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MRI of the brain, T2 fluid-attenuated inversion recovery (FLAIR) post-contrast images, confirmed the presence of the lesions, measuring up to 1.3 cm in maximal diameter, with associated vasogenic edema in the left precentral gyrus, right occipital lobe, and bilateral frontal opercula.
Source publication
Typical bronchial carcinoid tumors are known for their relatively indolent behavior. There are only four reported cases in the medical literature describing typical bronchial carcinoids metastasizing to the brain. Little is known about the pathogenesis and presentation of this disease due to the very small patient population.
A 67-year-old Hispanic...
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Context 1
... and abnormal cerebellar function, as seen with the finger-to-nose test. All laboratory results were within normal limits. Computed tomography (CT) with intravenous contrast of the brain and subsequent magnetic resonance imaging demonstrated multiple enhancing nodular densities throughout the brain, measuring up to 1.3 cm in maximum diameter ( fig. 1). CT with intravenous contrast of the chest, abdomen, and pelvis revealed a 2.5 × 2.7 × 3.5-cm 3 left hilar mass encasing the left upper lobe apical segmental artery ( fig. 2) and a 2.1 × 2.1 × 2.7-cm 3 medial left upper lobe mass abutting the anterior mediastinum. Bronchoscopic evaluation confirmed the findings of imaging studies and ...Similar publications
A 69-year-old woman was admitted electively for a laparoscopic cholecystectomy. Pre-operatively she had an ultrasound abdomen which demonstrated a large gallbladder (GB) stone. Intraoperatively, a nodule was noted on the liver supero-lateral to GB. The procedure was subsequently converted to open and the lesion was resected en-bloc with GB. The his...
Background:
A dural metastasis is one of the essential differential diagnoses of meningioma. In general, carcinomas of the breast and lung in females and prostate in males have been the most commonly reported primary lesions of dural metastases. However, dural metastasis of gallbladder carcinoma is extremely rare. Here, we report a unique case of...
Citations
... BC represents the well-differentiated subgroup of lung NET that originates from neuroendocrine Kulchitsky's cells located in the bronchial mucosa. It is characterized by an organoid arrangement of tumor cells in the form of trabecular, nesting or gyriform patterns [16]. ...
... The incidence rate of BC ranges from 0.2 to 2/100,000 population/year in Europe and the US [10,16]. Although it is a rare type of tumor, its incidence has been increasing rapidly over the past 30 years due to increased awareness and use of special immunohistochemistry stains for diagnosis [16,22]. ...
... The incidence rate of BC ranges from 0.2 to 2/100,000 population/year in Europe and the US [10,16]. Although it is a rare type of tumor, its incidence has been increasing rapidly over the past 30 years due to increased awareness and use of special immunohistochemistry stains for diagnosis [16,22]. BC is slightly more prevalent in white patients and in females [10]. ...
Bronchial carcinoids (BC) derive from the pulmonary neuroendocrine cell system while neuroblastoma (NB) derives from the neural crest and represents the peripheral nervous system. Nevertheless, their production of serotonin and catecholamines, respectively, permits comparison as neuroendocrine tumors (NETs). BC are most often diagnosed in adults accounting for 1-5% of all invasive lung malignancies in the adults. NB, primarily a pediatric cancer, accounts for 7-8% of all childhood cancers with the highest incidence in children younger than 5 years, and frequent metastasis to liver, skin, bone, and brain. The major standard treatments for BC is surgery followed by endocrine therapy and chemotherapies. NB patients on the other hand receive treatments according to presenting stage with chemotherapies dominant and now newer immunotherapies at more advanced stages. In general BC are more indolent but when less differentiated can be aggressive portending a poorer outcome. NB in contrast often present at an advanced stage and if high stage the overall survival approaches 25% despite extensive and other therapies. Early stage diagnosis still remains a challenge since symptomology depends on their neuroendocrine manifestation. Here we summarize the current knowledge and challenges in the management of BC and NB.
... Neurosurgeons are increasingly experiencing patients with brain metastasis from tumors diagnosed as neuroendocrine carcinoma. [2][3][4][5][6][7] However, few reports examined brain metastasis of such patients. ...
Background:
The most common sites of origin for neuroendocrine carcinoma are gastrointestinal tract and its accessory glands, and lungs.
