- Department of Medicine, Catholic University of Pernambuco, Recife, Brazil
- Department of Oncology, Hospital Memorial São José, Recife, Brazil
- Department of Medicine, Unifacisa University Center, Campina Grande, Brazil
- Department of Neurosurgery, Real Hospital Português, Recife, Brazil.
Otávio da Cunha Ferreira Neto, Department of Medicine, Catholic University of Pernambuco, Recife, Brazil.
DOI:10.25259/SNI_717_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Otávio da Cunha Ferreira Neto1, Roberto Borges Bezerra2, Rhuann Pontes dos Santos Silva1, Melissa Helena Rodrigues Silva1, Joaquim Fechine de Alencar Neto3, Arthur José Maia Lopes4. Brain metastasis from a thoracic myxofibrosarcoma: A case report and literature review. 18-Nov-2022;13:537
How to cite this URL: Otávio da Cunha Ferreira Neto1, Roberto Borges Bezerra2, Rhuann Pontes dos Santos Silva1, Melissa Helena Rodrigues Silva1, Joaquim Fechine de Alencar Neto3, Arthur José Maia Lopes4. Brain metastasis from a thoracic myxofibrosarcoma: A case report and literature review. 18-Nov-2022;13:537. Available from: https://surgicalneurologyint.com/surgicalint-articles/12009/
Background: Myxofibrosarcoma (MFS) is a type of sarcoma that mainly affects elderly people; it represents only 5% of all sarcomas and shows no line of differentiation. Intracranial MFS is a rare condition. At present, limited data exist regarding brain metastasis from MFS. This article reports a case of MFS and reviews the literature regarding MFS metastasis.
Case Description: We report a case of brain metastasis from chest wall MFS. The patient was diagnosed with an anterior thoracic MFS and underwent surgery and radiotherapy. One year later, he noticed a tumor on his left shoulder, and more than 1 year thereafter, bilateral lung metastasis was observed. Twelve months after lung metastasis, he presented to the emergency department and underwent contrast-enhanced magnetic resonance imaging, which demonstrated a left frontal tumor suggestive of brain metastasis. Since the main hypothesis was a sarcoma metastasis at the location close to the left motor area, and the patient had a good Karnofsky performance scale, the patient underwent neuronavigation-guided surgery. After surgery, the patient developed Grade III hemiparesis and aphasia. Brain tumor histopathology confirmed a malignant neoplasm with osteosarcomatous differentiation and metastasis from MFS.
Conclusion: We report a rare case of MFS metastasis. To the best of our knowledge, this is the eighth case of intracerebral metastasis from MFS.
Keywords: Brain metastasis, Case report, Myxofibrosarcoma, Sarcoma, Thoracic myxofibrosarcoma
Brain metastases are common events in cancer patients, occurring in approximately 10–30% of patients, and are among the most serious complications due to the negative neurological repercussions that directly impact patient quality of life.[
Except for leukemia and lymphoma, metastasis to the brain is rare.[
A 75-year-old man was diagnosed with anterior thoracic MFS and underwent surgery and radiotherapy. One year later, he noticed a tumor in his left shoulder. The patient was treated with neoadjuvant chemotherapy (ifosfamide + doxorubicin) followed by surgical resection and radiotherapy. One year after the shoulder metastasis diagnosis, bilateral lung metastasis was observed, and chemotherapy treatment (docetaxel + gemcitabine) was started. One year after lung metastasis, the patient presented to the emergency department with sudden onset weakness on the right side and a speech disorder. Neurological examination revealed Grade 4 hemiparesis and aphasia. He underwent brain computed tomography (CT), which revealed a hypodense left frontal lesion. He was prescribed dexamethasone and contrast-enhanced magnetic resonance imaging was performed, which revealed a left frontal tumor suggestive of brain metastasis [
MFS, formerly called malignant fibrous histiocytoma (MFH), is a soft-tissue neoplasm belonging to the sarcoma group, characterized by a diffuse infiltrative tissue pattern that can occur in any part of the body.[
MFSs have a high recurrence rate, ranging from 16% to 57%.[
Intracranial MFS is rare and some reports have described cases without extracranial sites.[
To the best of our knowledge, only seven cases of brain metastasis as a consequence of MFS have been reported, and this is the first case of metastasis from the chest wall.[
In this case, several prognostic factors were identified. The previous data showed that factors believed to negatively influence survival are advanced patient age, greater tumor size at resection, positive surgical resection margins, higher tumor grading, greater tumor necrosis, higher mitotic rate, low degree of myxoid areas, and intracerebral manifestations.[
The clinical manifestations of intracranial MFH vary and are largely dependent on the location of the tumor.[
The prognosis tends to be poor and survival is generally short.[
According to the literature regarding metastasis in the frontal lobe, specifically in the motor area due to MFS, this is a very rare case. This is the eighth case reporting intracerebral metastases from MFS and the first report from a lung site. Furthermore, more studies may aid in elucidating the prognostic parameters of this malignant condition, which may improve the quality of life of patients.
The authors certify that they have obtained all appropriate patient consent.
There are no conflicts of interest.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
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