Metastatic Tumors

Metastases to the nervous system are serious, even fatal, complications of malignancies of any organ of the body. Carcinomas are the most common malignancies to metastasize to the brain, followed by hemapoietic malignancies. Sarcoma metastasis is rare. Dissemination

figure 1 1.44

Primary large B-cell lymphoma. A 48-year-old man with no previous psychiatric history presented with confusion and bizarre behavior of 9 days' duration. He became irritable, agitated, sleepless, and incontinent. One day, he was found taking a shower with his clothes on. No evidence of trauma, immunodeficiency state, or systemic lymphomas was found. He was HIV-negative. On examination, his state of alertness fluctuated; one minute he was alert and responded appropriately, the next minute, he was unresponsive. His speech was slurred, at times, incoherent. He was picking at his clothes and bed sheet. He was able to stand with assistance. Reflexes were hyperactive, Babinski sign was present bilaterally, and muscle strength was good. He died 2 months after the initial symptoms. A. Contrast-enhanced CT scan shows bilateral hemispheric mass lesions in the genu and body of corpus callosum and periventricular white matter. Biopsy of the tumor shows (B) large B-cell lymphoma with (C) perivascular arrangement of tumor cells (HE stain). D. Concentrically arranged reticulin fibers encircle the tumor cells (reticulin stain), which (E) immunoreact for CD2O B-cell marker.

figure 1 1.44

Primary large B-cell lymphoma. A 48-year-old man with no previous psychiatric history presented with confusion and bizarre behavior of 9 days' duration. He became irritable, agitated, sleepless, and incontinent. One day, he was found taking a shower with his clothes on. No evidence of trauma, immunodeficiency state, or systemic lymphomas was found. He was HIV-negative. On examination, his state of alertness fluctuated; one minute he was alert and responded appropriately, the next minute, he was unresponsive. His speech was slurred, at times, incoherent. He was picking at his clothes and bed sheet. He was able to stand with assistance. Reflexes were hyperactive, Babinski sign was present bilaterally, and muscle strength was good. He died 2 months after the initial symptoms. A. Contrast-enhanced CT scan shows bilateral hemispheric mass lesions in the genu and body of corpus callosum and periventricular white matter. Biopsy of the tumor shows (B) large B-cell lymphoma with (C) perivascular arrangement of tumor cells (HE stain). D. Concentrically arranged reticulin fibers encircle the tumor cells (reticulin stain), which (E) immunoreact for CD2O B-cell marker.

occurs by the bloodstream, less often by direct invasion from neighboring malignancies in the nasopharynx, facial sinuses, orbit, inner ear, or parotid gland. Common sites of metastases are the brain parenchyma and the meninges, less often the spinal cord and peripheral nerves. An estimated 20% to 30% of cancer patients develop intracranial metastases, accounting widely for

13% to 39% of intracranial tumors. They are most common in middle-aged and elderly patients.

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