Brain Metastases: quest on primary site
Keywords:
Brain metastases, Central nervous system, Unknown Primary Site
Abstract
Background: Secondaries of brain (Brain metastases, BM) are most common central nervous system (CNS) tumors and it may be initial manifestation of systemic malignancies. Histomorphology of brain metastatic tumors along with immunohistochemistry (IHC) will helpful in the detection of unknown primary site (UPS) of brain metastases.
Aim: To evaluate unknown primary site of brain metastases with help of immunohistochemistry.
Material and Method: This study was conducted at the department of onco-pathology of our institute. Five years data from 2014 to 2018 were obtained from online Laboratory Information System (LIS), department of onco-pathology of our institute. IHC was performed on basis of histomorphology.
Results: Total 128 brain metastatic tumors were retrieved. Of which the present study have applied IHC on 107 cases and in remaining 21 cases, systemic malignancies were already diagnosed. Out of 107 cases, primary site was detected in 92.53% cases (n=99) and in 7.47% cases (n = 8), not able to detect primary site even after IHC. Lung was the most common primary site detected (n = 73) followed Gastrointestinal tract (GIT, n = 9).
Conclusion: Lung followed by breast are the most common primary malignancies for secondaries of brain (BM). Systemic approach using immunohistochemistry is really helpful in detection of unknown primary site of secondaries of brain (BM).
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References
1. Suki D. The epidemiology of brain metastases. In: Sawaya R, editior. Intracranial metastases; current management strategies. Malden (MA): Blackwell; 2004. pp 20.
2. Patchell RA. The management of brain metastases. Cancer Treat Rev. 2003;29(6):533-540. doi:10.1016/s0305-7372(03)00105-1.
3. Bouffet E, Perilongo G, Cancete A, Massimino M. Intracranial ependymomas in children: a critical review of prognostic factors and a plea for cooperation. Med Pediatr Oncol. 1998. 30(6):319-331. https://doi.org/10.1023/A:1012590505236.
4. Fox BD, Cheung VJ, Patel AJ, Suki D, Rao G. Epidemiology of metastatic brain tumors. Neurosurg Clin N Am. 2011;22(1):1-6. doi: 10.1016/j.nec.2010.08.007.
5. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14(1):48-54. doi: 10.1007/s11912-011-0203-y.
6. Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney and lung and melanoma. Cancer. 2002;94(10):2698-2705. doi:10.1002/cncr.10541.
7. Wen PY, Loeffler JS. Brain metastases. Curr Treat Options Oncol. 2000;1(5):447-458. doi:10.4103/2152-7806.111299.
8. Patnayak R, Jena A, Vijaylaxmi B, Lakshmi AY, Prasad BCM, Chowhan AK et al. Metastasis in central nervous system: Clinicopathological study with review of literature in a tertiary care center in South India. South Asian J Cancer. 2013;2(4):245-249. doi:10.4103/2278-330X.119885.
9. Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain metastases. Histology, multiplicity, surgery, and survival. Cancer. 1996;78(8):1781‑1788.
10. Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI. Identification of prognostic factors in patients with brain metastases: A review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43(4):795‑803. doi:10.1016/s0360-3016(98)00442-8.
11. Ascierto PA, Simeone E, Giannarelli D, Grimaldi AM, Romano A, Mozzillo N. Sequencing of BRAF inhibitors and ipilimumab in patients with metastatic melanoma: a possible algorithm for clinical use. J Transl Med. 2012;10:107. doi: 10.1186/1479-5876-10-107.
12. Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005;75(1):5-14. doi:10.1007/s11060-004-8093-6.
13. Salvati M, Frati A, Russo N, Brogna C, Piccirilli M, D’Andrea G et al. Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature. J Exp Clin Cancer Res 2005;24(2):203-207.
14. Nathoo N, Chahlavi A, Barnett GH, Toms SA. Pathobiology of brain metastases. J Clan Pathol. 2005;58(3):237-242. doi:10.1136/jcp.2003.013623.
15. Mut M, Schiff D, Shaffrey ME. Metastasis to nervous system: spinal epidural and intramedullary metastases. J Neurooncol. 2005;75(1):43-56. doi:10.1007/s11060-004-8097-2.
