Miliary brain metastasis presenting with dementia: Progression pattern of cancer metastases in the cerebral cortex

Ogawa, Masaya; Kurahashi, Kiyoe; Ebina, Atsuko; Kaimori, Mitsuomi; Wakabayashi, Keiji

doi:10.1111/j.1440-1789.2007.00782.x

Cited by 28 publications

(39 citation statements)

References 18 publications

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“…Miliary brain metastasis is diagnosed on the basis of findings showing diffuse miliary spread of punctate tumor nodules in the brain. Tumor cells are distributed in perivascular spaces without surrounding edema or mass effects [1,6-12], and it is suggested that tumor cells extend through the perivascular spaces into subpial surface [9]. There are no precise diagnostic criteria for miliary brain metastasis, however, and the size of metastatic lesions in cases previously reported ranges widely.…”

Section: Discussionmentioning

confidence: 99%

“…However, 4 of 17 cases in which brain MRI was performed did not show any abnormalities [6,7,9,13], and four of 13 cases in which gadolinium-enhanced brain MRI was performed did not show any contrast effects [4,6,11,13]. It is speculated that contrast-enhanced MRI could fail to delineate the metastatic lesions because the blood–brain barrier remains intact at an early point in the clinical course [9,11]. Nemzek et al .…”

Section: Discussionmentioning

confidence: 99%

“…In previous cases, convulsion [1,13], hemiparesis [1,10], memory disturbance [7-9], dementia-like symptoms or psychiatric symptoms [1-4,8-11,13,16,17], and disorientation [5-9,16] have been reported as primary symptoms. Patients with miliary brain metastasis can show an atypical clinical course and atypical symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

et al. 2012

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IntroductionMiliary brain metastasis is an extremely rare form of brain metastasis which can present with atypical imaging findings. We report the case of a patient with miliary brain metastasis of lung cancer showing calcification in metastatic lesions.Case presentationA 68-year-old Japanese woman was diagnosed with lung adenocarcinoma. Brain computed tomography revealed multiple small calcified lesions in both cerebral hemispheres. Mutation of the epidermal growth factor receptor gene (exon 21, L858R) in lung cancer cells was detected, and treatment with gefitinib was initiated. A partial response was observed; however, the patient was readmitted to our hospital because of regrowth of the primary lesion and complaints of nausea, headache, and difficulty walking. Brain magnetic resonance imaging revealed scattered tiny nodules enhanced by gadolinium. A diagnosis of leptomeningeal carcinomatosis was made on the basis of cerebrospinal fluid cytology. The patient’s general status worsened, and she died 356 days after the day of first medical examination. Upon autopsy, the brain was found to be edematous and swollen. Lung carcinoma cells were diffusely disseminated on the meningeal surface. Metastatic foci of small nodular form, accompanied by calcifications, were also found in the brain parenchyma. We diagnosed miliary metastasis of lung carcinoma.ConclusionsTo the best of our knowledge, this is the third report of calcified miliary brain metastasis confirmed by autopsy. We describe calcified lesions that increased in size during the clinical course of nine months. Brain computed tomography findings that reveal multiple small calcified lesions in patients with malignancy should raise suspicion of miliary brain metastasis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

et al. 2012

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“…The latter pattern is most frequently seen in lymphoma, and breast and gastric carcinoma. Rarely, solid organ tumors have also been reported to metastasize to the perivascular spaces (Virchow‐Robin spaces) without invading underlying parenchyma and is referred to as a miliary pattern of metastasis . The latter is detectable by MRI with gadopentetic acid (Gd‐DTPA) .…”

Section: Discussionmentioning

confidence: 99%

Intravascular carcinomatosis of central nervous system due to metastatic inflammatory breast cancer: A case report

2015

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Central nervous system (CNS) involvement by metastatic cancer is well-recognized and typically presents with multifocal solid tumors within the brain parenchyma or leptomeningeal dissemination. We describe herein a histologically very rare case of CNS metastasis in a 52-year-old woman who presented with mental status changes. Post mortem examination revealed extensive CNS involvement by metastatic inflammatory breast carcinoma, characterized by the presence of single tumor cells diffusely present within capillaries without parenchymal or perivascular invasion, and acute ischemic changes/infarcts bilaterally involving multiple areas. The cancer cells were found predominantly in the cerebral cortices and deep gray matter structures. Pre-mortem magnetic resonance and CT imaging of the brain did not identify metastatic cancer; however, widespread ischemic changes (i.e. brain infarcts) were identified. Inflammatory breast carcinoma is well-known to have a predilection for spread through lymphovascular spaces. Post mortem examination revealed tumor involvement of bilateral lungs, heart and bladder, with sinusoidal spread in the liver and lymph nodes and prominent involvement of the splenic red pulp in addition to extensive vascular involvement of the brain and spinal cord without a discrete mass, despite the presence of widely metastatic disease. The tumor cells in the CNS were strongly immunoreactive for pancytokeratin, E-cadherin, cytokeratin-7, epithelial membrane antigen and CAM 5.2. This unique histologic pattern of tumor spread is considered to represent "intravascular carcinomatosis" in the CNS, and most likely the cause of the patient's widespread ischemic injuries.

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“…[1336] Presence of multiple metastatic tumor foci surrounding blood vessels without parenchymal invasion is described as one pattern of miliary brain metastasis, and has been reported most often with nonsmall cell lung carcinomas. [37] In contrast, meningeal carcinomatosis [Figure 2], which represents subarachnoid dissemination with widespread meningeal studding, is mostly seen in lung and breast carcinomas. [58]…”

Section: Number Of Metastasesmentioning

confidence: 99%

Neuropathology of brain metastases

Pekmezci

Perry²

2013

Surg Neurol Int

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Metastatic tumors are the most common neoplasms encountered in the central nervous system (CNS), and continue to be major cause for mortality and morbidity. Macroscopic features and corresponding radiological findings can be diagnostic in majority of the cases, however, microscopic evaluation would be necessary when the differential diagnosis includes a primary CNS tumor, unknown primary tumor site, and when the resection of the tumor is either considered therapeutic or palliative. The first step in the diagnosis of a metastatic brain lesion is to exclude a primary CNS tumor, followed by verification or identification of the primary tumor and the site. Although general approach to a metastatic lesion from an unknown primary tumor is the same everywhere else, there are slight variations for the metastatic lesions in the CNS versus other regions. When morphological features are not enough to establish a definitive diagnosis, additional studies including immunohistochemical stains are applied. With the expending immunohistochemical armamentarium for pathologists, more accurate assessments are possible even in cases of unknown primary tumor. This review summarizes the diagnostic approach to CNS metastases, immunohistochemical assessment of neoplasm of unknown primary, and primary CNS lesions entering in the differential diagnosis of metastases.

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Miliary brain metastasis presenting with dementia: Progression pattern of cancer metastases in the cerebral cortex

Cited by 28 publications

References 18 publications

Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

Intravascular carcinomatosis of central nervous system due to metastatic inflammatory breast cancer: A case report

Neuropathology of brain metastases

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