in order to distinguish between these entities. A total of 61 patients were retrospectively enrolled (28 HGG, 33 CM). Fluid Attenuated Inversion Recovery (FLAIR) sequences were used to assess SAAC and contrast-enhanced T1-weighted sequences for PRS. A positive SAAC sign was present in 61% of HGG, and 12% of CM. Conversely, in SAAC-negative lesions, PRS was observed in 78% of CM and in 32% of HGG. Their association had a higher frequency in HGG than in the CM group (21 vs. 3%). While SAAC is specific for HGG and PRS, in the absence of SAAC, is relatively specific for CMs, their combined presence is highly suggestive of HGG.

Differentiation between Solitary Cerebral Metastasis and Astrocytoma on the Basis of Subventricular Zone Involvement on Magnetic Resonance Imaging.

PurposeTo determine the relationship between the subventricular zone (SVZ) and astrocytoma based on magnetic resonance imaging (MRI) and whether SVZ involvement can be used to distinguish solitary cerebral metastases (SCMs) from astrocytomas.MethodsThis retrospective study involved 154 patients with solitary low-grade astrocytoma (LGA), high-grade astrocytoma (HGA), and SCM, who underwent T1-weighted imaging (T1WI), Gd-DTPA–enhanced T1WI, and T2-weighted imaging (T2WI) or fluid-attenuated inversion recovery (FLAIR) T2WI. The spatial relationship between the tumor and SVZ was classified as “involvement” or “segregation” on contrast-enhanced T1WI for enhanced tumors and T2WI/FLAIR T2WI for non-enhanced tumors. Patient-based SVZ-contact rates were compared between the LGA, HGA, and SCM groups. The frequencies of involvement of various lateral ventricle regions by astrocytoma were compared. The correlation between SVZ involvement and tumor necrosis was analyzed.ResultsPatient-based SVZ-contact rates in SCM, LGA, and HGA were 24.1%, 68.8%, and 85.4%, respectively. Univariate analysis showed that the SVZ-contact rate was significantly different between SCM and astrocytoma (24.1% vs. 75.2% P < 0.001), also between LGA and HGA (68.1% vs. 85.4% P=0.037). After the tumor volume was adjusted as a covariate, SVZ-contact rates still differed between SCMs and astrocytomas (Odds ratio [OR]: 4.58, 95% Confidence interval [CI]: 1.65 to 12.8, P=0.004). Tumor volume differed between LGA and HGA (P< 0.001), and influenced the association between SVZ involvement and astrocytoma grade (P = 0.05). Among the lateral ventricle regions, the frontal horn was the most frequently involved by astrocytomas. SVZ-contact rates were higher in necrosis group compared with non-necrosis groups (83.9% vs. 50.0%, P < 0.001) among astrocytoma patients. Necrosis positively correlated with SVZ involvement in astrocytomas (rs = 0.342, P < 0.001), but did not correlate with SVZ involvement in SCMs (P = 0.193).ConclusionsCompared to SCMs, solitary cerebral astrocytomas exhibited spatial proximity to the SVZ, which might distinguish the supratentorial astrocytomas from SCMs.

Solitary Cerebral Metastases from Renal Cell Carcinoma 16 years After Nephrectomy

Tanidan l0 yil sonra gelisen lokal nuks ve uzak metastaz, renal hucreli kanserin (RCC) gec rekkurrensi olarak adlandirilir. Gec rekurrens %4.7-11 oraninda gorulmektedir. Bu olgu sunumunda RCC nedeniyle nefrektomi yapilan ve 16 yil sonra soliter beyin metastazi gelisen 54 yasindaki kadin hastayi tartismayi amacladik. Intrakranial tumor nedeni ile gross total eksizyon yapildi. Patolojik tanisi RCC metastazi olarak saptandi. Yapilan immunohistokimyasal incelemede beyin metastazi ile 16 yil once yapilan nefrektomi patolojisinin ayni oldugu saptandi. Postoperatif hastaya gamma-knife uygulandi. Hastaya interferon baslandi. Erken evre RCC hastalarinda da yillik kontrollerin >10 yil sonra da devam edilmesi ile nuksun erken saptanmasi ile cerrahi rezeksiyon sansi saglayabilir. Gelecekte yapilan calismalarla, gec rekkurens gelisiminde rol alan risk faktorlerinin belirlenmesi uzun takip suresi gereken hastalalari belirleme de katki saglayacaktir.

