Breast adenocarcinoma metastatic to epidural cervical spine meningioma : case report and review of the literature
While several cases of cancer metastatic to cranial meningiomas have been reported, metastasis to spinal meningioma has been reported only once, and a mechanism for such metastases has not been investigated. We report a case of breast carcinoma metastatic to an epidural cervical meningioma, summariz...
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Veröffentlicht in: | Journal of neuro-oncology 2005-11, Vol.75 (2), p.149-155 |
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description | While several cases of cancer metastatic to cranial meningiomas have been reported, metastasis to spinal meningioma has been reported only once, and a mechanism for such metastases has not been investigated. We report a case of breast carcinoma metastatic to an epidural cervical meningioma, summarize the literature on metastases to central nervous system meningiomas, and suggest a possible mechanism. Our patient, a 55-year-old woman, presented with difficulty walking, back pain, and quadriparesis. Magnetic resonance imaging revealed an enhancing C3-4 epidural lesion and an L4 compression fracture. Because of concern that the fracture and epidural lesion might represent metastases, we performed a metastatic work-up, which revealed a right breast mass. The patient underwent C3-C4 laminectomies and an epidural lesion was encountered. Intraoperative frozen section revealed mixed meningioma and breast adenocarcinoma. A gross total resection was achieved and the patient subsequently received spinal irradiation and hormonal therapy. Whereas a literature review revealed numerous reports of metastases to cranial meningiomas, this represents only the second reported case of such pathology in the spine. Mechanisms of this unusual process likely include meningiomas' vascularity, meningiomas' slow growth providing nutrient availability, and perhaps, as suggested by our analysis, E-cadherin expression by both meningiomas and breast cancer. Metastasis to meningioma must be considered in an epidural spinal lesion in all patients with a known malignancy, with surgical aggressiveness tailored to the intraoperative pathologic diagnosis. |
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We report a case of breast carcinoma metastatic to an epidural cervical meningioma, summarize the literature on metastases to central nervous system meningiomas, and suggest a possible mechanism. Our patient, a 55-year-old woman, presented with difficulty walking, back pain, and quadriparesis. Magnetic resonance imaging revealed an enhancing C3-4 epidural lesion and an L4 compression fracture. Because of concern that the fracture and epidural lesion might represent metastases, we performed a metastatic work-up, which revealed a right breast mass. The patient underwent C3-C4 laminectomies and an epidural lesion was encountered. Intraoperative frozen section revealed mixed meningioma and breast adenocarcinoma. A gross total resection was achieved and the patient subsequently received spinal irradiation and hormonal therapy. Whereas a literature review revealed numerous reports of metastases to cranial meningiomas, this represents only the second reported case of such pathology in the spine. Mechanisms of this unusual process likely include meningiomas' vascularity, meningiomas' slow growth providing nutrient availability, and perhaps, as suggested by our analysis, E-cadherin expression by both meningiomas and breast cancer. Metastasis to meningioma must be considered in an epidural spinal lesion in all patients with a known malignancy, with surgical aggressiveness tailored to the intraoperative pathologic diagnosis.</description><identifier>ISSN: 0167-594X</identifier><identifier>EISSN: 1573-7373</identifier><identifier>DOI: 10.1007/s11060-005-1408-4</identifier><identifier>PMID: 16132512</identifier><identifier>CODEN: JNODD2</identifier><language>eng</language><publisher>Dordrecht: Springer</publisher><subject>Adenocarcinoma - drug therapy ; Adenocarcinoma - pathology ; Antineoplastic Agents, Hormonal - therapeutic use ; Biological and medical sciences ; Breast Neoplasms - drug therapy ; Breast Neoplasms - pathology ; Carrier Proteins - metabolism ; Cervical Vertebrae - pathology ; Female ; Fractures, Compression - diagnostic imaging ; Glycoproteins - metabolism ; Humans ; Immunohistochemistry ; Lumbar Vertebrae - pathology ; Magnetic Resonance Imaging ; Medical sciences ; Meningioma - diagnosis ; Meningioma - metabolism ; Meningioma - pathology ; Meningioma - secondary ; Meningioma - surgery ; Middle Aged ; Neurology ; Nitriles - therapeutic use ; Orthopedic surgery ; Radiography ; Spinal Cord Neoplasms - diagnosis ; Spinal Cord Neoplasms - metabolism ; Spinal Cord Neoplasms - pathology ; Spinal Cord Neoplasms - secondary ; Spinal Cord Neoplasms - surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome ; Triazoles - therapeutic use ; Tumors of the nervous system. 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We report a case of breast carcinoma metastatic to an epidural cervical meningioma, summarize the literature on metastases to central nervous system meningiomas, and suggest a possible mechanism. Our patient, a 55-year-old woman, presented with difficulty walking, back pain, and quadriparesis. Magnetic resonance imaging revealed an enhancing C3-4 epidural lesion and an L4 compression fracture. Because of concern that the fracture and epidural lesion might represent metastases, we performed a metastatic work-up, which revealed a right breast mass. The patient underwent C3-C4 laminectomies and an epidural lesion was encountered. Intraoperative frozen section revealed mixed meningioma and breast adenocarcinoma. A gross total resection was achieved and the patient subsequently received spinal irradiation and hormonal therapy. Whereas a literature review revealed numerous reports of metastases to cranial meningiomas, this represents only the second reported case of such pathology in the spine. Mechanisms of this unusual process likely include meningiomas' vascularity, meningiomas' slow growth providing nutrient availability, and perhaps, as suggested by our analysis, E-cadherin expression by both meningiomas and breast cancer. Metastasis to meningioma must be considered in an epidural spinal lesion in all patients with a known malignancy, with surgical aggressiveness tailored to the intraoperative pathologic diagnosis.