Metastatic Carcinomas Presenting as Dural-Based Masses Mimicking Primary Intracranial Neoplasia
NM Savage, CH Alleyne, R Figueroa, S Sharma. Medical College of Georgia, Augusta, GA
Background: Clinical presentation with dural-based metastasis mimicking meningiomas is rare and described mostly as case reports from diverse primary locations. Proposed pathways include vascular spread and direct extension from calvarial or brain metastases.
Design: We retrospectively reviewed 6 cases with resection of dural-based metastatic carcinomas; five were clinically suspected to be meningiomas and one superficial glioblastoma.
Results: Patients' ages ranged from 59 to 80 years. MRIs showed extra-axial dural-based masses with contiguous but not primary brain involvement. The histopathologic and immunohistochemical diagnoses are tabulated. All primary sites were confirmed by subsequent clinical and radiologic evaluation except one case with immunoprofile for colorectal cancer where workup has yet to reveal a primary tumor.
|Age/Sex||Location||Radiology Impression||Immunoprofile||Path Proposed Primary||Confirmed Primary||Mode of Primary Confirmation|
|78/M||Frontal, temporal, & parietal||Multiple meningiomatosis||CK20+, PSA+, CK7-||Prostate||Prostate||Chart review; Previous outside diagnosis|
|75/M||L parietal||Meningioma||Pankeratin+, PSA+, CK7-, CK20-, TTF1-, CDX2-||Prostate||Prostate||CT showing enlarged prostate & bladder invasion|
|59/F||L frontal||Meningioma or metastasis||Pankeratin+, CK7+, CK20-, TTF1-, CDX2-, ER-, PR-||Breast||Breast||Subsequent breast biopsy showing invasive ductal carcinoma|
|80/M||R parieto-occipital||Meningioma||Pankeratin+, CK7+, TTF1+, chromogranin+, CK20-, CDX2-||Lung||Lung||CT showing lung mass with hepatic & adrenal metastases|
|71/F||L frontal||Meningioma or metastasis||CK20+, CK19+, CDX2+, CK7-, TTF1-||Colorectal||?||N/A|
|59/M||R parietal||GBM involving dura||CK7+, CK19+, CK20-, TTF1-, CDX2-, PSA-||Lung, upper GI, pancreatico-biliary, or head & neck||Lung||PET showing lung mass|