Central Nervous System Miliary Brain Metastasis Secondary to Breast Cancer: Case Report (original) (raw)
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Brain metastasis of breast cancer
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Breast cancer is the second most common malignant disease proceeding brain metastases following lung cancer. The incidence of brain metastasis seems to be increasing because of the detection of small metastases by magnetic resonance imaging and improvements in systemic therapy, resulting in longer survival. Because of advances in the diagnosis and management of this condition, most patients receive effective palliation, and the majority do not die from their brain metastases.
Arquivos de Neuro-Psiquiatria, 1998
In this retrospective study, 47 patients with clinical diagnosis of central nervous system metastases of breast cancer were evaluated by computerized tomography (CT), magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) examination. The patients were divided in 2 groups: 1, without leptomeningeal neoplasm and 2, with leptomeningeal neoplasm. In the group 2, the time interval between the primary disease and the central nervous system metastasis as well as the survival time were shorter than in group 1 (40 and 4.3 months in group 2 versus 57 and 10 months respectively, in group 1). In both groups the most common neurological symptoms and signs were intracranial hypertension and motor deficits. The most sensitive diagnostic methods were CT and MRI in group 1, and the CSF examination in group 2. The use of the tumor markers CEA and CA-15.3 in the routine examination of CSF showed promising results, mainly in leptomeningeal forms.
Brain metastasis in breast cancer: a comprehensive literature review
This comprehensive review provides information on epidemiology, size, grade, cerebral localization, clinical symptoms, treatments, and factors associated with longer survival in 14,599 patients with brain metastasis from breast cancer; the molecular features of breast cancers most likely to develop brain metastases and the potential use of these predictive molecular alterations for patient management and future therapeutic targets are also addressed. The review covers the data from 106 articles representing this subject in the era of modern neuroimaging (past 35 years). The incidence of brain metastasis from breast cancer (24 % in this review) is increasing due to advances in both imaging technologies leading to earlier detection of the brain metastases and introduction of novel therapies resulting in longer survival from the primary breast cancer. The mean age at the time of breast cancer and brain metastasis diagnoses was 50.3 and 48.8 years respectively. Axillary node metastasis was noted in 32.8 % of the patients who developed brain metastasis. The median time intervals between the diagnosis of breast cancer to identification of brain metastasis and from identification of brain metastasis to death were 34 and 15 months, respectively. The most common symptoms experienced in patients with brain metastasis consisted of headache (35 %), vomiting (26 %), nausea (23 %), hemiparesis (22 %), visual changes (13 %) and seizures (12 %). A majority of the patients had multiple metastases (54.2 %). Cerebellum and frontal lobes were the most common sites of metastasis (33 and 16 %, respectively). Of the primary tumors for which biomarkers were recorded, 37 % were estrogen receptor (ER)?, 41 % ER-, 36 % progesterone receptor (PR)?, 34 % PR-, 35 % human epithelial growth factor receptor 2 (HER2)?, 41 % HER2-, 27 % triple negative and 18 % triple positive (TP). Treatment in most patients consisted of a multimodality approach often with two or more of the following: whole brain radiation therapy (52 %), chemotherapy (51 %), stereotactic radiosurgery (20 %), surgical resection (14 %), trastuzumab (39 %) for HER2 positive tumors, and hormonal therapy (34 %) for ER and/or PR positive tumors. Factors that had an impact on prognosis included grade and size of the tumor, multiple metastases, presence of extra-cranial metastasis, triple negative or HER2? biomarker status, and high Karnovsky score. Novel therapies such as application of agents to reduce tumor angiogenesis or alter permeability of the blood brain barrier are being explored with preliminary results suggesting a potential to improve survival after brain metastasis. Other potential therapies based on genetic
Computerized tomography
In 60 patients with Brain Metastases (B.M.) secondary to breast or lung ncoplasia we evaluated the appearence of the first neurological clinical symptom and the findings of the examination by computerized tomography (CT). It was observed that in 79", of cases the first clinical symptom is possible without any repercussion on the motor pathways. Headache, observed in 36.5",, of the patients, suggests presentation of cerebral me&stases (M.C.) at the frontal or fronto-parietal level in 73",, of the cases, and multiple metastatization in 68"::. Other clinical symptoms which showed up less often were motor disturbances (204,,), convulsive crises (lO"i,) and character changes (8.5";). The existence of a relationship between the age and multiple B.M. was verified. They showed up in 69",, of the patients aged less than 50. In patients aged over 65 the appearance of single metastasis increases. especially in those B.M. secondary to breast neoplasia, where it was observed in 60",, of the cases. The most important differences observed between the two processes, are the greater development of B.M. at the cerebellar level (25%) and the greater appearance of convulsive crises (149,) in those patients with lung neoplasia. Computerized tomography Metastasis mamary gland neoplasia Lung neoplasia
Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report
Journal of Medical Case Reports, 2012
Introduction Miliary 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 presentation A 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 w...