Spontaneous regression of a solitary cerebral metastases in renal carcinoma followed by meningioma development under medroxyprogesterone acetate therapy

A case of regression of a probable cerebral metastasis of a hypernephroma after nephrectomy and hormone therapy is presented. The patient subsequently developed a meningioma after therapy with medroxyprogesterone acetate. A relationship between meningioma growth and sex hormones has been documented, but little is known about the effect of hormone therapies on tumour growth.

Solitary cerebral metastasis from lung cancer with very long survival: Report of two cases and review of the literature

Solitary cerebral metastases from lung cancer are not uncommon clinical events. Whatever treatment is adopted, long-term survival is rare. Very rare indeed are reports of patients surviving the discovery of lung cancer and brain metastasis for 10 years or more. Indeed, only 16 cases have been reported to our knowledge. We report two further cases, stressing the importance of correct clinicopathological staging so that treatment may be conducted in the way most likely to ensure longer and better survival and, pending a therapeutic breakthrough, to increase the number of long-term survivors.

Interstitial Brachytherapy

In the last several years there has been a renewed interest in interstitial brachytherapy for the treatment of both newly diagnosed and recurrent malignant gliomas and solitary cerebral metastases. A variety of techniques are currently in use for the planning and stereotactic implantation of radioactive isotopes into these tumors. Although there seems to be strong evidence to support the use of this technique for recurrent malignant gliomas, further work is needed to confirm its efficacy in an adjuvant setting for treating of newly diagnosed tumors and to determine the effect of the addition of hyperthermia or chemotherapy on outcome.

Solitary cerebral metastasis from a papillary carcinoma of the thyroid

A woman aged 52 was treated with radioactive iodine for a papillary carcinoma of the thyroid. Four years later she developed signs and symptoms of an intracranial space occupying lesion. A computed tomographic scan showed a mass in the right posterior frontal region. Although she was suspected of having metastatic disease a definite diagnosis was not established until she died 6 months later when post-mortem examination confirmed that she had a cerebral metastasis from a papillary carcinoma of the thyroid. There was no evidence of metastatic disease elsewhere in the body. Cerebral metastases from papillary carcinoma of the thyroid are uncommon but may occur in patients who have metastases in bones or lungs. A search of the literature has revealed only two patients with solitary cerebral metastases.

Monoclonal Antibody Immunophenotyping of Solitary Cerebral Metastases with Unknown Primary Sites

Various authors have reported the incidence of the solitary metastatic lesion to range from 25-85% of cases with known cerebral metastasis. In about 20% of these cases, no primary neoplasm is ever identified. The therapeutic alternatives considered depend to a great extent on the histopathology of the tumour. Unfortunately, the difficulty of making a correct diagnosis in this setting is compounded by all of the problems associated with tumour sampling, i.e. the representativeness of the sample, the often miniscule amounts of tissue obtained, mechanical deformation of the sample, etc. This study describes the use of a monoclonal antibody panel in the immunophenotyping of 45 tumours where the differential diagnosis was glioma versus metastatic tumour with no known primary site. The monoclonal antibodies used bound neuroectodermal antigens (UJ13A), cytokeratin (LE61), and epithelial membrane antigens (AUA1), as well as human milk fat globule antigens (HMFG1, HMFG2). The neuroectodermally-derived MAB UJ13A accurately and reproducibly differentiated gliomas and metastatic lesions with one exception. Oat cell carcinomas (n = 5) were positive for both UJ13A and cytokeratin (LE61). There were no cases in which metastatic tumours were positive for UJ13A and negative for cytokeratin. A combination of the LE61 and AUA1 MABs resulted in positive staining in 44/45 (98%) cases. Immunophenotyping made a substantial contribution in 13 cases (29%), and in three cases the MAB panel was responsible for the final diagnosis. The antibody panel described in this study enables primary CNS neoplasms to be accurately distinguished from nonlymphoid metastatic tumours. In addition, a positive diagnosis of carcinoma is made in 98% cases, although identification of the precise organ of origin is not generally possible.

Importance of Batson's plexus in the determination of isolated cerebral metastases

A study of the structure of Batson's plexus and the pathological data gathered from a large series of cases, suggest that this perivertebral venous system is an additional metastatic route, as the one described by Walker.

Cerebral Metastases from Bronchial Carcinomata

Cerebral Metastases from Bronchial Carcinomata