16. Takakura K, Sano K. Clinical features of intracranial metastatic tumors. In: Takakura K, Sano K, Hojo S, Hirano A, editors. Metastatic tumors of the central nervous system. Tokyo-New York: Igaku–Shoin. 1982:112-137. doi: 10.4103/0028-3886.232333.
17. Graus F, Walker RW, Allen JC. Brain metastases in children. J Pediatr 1983;103(4):558-561. doi: https://doi.org/10.1016/S0022-3476(83)80583-6.
18. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90. doi:10.3322/caac.20107.
19. Gupta A, Chaturvedi S, Jha D, Chaturvedi M. Revisiting metastatic central nervous system tumors with unknown primary using clinicopathological findings: A single neurosciences institutional study. Indian J Pathol Microbiol. 2019;62(3):368-374. doi: 10.4103/IJPM.IJPM_592_18.
20. Subramanian A, Harris A, Piggott K, Shieff C, Bradford R. Metastases to and from the central nervous system-the ‘relatively protected site’. Lancet Oncol. 2002;3(8):498-507. doi:10.1016/s1470-2045(02)00819-7.
21. Kamar FG, Posner JB. Brain metastases. Semin Neurol. 2010;30:217‑235. doi: 10.1055/s-0030-1255225.
22. Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases. Arch Neurol. 1988;45(7):741‑744. doi: 10.1001/archneur.1988.00520310047016.
23. Sawaya R, Bindal RK, Lang FF, Abi–Said D. Metastatic brain tumors. In: Kaye AH, Laws Jr ER, editors. Brain tumors. An encyclopedic approach. London: Churchill Livingstone. 2001;999-1026.
24. Weinberg JS, Lang FF, Sawaya R. Surgical management of brain metastases. Curr Oncol Rep. 2001;3(6):476-83. doi:10.1007/s11912-001-0068-6.
25. Graf AH, Buchberger W, Langmayr H, Schmid KW. Site preference of metastatic tumours of the brain. Virchows Arch A Pathol Anat Histopathol. 1988;412(5):493-498. doi:10.1007/bf00750584.
26. Sharma P, Trivedi P, Shah MJ. Evaluation of central nervous system metastases with immunohistochemistry correlation. Indian J Pathol Microbiol. 2014;57(3):376-379. doi: 10.4103/0377-4929.138719.
27. Le Chevalier T, Smith FP, Caille P, Constans JP, Rouesse JG. Sites of primary malignancies in patients presenting with cerebral metastases. a review of 120 cases. Cancer. 1985;56(4):880-882. doi:10.1002/1097-0142(19850815)56:4<880::aid-cncr2820560430>3.0.co;2-i.
28. Stoier M. Metastatic tumors of the brain. Acta Neurol Scand. 1965;41:262-278.
29. Bindal RK, Sawaya RE, Leavens ME, Taylor SH, Guinee VF. Sarcoma metastatic to the brain: results of
surgical treatment. Neurosurg. 1994;35(2):185-190. doi:10.1227/00006123-199408000-00002.
30. Gercovich FG, Luna MA and Gottlieb JA. Increased incidence of cerebral metastases in sarcoma patients with prolonged survival from chemotherapy. Report of cases of leiomyosarcoma and chondrosarcoma. Cancer. 1975;36(5):1843-1851. doi:10.1002/1097-0142(197511)36:5<1843::aid-cncr2820360541>3.0.co;2-v.
31. Yoshida S, Morii K, Watanabe M, Saito T. Brain metastasis in patients with sarcoma: an analysis of histological subtypes, clinical characteristics, and outcomes. Surg Neurol. 2000;54(2):160-164. doi:10.1016/s0090-3019(00)00293-7.
32. Pekmezci M, Perry A. Neuropathology of brain metastases. Surg Neurol Int. 2013;4(4):245-255. doi:10.4103/2152-7806.111302.
33. Srodon M, Westra WH. Immunohistochemical staining for thyroid transcription factor-1: a helpful aid in discerning primary site of tumor origin in patients with brain metastases. Hum Pathol. 2002;33(6):642-645. doi:10.1053/hupa.2002.124910.