Materials and methods:
One-hundred fifty cases diagnosed with metastatic brain lesions were retrieved from hospital records within 5 years. For these cases, the primary neoplasm, histopathological classification, metastasis, treatment, and fate all were studied.
Results:
Intracranial deposits were detected in 10%. The primary lesion was in the lungs in 87% of patients, and 1 patient in the breast and 1 in esophagus. Pathological classification of the primary lesion was Grade 2 (MIB-1: 3-20%) in 1 patient and neuroendocrine carcinoma (MIB-1: ≥21%) in 14 patients. The median period from onset of the primary lesion up to diagnosis of brain metastasis was 12.8 months. About 33% of patients had a single metastasis whereas 67% patients had multiple metastases. Brain metastasis was extirpated in 33% of patients. Stereotactic radiotherapy alone was administered in 20% of patients, and brain metastasis was favorably controlled in most of the patients with coadministration of cranial irradiation as appropriate. The median survival period from diagnosis of brain metastasis was 8.1 months.
Conclusion:
Most of patients with brain metastasis from neuroendocrine carcinoma showed the primary lesion in the lungs, and they had multiple metastases to the liver, lymph nodes, bones, and so forth at the time of diagnosis of brain metastasis. The guidelines for accurate diagnosis and treatment of neuroendocrine carcinoma should be immediately established based on further analyses of those patients with brain metastasis.
... With advances in pathological diagnosis of NETs, neurosurgeons are increasingly experiencing patients with brain metastasis from tumors diagnosed as NETs [2][3][4][5][6][7]. However, few reports examined brain metastasis of NET patients [2] and therefore, guidelines should be prepared for oncologists based on findings from clinical images and pathology as well as treatment and outcomes of brain metastasis of NETs, and then taking appropriate measures. ...
... Primary brain metastasis is mainly caused by primary lung NETs whereas pancreatic/gastrointestinal NETs are suggested to reach the brain as the final distal site of metastasis via metastasis to the liver, lymph node, lungs, or other organs. Brain metastasis from NETs has been frequently reported [2,[4][5][6][7] although standardized pathological analysis, diagnosis, and treatment have not been established. The European Neuroendocrine Tumor Society (ENETS) in 2012 published the consensus guidelines for the diagnosis and treatment of neuroendocrine tumors for each site of onset [10]. ...
Background:
A neuroendocrine tumor (NET) can develop anywhere in the body, but is mainly found in the pancreas, gastrointestinal tract, and lungs. This report is a retrospective study of the clinicopathological features of NET patients with brain metastasis whose tissue diagnosis was made at our hospital.
Methods:
Patients with brain metastasis evidenced by clinical records and images were accumulated among 302 patients in whom tissue diagnosis of NETs was made at our hospital between 2008 and 2013. In the patients, the primary lesion, pathological classification, pattern of metastasis, details of treatment, and outcomes were analyzed.
Results:
Brain metastasis was observed in 31 patients (10.3 %). The primary lesion was in the lungs in 26 patients (83.9 %), and the mammary glands, esophagus, and uterus in 1 patient each. Primary lesions were unknown in 2 patients, including 1 patient in whom NETs were detected in the lymph nodes alone. Pathological classification of the primary lesion was NET Grade 2 (Ki-67: 3 to 20 %) in 3 patients and neuroendocrine carcinoma (NEC, Ki-67: ≥21 %) in 26 patients. The median period from onset of the primary lesion up to diagnosis of brain metastasis was 12.8 months, and the brain lesion preceded brain metastasis in 6 patients. Ten patients had a single metastasis whereas 21 patients had multiple metastases, but no characteristics were observed in their images. Brain metastasis was extirpated in 10 patients. Stereotactic radiotherapy alone was administered in 6 patients, and brain metastasis was favorably controlled in most of the patients with coadministration of cranial irradiation as appropriate. The median survival period from diagnosis of brain metastasis was 8.1 months, and the major cause of death was aggravation of the primary lesion or metastatic lesions in other organs.
Conclusion:
Most of NET patients with brain metastasis showed the primary lesion of NEC in the lungs, and they had multiple metastases to the liver, lymph nodes, bones, and so forth at the time of diagnosis of brain metastasis. The guidelines for accurate diagnosis and treatment of NETs should be immediately established based on further analyses of NET patients with brain metastasis.
