Isolated brain metastases of osteosarcoma in a patient presenting with a patent foramen ovale

Abstract

We report the case of a patient in whom brain MR imaging was requested for initial symptoms of intracranial hypertension. The presence of multiple intracranial hemorrhagic lesions suggested brain metastases. Body screening showed periosteal osteosarcoma of the left fibula with no lung metastases, but with a patent foramen ovale which probably allowed neoplastic cells to reach the brain without being filtered through the lungs. The conclusion of this study was that a left-right cardiac communication is to be considered in cases of isolated brain metastases from osteosarcoma.

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

“…One similar case report was available in the literature isolated brain metastasis without lung involvement in a 12 years male child due to patent foramen ovale resulting in the right to left shunt. 8 Due to the availability of the new chemotherapeutic and radiotherapeutic treatments for soft tissue and bony sarcomas, there was prolonged survival due to systemic disease control, but there was an increased incidence of brain metastases due to less effective intracranial control. 14,15,19 There was also a higher incidence of brain metastasis in patients with other site metastasis at diagnosis of the tumor and patients with recurrence at 1 year of interval period.…”

“…11 The common mechanism for the spread of bone tumors is hematogenous, as the bones are devoid of lymphatics. 8 Brain metastases are relatively rare in osteosarcoma, with an incidence of 1.8 to 5.6%, and commonly seen in association with lung metastasis, with the postulated mechanism being tumor emboli from the lung migrating to the brain. 12 Mean duration of time interval from the initial diagnosis to brain metastasis in osteosarcoma is 20 months.…”

“…6,7 Another case of osteosarcoma described presented with isolated brain metastasis without lung involvement due to patent foramen ovale. 8 This case raises pertinent questions regarding the management of similar patients because the optimal treatment in such patients is not yet well defined. We report a case of isolated brain metastasis in a patient with recurrent fibular osteosarcoma without any documented cardiac abnormality or another site of metastasis.…”

MRI of osteosarcoma metastases in the brain of an old English Sheepdog

“…This explains the MRI signal intensity pattern of the brain lesions, which was characterized by hypointensity in all sequences in conjunction with a stippled appearance and lack of further signal void or blooming on the T2* images. It is common in people for brain osteosarcoma (and indeed soft tissue metastases) to mineralize and in some individuals, a hemorrhagic component has also been identified within metastatic lesions 12–14 …”