34. Bohinski RJ, Bejarano PA, Balko G, Warnick RE, Whitsett JA. Determination of lung as the primary site of cerebral metastatic adenocarcinomas using monoclonal antibody to thyroid transcription factor-1. J Neurooncol. 1998;40(3):227-231. doi: https://doi.org/10.1023/A:1006102607697.
2. Patchell RA. The management of brain metastases. Cancer Treat Rev. 2003;29(6):533-540. doi:10.1016/s0305-7372(03)00105-1.
3. Bouffet E, Perilongo G, Cancete A, Massimino M. Intracranial ependymomas in children: a critical review of prognostic factors and a plea for cooperation. Med Pediatr Oncol. 1998. 30(6):319-331. https://doi.org/10.1023/A:1012590505236.
4. Fox BD, Cheung VJ, Patel AJ, Suki D, Rao G. Epidemiology of metastatic brain tumors. Neurosurg Clin N Am. 2011;22(1):1-6. doi: 10.1016/j.nec.2010.08.007.
5. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14(1):48-54. doi: 10.1007/s11912-011-0203-y.
6. Schouten LJ, Rutten J, Huveneers HA, Twijnstra A. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney and lung and melanoma. Cancer. 2002;94(10):2698-2705. doi:10.1002/cncr.10541.
7. Wen PY, Loeffler JS. Brain metastases. Curr Treat Options Oncol. 2000;1(5):447-458. doi:10.4103/2152-7806.111299.
8. Patnayak R, Jena A, Vijaylaxmi B, Lakshmi AY, Prasad BCM, Chowhan AK et al. Metastasis in central nervous system: Clinicopathological study with review of literature in a tertiary care center in South India. South Asian J Cancer. 2013;2(4):245-249. doi:10.4103/2278-330X.119885.
9. Nussbaum ES, Djalilian HR, Cho KH, Hall WA. Brain metastases. Histology, multiplicity, surgery, and survival. Cancer. 1996;78(8):1781‑1788.
10. Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI. Identification of prognostic factors in patients with brain metastases: A review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43(4):795‑803. doi:10.1016/s0360-3016(98)00442-8.
11. Ascierto PA, Simeone E, Giannarelli D, Grimaldi AM, Romano A, Mozzillo N. Sequencing of BRAF inhibitors and ipilimumab in patients with metastatic melanoma: a possible algorithm for clinical use. J Transl Med. 2012;10:107. doi: 10.1186/1479-5876-10-107.
12. Gavrilovic IT, Posner JB. Brain metastases: epidemiology and pathophysiology. J Neurooncol. 2005;75(1):5-14. doi:10.1007/s11060-004-8093-6.
13. Salvati M, Frati A, Russo N, Brogna C, Piccirilli M, D’Andrea G et al. Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature. J Exp Clin Cancer Res 2005;24(2):203-207.
14. Nathoo N, Chahlavi A, Barnett GH, Toms SA. Pathobiology of brain metastases. J Clan Pathol. 2005;58(3):237-242. doi:10.1136/jcp.2003.013623.
15. Mut M, Schiff D, Shaffrey ME. Metastasis to nervous system: spinal epidural and intramedullary metastases. J Neurooncol. 2005;75(1):43-56. doi:10.1007/s11060-004-8097-2.
16. Takakura K, Sano K. Clinical features of intracranial metastatic tumors. In: Takakura K, Sano K, Hojo S, Hirano A, editors. Metastatic tumors of the central nervous system. Tokyo-New York: Igaku–Shoin. 1982:112-137. doi: 10.4103/0028-3886.232333.
17. Graus F, Walker RW, Allen JC. Brain metastases in children. J Pediatr 1983;103(4):558-561. doi: https://doi.org/10.1016/S0022-3476(83)80583-6.
18. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90. doi:10.3322/caac.20107.
19. Gupta A, Chaturvedi S, Jha D, Chaturvedi M. Revisiting metastatic central nervous system tumors with unknown primary using clinicopathological findings: A single neurosciences institutional study. Indian J Pathol Microbiol. 2019;62(3):368-374. doi: 10.4103/IJPM.IJPM_592_18.
