Central nervous system metastases from breast carcinoma: a clinical and laboratorial study in 47 patients

Abstract

-In this retrospective study, 47 patients with clinical diagnosis of central nervous system metastases of breast cancer were evaluated by computerized tomography (CT), magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. The patients were divided in 2 groups: 1, without leptomeningeal neoplasm and 2, with leptomeningeal neoplasm. In the group 2, the time interval between the primary disease and the central nervous system metastasis as well as the survival time were shorter than in group 1 (40 and 4.3 months in group 2 versus 57 and 10 months respectively, in group 1). In both groups the most common neurological symptoms and signs were intracranial hypertension and motor deficits. The most sensitive diagnostic methods were CT and MRI in group 1, and the CSF examination in group 2. The use of the tumor markers CEA and CA-15.3 in the routine examination of CSF showed promising results, mainly in leptomeningeal forms.KEY WORDS: central nervous system metastasis, breast cancer, cerebrospinal fluid, tumor markers. Metástases do sistema nervoso central por câncer de mama: estudo clínico-laboratorial em 47 pacientesRESUMO -Neste estudo retrospectivo, 47 pacientes com diagnóstico clínico de metástases do sistema nervoso por câncer de mama foram avaliados por tomografia computadorizada (TC), ressonância nuclear magnética (RNM) e por exames do líquido cefalorraqueano (LCR). Os pacientes foram divididos em 2 grupos: 1, sem neoplasia leptomeníngea e 2, com neoplasia leptomeníngea. No grupo 2 o intervalo de tempo entre a doença primária e o comprometimento do sistema nervoso e o tempo de sobrevida foram menores do que no grupo 1 (40 e 4,3 meses no grupo 2 versus 57 e 10 meses respectivamente, no grupo 1). Os sinais e sintomas neurológicos mais frequentes foram hipertensão intracraniana e déficits motores. Os exames mais sensíveis para o diagnóstico foram a TC e RNM no grupo 1 e o exame do LCR no grupo 2. O uso dos marcadores CEA e CA-15.3 na rotina do LCR mostrou resultados promissores, particularmente nas formas leptomeníngeas. PALAVRAS-CHAVE: metástases no sistema nervoso central, câncer de mama, líquido cefalorraqueano, marcadores tumorais.Autopsy studies show that central nervous system (CNS) metastasis of breast cancer occur in nearly 30% of the patients but only 10% are diagnosed or suspected clinically before death 1,2 . Recent epidemiological data indicate that the incidence of CNS metastasis has been increasing in the last two decades; this could be explained by the increased survival of the breast cancer patients nowadays 3,4 . The clinical presentation of these patients is pleomorphic, depending on the localization of the lesions, meningeal involvement and paraneoplastic syndromes, as well as on therapeutic complications 2,5 . Specific and sensitive diagnostic tools, both clinical and laboratorial, must be familiar to the neuro-oncologist.

Atypical presentation of a cervical breast-cancer metastasis mimicking a dumbbell-shaped neurinoma

“… 8 LM on the other hand are typically associated with headaches and nausea due to disruption of the CSF circulation and neurologic deficits of sensory and motor function in the case of compression of the spinal cord or nerve roots. 3,12,13,17 The majority of motor sensory dysfunction caused by LM is found to be of a myelopathic pattern rather than the effect of a single nerve root, 18 and most often affects the lower extremities. 16,17 While the initial manifestation of LM can occur between several weeks and 17 years following the primary diagnosis of BC, 6 rapid deterioration after the clinical diagnosis is common and the prognosis is poor.…”

“… 3,12,13,17 The majority of motor sensory dysfunction caused by LM is found to be of a myelopathic pattern rather than the effect of a single nerve root, 18 and most often affects the lower extremities. 16,17 While the initial manifestation of LM can occur between several weeks and 17 years following the primary diagnosis of BC, 6 rapid deterioration after the clinical diagnosis is common and the prognosis is poor. 6,11,19,20 Mean survival after diagnosis of LM is about 7.5 months 4,11 and one-year survival is 10–22%.…”

Leptomeningeal Metastasis

“…25,59 Despite these measures, CSF cytology may remain persistently negative, and CSF analysis may be aided by an evaluation for tumor markers which can be categorized as either specific or nonspecific to the underlying tumor histology (Table 6). Tumor markers specific for a tumor type include ␤2-microglobulin in lymphoid malignancies, 76 CA-125 in ovarian cancer, 77 CA 15-3 in breast cancer, 78 PSA in prostate cancer, 79 and ␤hCG for choriocarcinoma or germ cell tumors. Carcinoembryonic antigen (CEA) is associated with colorectal cancers but can also be found in other solid tumors.…”