Clinical and Translational Oncology, 2014
Breast cancer represents the second most frequent etiology of brain metastasis (BM). It is estimated that 10-30 % of patients with breast cancer are diagnosed with BM. Breast cancer BM are increasing due to the aging population, detection of subclinical disease, and better control of systemic disease. BM is a major cause of morbidity and mortality affecting neurocognition, speech, coordination, behavior, and quality of life. The therapy of BM remains controversial regarding use and timing of surgical resection, application of whole-brain radiotherapy, stereotactic radiosurgery and systemic drugs in patients with particular tumor subtypes. Despite numerous trials, the range of interpretation of these has resulted in differing treatment perspectives. This paper is a review of the state of the art and a multidisciplinary guideline on strategies to improve the therapeutic index in this situation.
Primary Care Update for OB/GYNS, 1997
Brain metastases are the most common neurological complication of systemic cancer, accounting for nearly 270,000 new cases annually in the United States. The incidence appears to be increasing as cancer patients survive longer. Despite recent diagnostic and therapeutic advances, the optimal management remains unclear. The options include corticosteroids, radiation therapy, surgery, and chemotherapy, This article provides an overview of the etiology, presentation, diagnosis and management of brain metastases. (Prim Care Update OblGyns 1997;4:127-130.
Breast Cancer, 2004
Over a period of 10 years, twenty-two patients with T2-3N2Mx breast cancer presented with symptoms of increased intracranial pressure (ICP), but brain CT scan and/or MRI didnot reveal any signs of a space occupying lesion. A brain CT scan and an MRI study were performed every 15 days. Ten patients refused this close follow up. Thus, two groups were formed group A (n = 12) included the patients who were close's followed and group B (n = 10) consisted of those patients who were not. Therefore, Group A, being under careful follow-up, initiated radiotherapy were quickly. The median time from the presentation of increased ICP symptoms until the appearance of metastases on CT and/or MRI directly followed by brain irradiation was 48 days (SE = 6.1) for group A and 72 days (SE = 0.7) for group B (p = 0.0085, log-rank test). In group A, median Overall Survival (OS) was 171.0 (SE = 21.5) days, and was 99.0 (SE = 6.3) days (p = 0.014) for group B. Volumetric analysis of the secondary brain lesions at the initiation of radiotherapy showed a total volume of metastatic lesions of 19.5 -+ 13.9 cm 3 versus 65.3 -+ 20.7 cm 3 for groups A and B, respectively (p < 0.001, Mann-Whitney test). Post-radiotherapy, Karnofsky Performance Status and Visual Analogue Score were also improved for group A versus B (p = 0.002). Group A appeared to benefit from close follow-up since the metastases were detected and irradiation was given sooner compared with group B, thus achieving better performance status and prolonged survival. Radiologically silent brain metastases from breast cancer should not be ignored because timely whole brain irradiation should be the goal of clinicians. Clinical suspicion should lead to close follow-up with multiple CT/MRI studies and cerebral spinal fluid cytology until the final diagnosis.
Determining The Frequency And Underlying Factors Of Brain Metastasis Symptoms
International Journal of Radiation Oncology Biology Physics, 2020
Breast cancer that metastasizes to the leptomeninges is associated with high neurological morbidity and limited survival. The clinical presentation of leptomeningeal disease (LD) is varied and generally has an imaging correlate which may range from subtle to overt. Patients with LD are often treated with combinations of systemic therapy, intrathecal therapy, and radiation therapy. Patients with new diagnosis of LD who have shorter predicted survival may benefit from more aggressive therapy, such as early whole brain radiotherapy and/or intrathecal chemotherapy. We reviewed demographic and clinical features to identify predictors of survival among patients with new diagnosis of LD. Materials/Methods: We retrospectively analyzed the medical records of breast cancer patients at a single institution who developed LD between September 2001 and December 2018. Patients with LD were identified by neuroradiology confirmation of LD on MRI of the brain and/or spine. Demographic characteristics, breast cancer histopathology, clinical history, extracranial burden of disease, and systemic and local treatments were analyzed with log-rank tests and Cox regression. Variables that were statistically significant on univariate analysis were evaluated for multivariable modeling using forward selection, and variables were retained if the twosided p-value was < 0.05. Results: We studied 62 breast cancer patients with LM, of whom 50 died during the follow up period. With median follow up time of 7.5 months (IQR 2.7-16.4), median OS was 10.0 months (95% CI 6.2-14.7). Among subtypes, 38 patients (61%) had hormone-receptor positive, 27 patients (44%) had HER2-positive, and 9 patients (15%) had triple-negative disease. 27 patients (44%) had CNS-directed radiosurgery (RS), and 21 patients (34%) had whole-brain radiation prior to LD diagnosis. In a multivariable model, increased hazard of death was associated with non-Caucasian ethnicity (HR 2.40, 95% CI 1.26-4.61), triple-negative breast cancer molecular subtype (HR 2.12, 95% CI 0.95-4.75), grade 3 breast cancer histology (HR 2.02, 95% CI 1.10-3.73), and atypical or malignant cells found in the CSF within a month of radiographic diagnosis of LD on MRI (HR 3.63, 95% CI 1.85-7.12). Receiving intrathecal chemotherapy, CNS RS after LD diagnosis, and the number of RS treatments before LD diagnosis, after LD, or total, were not independently statistically significant. Conclusion: Patients with high-grade breast cancer, triple-negative breast cancer, or CSF test results positive for malignant cells had a higher hazard of death during the follow up period, and may benefit from earlier and/or more aggressive therapy, including comprehensive CNS-directed radiotherapy. Notably, demographic differences in survival may reflect health disparities, warranting further investigation and intervention.