20. Subramanian A, Harris A, Piggott K, Shieff C, Bradford R. Metastases to and from the central nervous system-the ‘relatively protected site’. Lancet Oncol. 2002;3(8):498-507. doi:10.1016/s1470-2045(02)00819-7.
21. Kamar FG, Posner JB. Brain metastases. Semin Neurol. 2010;30:217‑235. doi: 10.1055/s-0030-1255225.
22. Delattre JY, Krol G, Thaler HT, Posner JB. Distribution of brain metastases. Arch Neurol. 1988;45(7):741‑744. doi: 10.1001/archneur.1988.00520310047016.
23. Sawaya R, Bindal RK, Lang FF, Abi–Said D. Metastatic brain tumors. In: Kaye AH, Laws Jr ER, editors. Brain tumors. An encyclopedic approach. London: Churchill Livingstone. 2001;999-1026.
24. Weinberg JS, Lang FF, Sawaya R. Surgical management of brain metastases. Curr Oncol Rep. 2001;3(6):476-83. doi:10.1007/s11912-001-0068-6.
25. Graf AH, Buchberger W, Langmayr H, Schmid KW. Site preference of metastatic tumours of the brain. Virchows Arch A Pathol Anat Histopathol. 1988;412(5):493-498. doi:10.1007/bf00750584.
26. Sharma P, Trivedi P, Shah MJ. Evaluation of central nervous system metastases with immunohistochemistry correlation. Indian J Pathol Microbiol. 2014;57(3):376-379. doi: 10.4103/0377-4929.138719.
27. Le Chevalier T, Smith FP, Caille P, Constans JP, Rouesse JG. Sites of primary malignancies in patients presenting with cerebral metastases. a review of 120 cases. Cancer. 1985;56(4):880-882. doi:10.1002/1097-0142(19850815)56:4<880::aid-cncr2820560430>3.0.co;2-i.
28. Stoier M. Metastatic tumors of the brain. Acta Neurol Scand. 1965;41:262-278.
29. Bindal RK, Sawaya RE, Leavens ME, Taylor SH, Guinee VF. Sarcoma metastatic to the brain: results of
surgical treatment. Neurosurg. 1994;35(2):185-190. doi:10.1227/00006123-199408000-00002.
30. Gercovich FG, Luna MA and Gottlieb JA. Increased incidence of cerebral metastases in sarcoma patients with prolonged survival from chemotherapy. Report of cases of leiomyosarcoma and chondrosarcoma. Cancer. 1975;36(5):1843-1851. doi:10.1002/1097-0142(197511)36:5<1843::aid-cncr2820360541>3.0.co;2-v.
31. Yoshida S, Morii K, Watanabe M, Saito T. Brain metastasis in patients with sarcoma: an analysis of histological subtypes, clinical characteristics, and outcomes. Surg Neurol. 2000;54(2):160-164. doi:10.1016/s0090-3019(00)00293-7.
32. Pekmezci M, Perry A. Neuropathology of brain metastases. Surg Neurol Int. 2013;4(4):245-255. doi:10.4103/2152-7806.111302.
33. Srodon M, Westra WH. Immunohistochemical staining for thyroid transcription factor-1: a helpful aid in discerning primary site of tumor origin in patients with brain metastases. Hum Pathol. 2002;33(6):642-645. doi:10.1053/hupa.2002.124910.
34. Bohinski RJ, Bejarano PA, Balko G, Warnick RE, Whitsett JA. Determination of lung as the primary site of cerebral metastatic adenocarcinomas using monoclonal antibody to thyroid transcription factor-1. J Neurooncol. 1998;40(3):227-231. doi: https://doi.org/10.1023/A:1006102607697.
CITATION
DOI: 10.17511/jopm.2019.i12.07
Published: 2019-12-19
How to Cite
Arvindbhai Prajapati, J., Hemal Shah, A., Pinakin Trivedi, P., Jigar Gami, A., Rasesh Vyas, V., & Sanjay Gandgi (Gandhi), J. (2019). Brain Metastases: quest on primary site. Tropical Journal of Pathology and Microbiology, 5(12), 1008-1014. https://doi.org/10.17511/jopm.2019.i12.07
Section
Original Article
OAI - Open Archives Initiative
