Melanoma brain metastases presenting as delirium: a case report

Abstract Background Metastatic tumours sometimes present with neuropsychiatric symptoms, however psychiatric symptoms as rarely the first clinical manifestation. Cutaneous melanoma is the third most common cause of brain metastasis, with known risk factors increasing the chance of such central nervous system metastization. Objectives We present a clinical report of delirium as the first clinical manifestation of melanoma brain metastases, illustrating the relevance of an adequate and early differential diagnosis. Methods In addition to describing the clinical case, searches were undertaken in PubMed and other databases using keywords such as “brain metastasis”, “melanoma”, “agitation”, “psychiatric” and “delirium”. Results We here report the case of a 52-year-old female patient evaluated by Liaison Psychiatry after sudden onset of delirium while admitted at the Gastroenterology Department to study a hypothesis of pancreatitis. A head CT scan identified brain metastases, and after further examination, including brain biopsy, melanoma brain metastization was confirmed. Discussion Some of the diagnostic challenges of psychiatric symptoms associated with secondary brain tumours are discussed, underlining the importance of an adequate differential diagnosis when working in Psychiatry Liaison.

Analysis of the risk factors for brain metastasis among patients with metastatic breast cancer / 中国医师杂志

Objective This study aimed at retrospective analysis of some metastatic breast cancer cases,investigated the recurrence of brain metastases of metastatic breast cancer in patients with risk factors,and provided a reference for the implementation of prevention strategies in the treatment plan and a reasonable choice.Methods A total of 796 breast cancer cases was visited,of whom 456 patients with recurrent metastatic breast cancer,in which 61 patients were with brain metastasis.The follow-up data were analyzed with SPSS13.0 software.x2 was used to test the age,estrogen receptor (ER),progesterone receptor (PR),cerbB-2 expression,lymph node metastasis,and brain metastasis.The COX proportional hazard model was used to analyze the recurrence and metastasis in patients with single-factor,multi-factor analysis,in order to obtain the independent prognostic factors.Results The x2 tests that group age ≤ 35 years,hormone receptor-negative,CerbB-2 (2 +)/(3 +) has a higher risk than another group (x2 =24.92,8.28,4.02,P ＜0.01 orP ＜0.05).COX univariate analysis showed that patient age,tumor size,ER and PR expression,CerbB-2 expression,lung metastases were looked.as the first metastatic site and hormone therapy.Those were significant factors whether the patient suffered from brain metastasis (P ＜ 0.05).COX multivariate analysis showed that age,ER and PR expression,CerbB-2 expression,and lung metastases were looked as the first metastatic site acted as an independent prognostic factor for brain metastasis (P ＜0.05).Conclusions Age,ER and PR expression,CerbB-2 expression,lung metastases as the first metastatic site are the independent prognostic factors for brain metastasis.

Metastatic Brain Tumor from Cardiac Chondrosarcoma: A Case Report

Primary chondrosarcoma of the heart and its metastasis to the brain is extremely rare. We describe the case ofa patient who underwent resection of cardiac chon-drosarcoma only to relapse with brain metastasis two yearslater. MR images showed that these metastatic tumors were slightly hypointense relative to the brain onT1-weighted images and hyperintense on T2-weighted images. The masses were highly enhanced. Peritumoraledema appeared less extens ive and the focal cystic portion was seen within the mass, corresponding to myxoid degeneration.

MR Findings of Metastatic Adenocarcinoma and Non-adenocarcinoma in the Brain

PURPOSE: To evaluate the differences in MR findings of metastatic adenocarcinoma and non-adenocarcinoma of thebrain. MATERIALS AND METHODS: We retrospectively analyzed MR findigns of metastatic brain tumors in 32 patients;in all cases, pathologic diagnosis was estabilished by biopsy or surgical resection. The signal intensities ofbrain lesions on multiple pulse sequences were compared. The enhancement patterns, degree of peritumoral edema,and number and size of brain lesions were also compared. RESULTS: The study group consisted of 19 patients withmetastatic adenocarcinoma and 13 with metastatic non-adenocarcinoma ; there were 64 adenocarcinomas and 45non-adenocarcinomas. On T1WI, the signal intensity of the lesions was hypointense, isointense, and hyperintense in57.8%, 39.0%, and 3.2% of adenocarcinomas; and 84.5%, 13.3%, and 2.2% of non-adenocarcinomas, respectively. OnT2WI, signals were hyperintense, isointense, hypointense, and heterogeneous in 67.2%, 10.9%, 17.2%, and 4.7% ofadenocarcinomas ; and 80%, 0%, 8.9%, and 11.1% of non-adenocarcinomas, respectively. On T2WI, seven of 19 patientswith adenocarcinoma and two of 13 with non-adenocarcinoma were either hypo- or isointense relative to the whitematter. In the adenocarcinoma group, hypo- or isointensity was seen in four cases of gastrointestinal cancer, twoof lung cancer, and one of endometrial cancer ; in the non-adenocarcinoma group, this was seen in retroperitonealembryonal carcinoma and small cell carcinoma of the lung. Two cases of adenocarcinoma showed hypointensity on T2WIand hyperintensity on TIWI, and this was probably related to the presence of blood products. On histopathology,one case of adenocarcinoma showing hypointensity on T2WI was shown to contain mucin. CONCLUSION: When brainmetastasis shows hypo- or isointensity on T2WI, adenocarcinoma is more likely than non-adenocarcinoma.

Solitary Hemorrhagic Brain Metastasis from Pulmonary Blastoma: A Case Report

Pulmonary blastoma is a rare primary lung malignancy consisting of mesenchymal and epithelial components resembling the fetal lung. We report a case of pulmonary blastoma with solitary hemorrhagic brain metastasis in a 32-year-old man. This metastatic lesion was composed mainly of hemorrhagic high density and central necrotic low density areas; on CT it showed partial contrast enhancement and was thus impossible to distinguish from other hemorrhagic lesions.

Comparison of Solitary Cerebral Metastasis and Glioblastoma Multiforme

PURPOSE: The purpose of this study is to evaluate the MR images of solitary cerebral metastasis and glioblastoma multiforme to determine the differential findings. MATERIALS AND METHODS: Ten cases of solitarycerebral metastasis and 14 cases of glioblastoma multiforme were retrospectively reviewed, all of which were proved by pathologically. The MR findings were compared in regard to tumor size and location, degree of edema, enhancement pattern, and shape of rim enhancement. RESULTS: Mean maximum diameter of solitary cerebral metastasis was 3.85cm(s.d. 1.47). Metastatic lesions were located in corticomedullary junction(70%) with cerebellum in 2cases. The locations of glioblastoma multiforme were white matter(64%) without cerebellar involvement and the mean maximum diameter was 5.43cm(s.d. 0.99). In solitary cerebral metastasis, the size of edema was larger than thetumor diameter in 50%, but glioblastoma multiforme did not show severe degree of edema. Rim enhancement seen in 7cases of solitary cerebral metastasis showed unilocular shape and complete rim in 6 cases, and even thickness and smooth inner margin in 5 cases. Howevere, rim enhancement seen in 11 cases of glioblastoma multiforme showed multilocular appearance with septa in all cases, incomplete rim in 5 cases, and uneven thickness and irregular inner margin in 10 cases. CONCLUSION: Tumor location, degree of edema, and rim enhancement pattern on Gd-enhanced MR may be useful in differentiation between solitary cerebral metastasis and glioblastoma multiforme.