Calcified Brain Metastases from Osteosarcoma

Pablo-Fernández, Eduardo De; Gómez-Herrera, J. J.; Sierra-Hidalgo, Fernando; Sánchez‐Ferro, Álvaro

doi:10.1017/s0317167100013810

Cited by 5 publications

(4 citation statements)

References 2 publications

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“…21 A unique radiological finding in osteosarcoma metastasis brain is large calcifications within the mass lesion and typically described as “bone within the brain” appearance. 22 23 Our case showed lack of calcification which could be due to the chondroblastic nature of the tumor as evidenced in histopathology. Param et al observed 87 patients and showed that 45% of patients had lung involvement and only 13% of patients had brain metastasis with lung involvement on follow-up.…”

Section: Discussionmentioning

confidence: 63%

Isolated Cerebral Metachronous Metastasis in Fibular Osteosarcoma: A Rare Case Report with Review of Literature

Nayak,

Rastogi,

Sebastian

et al. 2023

Indian J Med Paediatr Oncol

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Isolated brain involvement is rarely reported as isolated metachronous metastasis from osteosarcoma. Herein, we report a case of fibular osteosarcoma in a young female who presented with solitary hemorrhagic metachronous cerebral metastasis after years of disease-free interval. Imaging showed a large mass lesion in the right posterior temporal lobe with internal areas of bleed not associated with calcification or ossification mimicking high-grade glioma. No other sites of distant metastases were found on the workup. Two-dimensional echocardiography was done to rule out any cardiac anomaly, including the shunt defect, but no abnormality was detected. She was operated for the cerebral lesion, and histopathology of the resected specimen showed osteosarcoma. The patient was started on chemotherapy and is doing well so far. This case presents a unique scenario of osteosarcoma with an isolated lesion in the brain without any other site of distant metastasis.

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Section: Discussionmentioning

confidence: 63%

Isolated Cerebral Metachronous Metastasis in Fibular Osteosarcoma: A Rare Case Report with Review of Literature

Nayak,

Rastogi,

Sebastian

et al. 2023

Indian J Med Paediatr Oncol

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“…It is unusual in medulloblastomas [9], low grade astrocytomas (pilocytic astrocytoma) [10], oligodendrogliomas and glioblastomas [11]. Histological markers suggesting a better prognosis in glioblastomas include the presence of giant cells and differentiation, as well as calcified brain metastases from osteosarcoma [12], and other carcinomas [13,14]. Among the differential diagnosis of brain intraparenchymal calcifications, metastases are considered uncommon and found predominantly in patients treated with radiotherapy (RT) [5,6,13,14].…”

Section: Discussionmentioning

confidence: 99%

Gliosarcoma with Complete Osteosarcomatous Differentiation and Extensive Calcification: Case Report

Tena-Suck,

Salinas-Lara,

Sanchez-Garibay

et al. 2023

Med Clin Case Rep

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Gliosarcoma is a rare malignant tumor, grade IV according to WHO. It presents malignant biphasic glial and sarcomatous components. Calcifications and ossification are uncommon findings in these tumors. We reported a rare case of gliosarcoma with extense osseous differentiation and dystrophic calcification. A 51- year-old man that presented intense headache, visual alterations, and with an observed temporal right lobe tumor. He was surgically operated and the histopathological diagnosis was a gliosarcoma with osseous and cartilaginous component. He received radiotherapy with a total dose of 66 grays (GY) in 30 fractions. He then was hospitalized again due to intense headache and pyramidal syndrome. He was surgically intervened and an enormous indurated tumor that showed only dystrophic calcifications, osseous spikes, extensive necrosis and ghost glial cells was observed. Few viable neoplastic cells were determined. This tumor showed loss of Glial acidic fibrillary protein (GFAP), and Vimentin, Ostecondrin, Osteoponin, Ki-67, and blood vessel immunoexpression. Now, it is known that the effect of radiotherapy has influence in the development of tumors (specially in gliomas), but regression with extensive osseous dystrophic calcification after therapy can rarely be observed. Some authors refer to these as “tumoral stones”. Extensive calcification could be a sign of a good prognosis as it facilitates extirpation during surgery, although a broaden study in this topic is necessary to affirm this sentence. This is a rare case of gliosarcoma with rapid involution of tumor and stone formation secondary to radiotherapy.

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“…More recent studies report only single or limited number of cases of CBM [5,[7][8][9][10][17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…The primary tumors reported to be responsible for CBM are squamous cell carcinoma and adenocarcinoma of the lung, breast adenocarcinoma, sarcoma of the mediastinum, squamous cell carcinoma of the cervix, adenocarcinoma of the pancreas, non-Hodgkin's lymphoma, osteosarcomas, and colorectal and ovarian adenocarcinomas [5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Calcified brain metastases may be more frequent than normally considered

et al. 2020

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Objectives To verify the incidence of calcified brain metastases (CBM), illustrating the different presentation patterns and histology of primary tumor. Methods A series of 1002 consecutive brain computed tomography (CT) scans of patients with known primary tumors was retrospectively assessed. CBM were defined by the presence of calcification within intra-axial-enhancing lesions; identification of CBM was based on visual examination and ROI analysis (> 85 Hounsfield units). Also, calcifications in the primary tumor of all patients with brain metastases were evaluated. In CBM patients, we investigated the type of calcifications (punctate, nodular, cluster, ring, coarse), the histology of primary tumor, and if a previous RT was performed. Results Among 190 (18.9%) patients with brain metastatic disease, 34 presented with CBM (17.9%). Sixteen patients were previously treated with RT, while 18 presented calcifications ab initio (9.5% of all brain metastases). The majority of patients with CBM had a primitive lung adenocarcinoma (56%), followed by breast ductal invasive carcinoma (20%) and small cell lung carcinoma (11.8%). CBM were single in 44.1% of patients and multiple in 55.9%. With regard to the type of calcifications, the majority of CBM were punctate, without specific correlations between calcification type and histology of primary tumor. No patients with ab initio CBM had calcifications in primary tumor. Conclusion In conclusion, our data show that CBM are more common than usually thought, showing an incidence of 9.5% ab initio in patients with brain metastases. This study underlines that neuroradiologists should not overlook intraparenchymal brain calcifications, especially in oncologic patients. Key Points • Among the differential diagnosis of brain intraparenchymal calcifications, metastases are considered uncommon and found predominantly in patients treated with radiotherapy (RT). • Our data show that CBM are more common than usually thought, showing an incidence of 9.5% ab initio in patients with brain metastases. • A proportion of intraparenchymal brain calcifications, especially in oncologic patients, might represent evolving lesions and neuroradiologists should not overlook them to avoid a delay in diagnosis and treatment.

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Calcified Brain Metastases from Osteosarcoma

Cited by 5 publications

References 2 publications

Isolated Cerebral Metachronous Metastasis in Fibular Osteosarcoma: A Rare Case Report with Review of Literature

Isolated Cerebral Metachronous Metastasis in Fibular Osteosarcoma: A Rare Case Report with Review of Literature

Gliosarcoma with Complete Osteosarcomatous Differentiation and Extensive Calcification: Case Report

Calcified brain metastases may be more frequent than normally considered

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