... Algunos factores de riesgo identificados y propuestos para el desarrollo de este tipo de tumores son: tabaquismo, neoplasia endocrina múltiple 1 (NEM-1) y asbestosis 7,8 ; así mismo el tumor carcinoide se ha vinculado en un caso aislado al síndrome miasténico de Lambert Eaton 9 . ...
Introduction
Pulmonary carcinoid tumors are very rare. Clinical manifestations depend upon the anatomical location. Central tumors produce hemoptysis, bronchial obstruction and dyspnea. One quarter (25%) of the total remain asymptomatic.
Methodology
Retrospective analysis of patients with bronchopulmonary carcinoid tumor during a period of 5 years (January 2007-January 2012). A record was made of gender, age, evolution of symptoms, radiological and histopathological characteristics, type of surgical intervention, and mean hospital days. Posterolateral thoracotomy was performed in all cases.
Results
Complete tumor resection was achieved in all cases. The mean age was 37.8 years. Time of evolution from beginning of symptoms to diagnosis was 8.4 months. Mean hospital days was 6.2 years.
Conclusions
The aim of surgical treatment is to achieve complete tumor resection with a conservative approach. In case of atypical tumors, a much wider and more aggressive surgery is attempted, as well as lymph node resection.
Typical and atypical bronchial carcinoid account for around 2% of all neuroendocrine neoplasms of pulmonary origin. Fewer than 5% of patients with these cancers are thought to develop brain metastases, and hence routine intracranial imaging is not currently included in staging investigations. In this study, retrospective case note analysis was performed on 280 patients diagnosed with either typical carcinoid (TC) or atypical carcinoid (AC) at a large, single‐site cancer centre. None of the 219 patients with TC developed brain metastases during the course of their disease, whereas seven of the 61 AC (11.5%) were found to have intracranial spread, four of which were present at the point of diagnosis. A Cox proportional hazard model showed that a Ki‐67 expression ≥18%, patient age ≥65 years and disease stage at diagnosis were all independently and significantly associated with the development of brain metastases in AC. This study has found new evidence that the incidence of brain metastases in AC is significantly higher than previously thought. Of all the variables reviewed, Ki‐67 expression was most strongly associated with the development of intracranial disease in AC and could be readily translated into clinical practice. Predictive factors such as age, disease stage and Ki‐67 expression could be used to identify patients at particularly increased risk of brain metastases, who would benefit from early intracranial imaging. This could allow for earlier detection and treatment of metastases, with the potential to improve clinical outcomes and patient quality of life.
Object:
Carcinoid tumors are rare and have generally been regarded as indolent neoplasms. Systemic disease is often incurable; however, patients may live years with this disease. Furthermore, metastatic brain lesions are extremely uncommon. As such, few series have examined outcomes and prognostic factors in those with brain involvement.
Methods:
The authors performed a retrospective review of patients who underwent primary treatment at Mayo Clinic in Rochester, Minnesota, for metastatic carcinoid tumors to the brain between 1986 and 2011. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier statistics. Cox proportional hazards were used to determine predictors of survival.
Results:
Fifteen patients underwent primary treatment for metastatic carcinoid tumors to the brain between 1986 and 2011. Their mean age was 58 ± 12 years. Eighty percent (n = 12) of patients underwent surgery, whereas 2 received stereotactic radiosurgery and 1 had whole-brain radiation therapy (WBRT) as the primary treatment. The median follow-up duration was 19 months (maximum 124 months). Systemic disease progression occurred in 73% and was the leading cause of death in known cases, while intracranial disease recurred in 40%. The median PFS and OS were 21 and 19 months, respectively. The use of adjuvant WBRT correlated with improved PFS (HR 0.15, CI 0.0074-0.95, p = 0.044). Those who underwent surgery as primary modalities trended toward longer progression-free intervals (p = 0.095), although this did not reach significance.
Conclusions:
Metastatic carcinoid disease to the brain appears to have a worse prognosis than that of other extracranial metastases. Although there was a trend toward a survival advantage in patients who underwent surgery and WBRT, further study is needed to establish definitive treatment recommendations.
