Brain metastases from breast cancer.

BACKGROUND: Breast cancer (BC) is one of the commonest causes of brain metastases (BM): approximately 10-16 % of patients diagnosed with metastatic breast cancer will eventually develop BM during the course of their disease, however, certain subtypes have a higher risk of this event. The aim of this analysis was therefore to evaluate the prognosis and the pattern and imaging features of BM according to different BC subtypes. PATIENTS AND METHODS: We retrospectively reviewed the case records of patients with breast cancer and evidence of brain metastases from the database of IPO Porto between 2014-2018. The data obtained were statistically analysed. RESULTS: We analysed 147 patients with BM from BC. The triple-negative subtype had the shortest overall survival (OS) after BM, besides a short period of time between BC and BM. HER2 overexpressing tumors had the longest OS. The estrogen-receptor positive group had the greatest interval between initial BC diagnosis and diagnosis of BM. Larger lesions showed a heterogeneous contrast enhancement and were heterogeneous pn T2WI sequences; a hyposignal on T2*WI was also associated with larger lesions. Triple-negative BC tended to have more heterogeneous lesions on T1WI. We noticed that the hippocampus is rarely affected by metastatic lesions. CONCLUSIONS: Based on the BC subtype it is possible to make a prediction about the prognosis of the disease and some imaging features of the BM, but not about their pattern of distribution. These data support further research concerning prevention, early detection, and treatment of BM from BC.

[Spinal cord compression by testicular germ cell tumor: case report]. / Compressão medular por tumor de células germinativas do testículo.

Malignant spinal cord compression occurs in 2.5% - 5% cancer patients. Early diagnosis and therapeutic intervention are critical for pain control and improvement of any neurological deficit. Treatment should be directed to the underlying disease together with appropriate symptom management. The case of a man with tetraparesis of 24 hours duration is presented. He had surgery five days earlier because of a testicular tumor and spinal magnetic resonance imaging (MRI) showed spinal cord compression by a soft tissue mass between C7 and D2. After confirming the diagnosis of mixed germ cell tumor, stage IIIC, the patient began chemotherapy with progressive neurological improvement. Two years after diagnosis the patient presents a slight reduction of strength in the right hand and remains without any evidence of disease. This case illustrates the importance of early diagnosis of spinal cord compression and one of the main indications for the use of chemotherapy as the treatment for an oncologic emergency.

[Systemic lupus erythematosus: imaging of central nervous system involvement by magnetic resonance]. / Lupus eritematoso sistémico: a ressonância magnética no envolvimento do sistema nervoso central.

UNLABELLED: Patients with systemic lupus erythematosus (SLE) can develop dysfunction of the central nervous system (CNS) and have several neurologic syndromes with heterogeneous pathogenic mechanisms. The most common neurologic manifestations of SLE are organic mental syndromes, functional psychoses and seizures. METHODS: We retrospectively reviewed the magnetic resonance imaging (MRI) of SLE patients with CNS involvement followed in S. João Hospital Rheumatology clinic. Only patients with abnormal MRI were selected. RESULTS: In 42 patients studied there were 22 (52,4%) cases with abnormal MRI. Patient's age ranged between 20 and 63 years (mean 35,6). All were females. MRI showed multiple periventricular white matter lesions in 16 cases (68,2%) and cerebral infarctions in 3 cases (13,6%). There were atrophic changes in 4 cases (18,2%) and cerebral hemorrhage in 2 cases (9,1%). There was a case (4,5%) of transverse myelitis associated with acute optic neuritis (Devic's syndrome) and 1 case (4,5%) of predominantly posterior white matter signal abnormalities (reversible posterior leukoencephalopathy syndrome). CONCLUSION: This study confirms MRI importance on in identifying and characterizing CNS abnormalities, which contributes to better investigation and management of these patients. The authors discuss etiological possibilities of the different imagiological findings.

[Epidural lipomatosis secondary to corticotherapy]. / Lipomatose epidural secundária a corticoterapia.

Spinal epidural lipomatosis is the excessive deposition of unencapsulated fat in the epidural space. This is a rare disorder often associated with high levels of endogenous steroids or the administration of exogenous steroids. A precocious diagnosis is important because it influences the clinical evolution and the therapeutics option. The computed tomography (CT) and magnetic resonance imaging (MRI) are very important to the diagnosis. Authors report a case of a mediastinal and epidural lipomatosis in a man receiving corticoid therapy, with symptoms consistent with acute respiratory failure and progressive paraparesis.