Multifaceted central nervous system metastases: An analysis of the clinicopathologic spectrum

• Author Details:   
• Manveen Kaur ^*
• RPS Punia
• Pooja Sharma
• Ranjeev Bhagat
• Phiza Aggarwal
• Uma Handa
• Vipin Gupta

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Background: Central nervous system (CNS) metastases are the most common causes of neurologic abnormalities in patients with systemic malignancies. They can often be the initial manifestations of an undetected primary elsewhere.

Materials and Methods: This is a retrospective study which included 55 patients diagnosed with either brain or spinal cord metastases. The study period was four years. The cases were classified based on histopathology and immunohistochemistry was performed in cases of metastases from unknown primary. Primary CNS tumors were excluded from the study.

Results: In the study period, a total of 169 CNS neoplasms were diagnosed, including 114 (67.5%) primary and 55 (32.5%) secondary tumors. Most of the patients were in the 5th-6th decade of life, with a male preponderance (M:F ratio of 2.6:1). The most common site for metastases in CNS was cerebrum (n=30, 54.5%) followed by spinal cord (n=19, 34.5%) and cerebellum (n=6, 11%) respectively. The most common histological type was adenocarcinoma (65.4%) followed by poorly differentiated carcinoma (20.1%) and squamous cell carcinoma (12.1%). Primary sites could be detected in 48 cases (71.8%). The most common site of primary malignancy was lung (n=16, 29%) followed by kidney (n=7, 12.7%) and prostate (n=6; 10.9%). Two unusual cases with metastatic urothelial carcinoma were identified.

Conclusion: Metastatic tumors of brain and spinal cord are a major cause of morbidity and mortality and may pose a diagnostic difficulty on clinical and radiological examination. Histopathologic examination with the aid of immunohistochemistry is of utmost importance to render the correct diagnosis.