Extraneural Metastases of Primary Central Nervous System Tumors Identified by Fine Needle Aspiration: A Retrospective Analysis

Abstract

Objective: Extraneural metastasis (EM) of primary central nervous system (PCNS) neoplasms is rare and signifies a poor clinical outcome. Due to its infrequent occurrence, relatively few reports on the cytomorphology of these neoplasms have been published. We describe a series of 19 cases from 16 patients at a single, large tertiary care center. Study design: A retrospective analysis of 19 cases of metastases from PCNS neoplasms identified on fine needle aspiration (FNA) in 8 male and 8 female patients aged 14-72 years (mean age 39.6) from 1989 to 2013 was conducted to further characterize the cytomorphologic features identified at metastatic sites. Results: Six different PCNS neoplasms were identified: meningioma, glioblastoma, hemangiopericytoma (HPC), oligodendroglioma, medulloblastoma, and retinoblastoma. The mean latency period between the diagnoses of the primary and first metastatic tumors was 7.4 years (range 0-15). The most common PCNS malignancy responsible for EM was HPC. The most common metastatic sites were the lung (31%) and soft tissue/bone (31%). Conclusions: EM of PCNS tumors is extremely rare. FNA allows for quick, safe and accurate diagnosis. Cytomorphologic features are characteristic, and in conjunction with the clinical history and immunohistochemistry, an accurate diagnosis was obtained in 100% of the cases.

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

“…As demonstrated by cases 3 and 4 of our series, metastases in and around the parotid gland area are not limited to glioblastomas and may also occur with primary CNS neoplasm of lower WHO grade. Indeed, one case of oligodendroglioma, a WHO grade II tumor, with metastasis to the parotid gland after intracranial recurrence and progression to WHO grade III has previously been reported [8, 32]. Case 3 of our series was previously reported [33]; however, the findings of the FNA were not included.…”

“…Of note, neither institution contributing to our study has a significant pediatric focus. Furthermore, Vandenbussche et al [8] noted the long latency period prior to ENM for most hemangiopericytomas in their series, which was followed by a somewhat shorter latency period for meningiomas. In our small series, the latency period was highly variable and ranged between few months in the case of a glioblastoma with a primitive neuronal component and almost 2 decades in the case of an atypical meningioma.…”

“…In 2014, Vandenbussche et al [8] published a large series of 16 cases with ENM of primary CNS tumors. The majority of cases in their series were diagnosed as hemangiopericytomas ( n = 8) with meningiomas ( n = 3) representing the next most frequent tumor entity.…”

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

“…As demonstrated by cases 3 and 4 of our series, metastases in and around the parotid gland area are not limited to glioblastomas and may also occur with primary CNS neoplasm of lower WHO grade. Indeed, one case of oligodendroglioma, a WHO grade II tumor, with metastasis to the parotid gland after intracranial recurrence and progression to WHO grade III has previously been reported [8, 32]. Case 3 of our series was previously reported [33]; however, the findings of the FNA were not included.…”

“…Of note, neither institution contributing to our study has a significant pediatric focus. Furthermore, Vandenbussche et al [8] noted the long latency period prior to ENM for most hemangiopericytomas in their series, which was followed by a somewhat shorter latency period for meningiomas. In our small series, the latency period was highly variable and ranged between few months in the case of a glioblastoma with a primitive neuronal component and almost 2 decades in the case of an atypical meningioma.…”

“…In 2014, Vandenbussche et al [8] published a large series of 16 cases with ENM of primary CNS tumors. The majority of cases in their series were diagnosed as hemangiopericytomas ( n = 8) with meningiomas ( n = 3) representing the next most frequent tumor entity.…”

Squash Cytology of a Dural-Based High-Grade Chondrosarcoma May Mimic That of Glioblastoma in the Central Nervous System

“…Fibrillary or necrotic dirty background is one of the noticeable cytologic findings of glioblastoma or gliosarcoma. Glioblastoma is composed of singly scattered large cells or loosely cohesive, disorderly clusters of cells showing scant cytoplasm, marked nuclear pleomorphism with hyperchromatic chromatin and prominent nucleoli [12]. The cytology of glioblastoma shows marked pleomorphism, cellularity, mitoses, necrosis and endothelial hyperplasia, whereas gliosarcoma is composed of biphasic glial and sarcomatous components; the glial component is composed of high cellularity of markedly pleomorphic cells in a fibrillary background as well as in a blood background [13].…”

Cytomorphologic and clinicoradiologic analysis of primary nonhematologic central nervous system tumors with positive cerebrospinal fluid

