Metastatic carcinoma in the brain - Erler Zimmer

Metastatic carcinoma in the brain - Erler Zimmer

Clinical History

This 51-year-old woman underwent surgery for breast carcinoma two years before presentation. Her main complaint was left-sided ataxia for the two weeks prior, preceded by a fainting attack followed by left-sided weakness. Examination revealed a left spastic paresis, creating uncertainty regarding the diagnosis due to the rapid onset, suggestive of a vascular lesion. She was discharged from the hospital, but six weeks after the initial presentation, she was re-admitted with left-sided seizures. Lumbar puncture and re-examination provided no informative results. EEG showed a right anterior temporal abnormality. Angiography confirmed the presence of a large space-occupying lesion in the right cerebrum. On the ward, there was a steady deterioration of the patient’s condition, ultimately leading to death.

Pathology

The specimen is the cerebrum sliced horizontally. On the superior view, the right hemisphere is notably enlarged, particularly in the parietal region where the gyrae are widened, and three cystic tumors are evident. The largest, measuring 5 cm in diameter, is in the right parietal region. A smaller tumor, 2 x 1.5 cm in diameter, is located close to the posterior margin of the largest tumor. A third one, 1.5 cm in diameter, is present in the left parietal region. The tumors have predominantly involved white matter. The wall of each lesion is composed of shaggy, friable, greyish tissue. Necropsy revealed ulceration of the largest tumor into the right lateral ventricle (more apparent on examination of the inferior surface). Sub-falcine herniation was also observed, along with displacement of the basal ganglia and internal capsule. Histological examination revealed metastatic carcinoma in the viable areas. Other metastases were found in the liver and bone. Histology of a liver metastasis was consistent with origin from a primary carcinoma of the breast.