Intracerebral metastases pathophysiology

Intracerebral metastases Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Pathophysiology

Gross Pathology

• Typically metastases are sharply demarcated from the surrounding parenchyme and usually there is a zone of peritumoral edema out of proportion with the tumor size.
• Common intracranial sites associated with subependymal giant cell astrocytoma include:

• Cerebrum (80%)
• Cerebellum (15%)
• Brain stem (5% )

Gallery

• 

  _{This solitary brain metastasis from thyroid papillary carcinoma resulted in neurological symptoms. The thyroid primary was clinically occult. (Courtesy of Dr. Nikola Kostich, Minneapolis, MN.).}

Microscopic Pathology

The histopathological appearance of intracerebral metastases may vary with the type of primary tumor. Common findings are listed below:

• Tubule formation/glands
• Well-circumscribed and sharply demarcated from surrounding tissue (with the exception of melanoma metastasis)
• Mitoses
• Nuclear atypia

• Nuclear hyperchromasia
• Variation of nuclear size
• Variation of nuclear shape

Gallery

• 

  _{Very low magnification micrograph demonstrating metastatic adenocarcinoma that from a colorectal primary, i.e. colorectal carcinoma, by immunostains on HPS stain. The cerebellum seen on the image has Bergmann gliosis and Purkinje cell loss.}

• 

  _{High magnification micrograph demonstrating metastatic adenocarcinoma that is from a colorectal primary, i.e. colorectal carcinoma, by immunostains on HPS stain. The cerebellum has Bergmann gliosis and Purkinje cell loss.}

• 

  _{High magnification micrograph of a brain metastasis on HPS stain demonstrating normal brain tissue on the left and tumor cells on the right. The sharp demarcation between tumor and normal is typical of brain metastases.}

• 

  _{Adenocarcinoma infiltrating the brain in a case of lung cancer on H&E stain.}

Immunohistochemistry

The immunohistochemistry profile of intracerebral metastases may vary with the type of the primary tumor. Intracerebral metastases are demonstrated by positivity to tumor markers such as:

• General brain metastases: Pankeratin +ve, GFAP -ve
• Lung adenocarcinoma and small cell lung carcinoma: TTF-1 +ve, CK7 +ve, CK20 -ve
• Breast carcinoma: CK7 +ve, ER +ve, PR +ve, BRST2 +ve/-ve
• Colorectal carcinoma: CK20 +ve, CDX2 +ve, TTF-1 -ve, CK7 -ve
• Clear cell renal cell carcinoma: PAX8 +ve, vimentin +ve, CD10 +ve, CK7 -ve, CK20 -ve
• Melanoma: S-100 +ve, HMB-45 +ve, Melan A +ve.

References

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