“…The sample size of other tumor types was too small to draw meaningful conclusions regarding the latency. However, the overall latency to CSF involvement is generally much shorter than the latency to extraneural spread, which is much more rare and may be ≥10 years …”

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

“…As demonstrated by cases 3 and 4 of our series, metastases in and around the parotid gland area are not limited to glioblastomas and may also occur with primary CNS neoplasm of lower WHO grade. Indeed, one case of oligodendroglioma, a WHO grade II tumor, with metastasis to the parotid gland after intracranial recurrence and progression to WHO grade III has previously been reported [8, 32]. Case 3 of our series was previously reported [33]; however, the findings of the FNA were not included.…”

“…Of note, neither institution contributing to our study has a significant pediatric focus. Furthermore, Vandenbussche et al [8] noted the long latency period prior to ENM for most hemangiopericytomas in their series, which was followed by a somewhat shorter latency period for meningiomas. In our small series, the latency period was highly variable and ranged between few months in the case of a glioblastoma with a primitive neuronal component and almost 2 decades in the case of an atypical meningioma.…”

“…In 2014, Vandenbussche et al [8] published a large series of 16 cases with ENM of primary CNS tumors. The majority of cases in their series were diagnosed as hemangiopericytomas ( n = 8) with meningiomas ( n = 3) representing the next most frequent tumor entity.…”

Squash Cytology of a Dural-Based High-Grade Chondrosarcoma May Mimic That of Glioblastoma in the Central Nervous System

“…Fibrillary or necrotic dirty background is one of the noticeable cytologic findings of glioblastoma or gliosarcoma. Glioblastoma is composed of singly scattered large cells or loosely cohesive, disorderly clusters of cells showing scant cytoplasm, marked nuclear pleomorphism with hyperchromatic chromatin and prominent nucleoli [12]. The cytology of glioblastoma shows marked pleomorphism, cellularity, mitoses, necrosis and endothelial hyperplasia, whereas gliosarcoma is composed of biphasic glial and sarcomatous components; the glial component is composed of high cellularity of markedly pleomorphic cells in a fibrillary background as well as in a blood background [13].…”

Cytomorphologic and clinicoradiologic analysis of primary nonhematologic central nervous system tumors with positive cerebrospinal fluid

“…The sample size of other tumor types was too small to draw meaningful conclusions regarding the latency. However, the overall latency to CSF involvement is generally much shorter than the latency to extraneural spread, which is much more rare and may be ≥10 years …”

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

“…As demonstrated by cases 3 and 4 of our series, metastases in and around the parotid gland area are not limited to glioblastomas and may also occur with primary CNS neoplasm of lower WHO grade. Indeed, one case of oligodendroglioma, a WHO grade II tumor, with metastasis to the parotid gland after intracranial recurrence and progression to WHO grade III has previously been reported [8, 32]. Case 3 of our series was previously reported [33]; however, the findings of the FNA were not included.…”

“…Of note, neither institution contributing to our study has a significant pediatric focus. Furthermore, Vandenbussche et al [8] noted the long latency period prior to ENM for most hemangiopericytomas in their series, which was followed by a somewhat shorter latency period for meningiomas. In our small series, the latency period was highly variable and ranged between few months in the case of a glioblastoma with a primitive neuronal component and almost 2 decades in the case of an atypical meningioma.…”

“…In 2014, Vandenbussche et al [8] published a large series of 16 cases with ENM of primary CNS tumors. The majority of cases in their series were diagnosed as hemangiopericytomas ( n = 8) with meningiomas ( n = 3) representing the next most frequent tumor entity.…”

Squash Cytology of a Dural-Based High-Grade Chondrosarcoma May Mimic That of Glioblastoma in the Central Nervous System

“…Fibrillary or necrotic dirty background is one of the noticeable cytologic findings of glioblastoma or gliosarcoma. Glioblastoma is composed of singly scattered large cells or loosely cohesive, disorderly clusters of cells showing scant cytoplasm, marked nuclear pleomorphism with hyperchromatic chromatin and prominent nucleoli [12]. The cytology of glioblastoma shows marked pleomorphism, cellularity, mitoses, necrosis and endothelial hyperplasia, whereas gliosarcoma is composed of biphasic glial and sarcomatous components; the glial component is composed of high cellularity of markedly pleomorphic cells in a fibrillary background as well as in a blood background [13].…”

Cytomorphologic and clinicoradiologic analysis of primary nonhematologic central nervous system tumors with positive cerebrospinal fluid

“…The sample size of other tumor types was too small to draw meaningful conclusions regarding the latency. However, the overall latency to CSF involvement is generally much shorter than the latency to extraneural spread, which is much more rare and may be ≥10 years …”