Intracerebral metastases pathophysiology

Intracerebral metastases Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Intracerebral Metastases from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Intracerebral metastases pathophysiology On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Intracerebral metastases pathophysiology All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Intracerebral metastases pathophysiology
CDC on Intracerebral metastases pathophysiology
Intracerebral metastases pathophysiology in the news
Blogs on Intracerebral metastases pathophysiology
Directions to Hospitals Treating Intracerebral metastases
Risk calculators and risk factors for Intracerebral metastases pathophysiology

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.

Gallery

• 

  _{Immunohistochemistry profile of intracerebral metastases from an adenocarcinoma of lung (primary) demonstrating positivity to CK7, CK20, and TTF1.}

References

Template:WikiDoc Sources