Uncommon Case of Brain Metastasis in a Patient with a History of Heavy Smoking

Abstract

Primary sarcomas of the aorta are extremely uncommon. Depending on histomorphology and immunohistochemical pattern, intimal sarcomas can show angiosarcomatous differentiation. Here, we describe the case of a 60-year-old woman with a primary intimal sarcoma of the aortic arch and signs of cerebral metastatic disease as the initial manifestation. After the patient experienced the onset of severe headaches, ataxia, and left-sided weakness, magnetic resonance imaging showed several brain lesions. Histologic assessment of a brain biopsy specimen revealed a malignant tumour composed of large pleomorphic cells that were positive for pancytokeratin and CD10. Radiation to the brain did not significantly improve the patient’s symptoms, and cranial computed tomography (ct) imaging revealed several metastases, indicating lack of response. Because of the patient’s smoking history, the presence of central nervous system and skeletal metastases on combined positron-emission tomography and ct imaging, and the focal pan-cytokeratin positivity of the tumour, carcinoma of the lung was favoured as the primary tumour. Despite chemotherapy with cisplatin and etoposide, the patient’s neurologic symptoms and general condition deteriorated rapidly, and she died within a few days. At autopsy, an undifferentiated intimal sarcoma of the aortic arch was diagnosed. The primary tumour in the aorta consisted of large pleomorphic cells. Immunohistochemical analysis of the aortic tumour and brain metastases demonstrated diffuse positivity for vimentin and p53 and focal S-100 staining. In summary, we report a challenging case of advanced intimal sarcoma of the aortic arch with brain and bone metastases at initial presentation. Our report demonstrates the difficulties in diagnosing and treating this disease, and the need for multicentre studies to accrue more patients for investigations of optimal therapy.

Pyothorax-associated angiosarcoma metastasized to the brain with multiple and progressively expanding hematomas: Case report and literature review

“…[ 36 ] To the best of our knowledge, 34 cases of metastatic brain angiosarcoma have been reported, half of which were metastases from the heart [ Table 1 ]. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 ] Metastatic lesions of the brain are usually multiple at diagnosis, and differentiation from intracerebral hemorrhages[ 26 ] or cavernous angiomas[ 23 27 ] based only on radiological findings is difficult. Only two previous cases had a history of expanding hematoma in a short period as was observed in our case.…”

Neoplastic Ruptured Cerebral Aneurysm Caused by Intimal Sarcoma: A Case Report

“…3) Currently, although a number of case reports and small case series have been reported, diagnosis and treatment of ISA remains difficult. 1,[4][5][6][7][8][9] ISA is highly invasive, and the mean overall survival time ranges from 5 to 18 months. 2) At the time of diagnosis, metastasis is found in approximately 75% of patients, with common locations including the bone, lung, liver, spleen, kidney, skin, and brain.…”

“…2) At the time of diagnosis, metastasis is found in approximately 75% of patients, with common locations including the bone, lung, liver, spleen, kidney, skin, and brain. [7][8][9][10] Herein, we describe a case of an ISA-metastasized middle cerebral artery (MCA) that formed a neoplastic aneurysm, resulting in a subarachnoid hemorrhage (SAH). To the best of our knowledge, no comparable cases have been reported to date.…”

Multiple Embolic Infarction Due to a Primary Aortic Intimal Sarcoma

“…There have been less than 40 reported cases of primary aortic intimal sarcoma. The most common locations of the tumor are the abdominal aorta (40%), thoracic aorta (20%), and thoracoabdominal aorta (10%) [ 1 - 3 ]. Most clinical presentations are embolic phenomena or vessel occlusion or obstruction, i.e.…”

“…The prognosis of this tumor is dismal because of the advanced stage at which the disease is diagnosed in most cases. Mean survival period of patients with an established diagnosis is around 16 months (range: 0-168 months), and the 3- and 5-year survival rates are about 11.2% and 8%, respectively [ 3 , 6 ]. Therefore, clinicians must be aware of intimal aortic sarcoma in patients with recurrent emboli and unusual location of thrombi in the aortic arch.…”