- Department of Neurosurgery, Baskent University Medical Faculty, Maresal Fevzi Cakmak Cad. 10. Sokak No: 45 C 06490, Bahcelievler, Ankara, Turkey
- Department of Pathology, Baskent University Medical Faculty, Maresal Fevzi Cakmak Cad. 10. Sokak No: 45 C 06490, Bahcelievler, Ankara, Turkey
Correspondence Address:
Salih Gulsen
Department of Pathology, Baskent University Medical Faculty, Maresal Fevzi Cakmak Cad. 10. Sokak No: 45 C 06490, Bahcelievler, Ankara, Turkey
DOI:10.4103/2152-7806.117176
Copyright: © 2013 Gulsen S This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Gulsen S, Terzi A. Multiple brain metastases in a patient with uterine papillary serous adenocarcinoma: Treatment options for this rarely seen metastatic brain tumor. Surg Neurol Int 28-Aug-2013;4:111
How to cite this URL: Gulsen S, Terzi A. Multiple brain metastases in a patient with uterine papillary serous adenocarcinoma: Treatment options for this rarely seen metastatic brain tumor. Surg Neurol Int 28-Aug-2013;4:111. Available from: http://sni.wpengine.com/surgicalint_articles/multiple-brain-metastases-in-a-patient-with-uterine-papillary-serous-adenocarcinoma-treatment-options-for-this-rarely-seen-metastatic-brain-tumor/
Abstract
Background:Uterine papillary serous adenocarcinoma (UPSAC) occurs 10-fold less frequently than endometrial carcinoma, and is referred to type 2 endometrial adenocarcinoma. The prognosis of UPSAC is worse than that of type I endometrial carcinoma. Herein we report what is only the second case of UPSAC, but it should prove to be more informative than the first reported case.
Case Description:A 71-year-old female had three different metastases in the brain; two of the metastases were located in the posterior fossa within the cerebellar parenchyma with perilesional edema, but no mass effect, and the third metastasis was located in the right frontal lobe, and caused hemispheric edema and subfalcine herniation. The lesion that caused mass effect was completely extirpated without any surgical complications. The patient's recovery was excellent. She is able to walk independently, and use her left hand and left arm. Her Karnofsky performance score 5 months postsurgery was 80/100.
Conclusion:Based on the outcome in the presented case, we think that in any UPSAC patient with a metastatic brain tumor causing mass effect the symptomatic metastatic tumor must be removed, regardless of disease grade, to ensure optimal quality of life.
Keywords: Adenocarcinoma cerebrum, cerebellum, metastases, uterine
INTRODUCTION
Hendrickson et al. were the first to describe uterine papillary serous adenocarcinoma (UPSAC) (also known as type 2 endometrial carcinoma), an aggressive form of endometrial carcinoma.[
CASE REPORT
A 71-year-old female underwent abdominal hysterectomy with bilateral salpingo-oopherectomy 2 years and 3 months ago. Histopathological examination of the biopsy specimen showed UPSAC. Adjuvant chemotherapy was given after the abdominal hysterectomy. The patient's Glasgow Coma Scale score was 12/15 at the time of admission to our hospital. She presented with a 20-day history of headache and left hemiparesis, and she could not walk or use her left arm and left hand. Cranial magnetic resonance iaging (MRI) showed three lesions; two were located in the parenchyma of the cerebellum and had perilesional edema. but had no shift effect or obstruction on the fourth ventricle and the third lesion was located in the right frontobasal frontal lobe, and caused a large hemispheric edema and subfalcine herniation [
Figure 2
(TIWI: a, axial; b, sagittal; c, coronal.) Postcontrast MRI show enhancing lesion which is well defined and relatively homogenous and is located in the base of the right frontal lobe, and it is just above the orbital roof. The mass causes edema, midline shift and subfalcine herniation due to massive edema in the right cerebral hemisphere. The size of the lesion is 33 × 32 × 24 mm in three different sections
Figure 3
TIWI: (a, axial; b, sagittal; c, coronal.) Postcontrast enhanced MRI show enhancing two different mass lesions in the cerebellum. Both of these lesions cause minimal mass effect. The size of the lesion which is placed around right inferior cerebellar peduncle is 11 × 15 × 12 mm in three different sections
The patient underwent frontal craniotomy with gross total extirpation of the tumor located in the right frontal lobe on September 12, 2012. There were no surgical complications, such as bleeding or adhesiveness adjacent to the brain tissue during the removal of the tumor. The other two lesions located in the posterior fossa were left untouched because they had no mass effect. Histopathological examination of the biopsy specimen was consistent with metastatic UPSAC [
Figure 4
Brain metastatic endometrial serous type carcinoma. A nodule of metastatic neoplastic glands with luminal micropapillary structures (white arrows) compresses adjacent glial tissue (left side) showing marked reactive gliosis, lymphoplasmositer infiltrate and microcalcifications (black arrow). Hematoxylin and eosin (H and E) stain ×100
The patient was able to walk with the assistance of a walker, and underwent follow-up cranial computed tomography (CT) 2 days postsurgery [
DISCUSSION
Metastatic brain tumors are the most common brain tumor and have an annual incidence rate 10-fold higher than primary brain tumors.[
The posterior fossa–or cerebellar parenchyma–is the second most common location of metastatic lesions, accounting for 16% of all cranial metastases.[
Metastasis of UPSAC to the cerebrum in the presented case was histopathologically confirmed, and to the best of our knowledge the presented case is the first to undergo surgical resection due to metastatic UPSAC in the cerebrum. The presented case was free of any brain metastasis 27 months following hysterectomy, which is consistent with the literature regarding endometrial carcinoma, but we did not find any data concerning brain metastasis with UPSAC in the literature.[
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