</description><subject>Adenocarcinoma - drug therapy</subject><subject>Adenocarcinoma - pathology</subject><subject>Antineoplastic Agents, Hormonal - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - pathology</subject><subject>Carrier Proteins - metabolism</subject><subject>Cervical Vertebrae - pathology</subject><subject>Female</subject><subject>Fractures, Compression - diagnostic imaging</subject><subject>Glycoproteins - metabolism</subject><subject>Humans</subject><subject>Immunohistochemistry</subject><subject>Lumbar Vertebrae - pathology</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical sciences</subject><subject>Meningioma - diagnosis</subject><subject>Meningioma - metabolism</subject><subject>Meningioma - pathology</subject><subject>Meningioma - secondary</subject><subject>Meningioma - surgery</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Nitriles - therapeutic use</subject><subject>Orthopedic surgery</subject><subject>Radiography</subject><subject>Spinal Cord Neoplasms - diagnosis</subject><subject>Spinal Cord Neoplasms - metabolism</subject><subject>Spinal Cord Neoplasms - pathology</subject><subject>Spinal Cord Neoplasms - secondary</subject><subject>Spinal Cord Neoplasms - surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><subject>Triazoles - therapeutic use</subject><subject>Tumors of the nervous system. 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Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><topic>Triazoles - therapeutic use</topic><topic>Tumors of the nervous system. Phacomatoses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>AGHI, Manish</creatorcontrib><creatorcontrib>KIEHL, Tim-Rasmus</creatorcontrib><creatorcontrib>BRISMAN, Jonathan L</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neuro-oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>AGHI, Manish</au><au>KIEHL, Tim-Rasmus</au><au>BRISMAN, Jonathan L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Breast adenocarcinoma metastatic to epidural cervical spine meningioma : case report and review of the literature</atitle><jtitle>Journal of neuro-oncology</jtitle><addtitle>J Neurooncol</addtitle><date>2005-11-01</date><risdate>2005</risdate><volume>75</volume><issue>2</issue><spage>149</spage><epage>155</epage><pages>149-155</pages><issn>0167-594X</issn><eissn>1573-7373</eissn><coden>JNODD2</coden><abstract>While several cases of cancer metastatic to cranial meningiomas have been reported, metastasis to spinal meningioma has been reported only once, and a mechanism for such metastases has not been investigated. We report a case of breast carcinoma metastatic to an epidural cervical meningioma, summarize the literature on metastases to central nervous system meningiomas, and suggest a possible mechanism. Our patient, a 55-year-old woman, presented with difficulty walking, back pain, and quadriparesis. Magnetic resonance imaging revealed an enhancing C3-4 epidural lesion and an L4 compression fracture. Because of concern that the fracture and epidural lesion might represent metastases, we performed a metastatic work-up, which revealed a right breast mass. The patient underwent C3-C4 laminectomies and an epidural lesion was encountered. Intraoperative frozen section revealed mixed meningioma and breast adenocarcinoma. A gross total resection was achieved and the patient subsequently received spinal irradiation and hormonal therapy. Whereas a literature review revealed numerous reports of metastases to cranial meningiomas, this represents only the second reported case of such pathology in the spine. Mechanisms of this unusual process likely include meningiomas' vascularity, meningiomas' slow growth providing nutrient availability, and perhaps, as suggested by our analysis, E-cadherin expression by both meningiomas and breast cancer. Metastasis to meningioma must be considered in an epidural spinal lesion in all patients with a known malignancy, with surgical aggressiveness tailored to the intraoperative pathologic diagnosis.</abstract><cop>Dordrecht</cop><pub>Springer</pub><pmid>16132512</pmid><doi>10.1007/s11060-005-1408-4</doi><tpages>7</tpages></addata></record> |
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subjects | Adenocarcinoma - drug therapy Adenocarcinoma - pathology Antineoplastic Agents, Hormonal - therapeutic use Biological and medical sciences Breast Neoplasms - drug therapy Breast Neoplasms - pathology Carrier Proteins - metabolism Cervical Vertebrae - pathology Female Fractures, Compression - diagnostic imaging Glycoproteins - metabolism Humans Immunohistochemistry Lumbar Vertebrae - pathology Magnetic Resonance Imaging Medical sciences Meningioma - diagnosis Meningioma - metabolism Meningioma - pathology Meningioma - secondary Meningioma - surgery Middle Aged Neurology Nitriles - therapeutic use Orthopedic surgery Radiography Spinal Cord Neoplasms - diagnosis Spinal Cord Neoplasms - metabolism Spinal Cord Neoplasms - pathology Spinal Cord Neoplasms - secondary Spinal Cord Neoplasms - surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Triazoles - therapeutic use Tumors of the nervous system. Phacomatoses |
title | Breast adenocarcinoma metastatic to epidural cervical spine meningioma : case report and review of the literature |
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